Preschooler development

All children develop a little differently. If you are concerned about your child's development, talk to your child's health care provider.

PHYSICAL DEVELOPMENT

The typical 3- to 6-year-old:

• Gains about 4 to 5 pounds (1.8 to 2.25 kilograms) per year
• Grows about 2 to 3 inches (5 to 7.5 centimeters) per year
• Has all 20 primary teeth by age 3
• Has 20/20 vision by age 4
• Sleeps 11 to 13 hours at night, most often without a daytime nap

Gross motor development in the 3- to 6-year-old should include:

• Becoming more skilled at running, jumping, early throwing, and kicking
• Catching a bounced ball
• Pedaling a tricycle (at 3 years); becoming able to steer well at around age 4
• Hopping on one foot (at around 4 years), and later balancing on one foot for up to 5 seconds
• Doing a heel-to-toe walk (at around age 5)

Fine motor development milestones at about age 3 should include:

• Drawing a circle
• Drawing a person with 3 parts
• Beginning to use children's blunt-tip scissors
• Self-dressing (with supervision)

Fine motor development milestones at about age 4 should include:

• Drawing a square
• Using scissors, and eventually cutting a straight line
• Putting on clothes properly
• Managing a spoon and fork neatly while eating

Fine motor development milestones at about age 5 should include:

• Spreading with a knife
• Drawing a triangle

LANGUAGE DEVELOPMENT

The 3-year-old uses:

• Pronouns and prepositions appropriately
• Three-word sentences
• Plural words

The 4-year-old begins to:

• Understand size relationships
• Follow a 3-step command
• Count to 4
• Name 4 colors
• Enjoy rhymes and word play

The 5-year-old:

• Shows early understanding of time concepts
• Counts to 10
• Knows telephone number
• Responds to "why" questions

Stuttering may occur in the normal language development of toddlers ages 3 to 4 years. It occurs because ideas come to mind faster than the child is able to express them, especially if the child is stressed or excited.

When the child is speaking, give your full, prompt attention. Do not comment on the stuttering. Consider having the child evaluated by a speech pathologist if:

• There are other signs with the stuttering, such as tics, grimacing, or extreme self-consciousness.
• The stuttering lasts longer than 6 months.

BEHAVIOR

The preschooler learns the social skills needed to play and work with other children. As time passes, the child is better able to cooperate with a larger number of peers. Although 4- to 5-year-olds may be able to start playing games that have rules, the rules are likely to change, often at the whim of the dominant child.

It is common in a small group of preschoolers to see a dominant child emerge who tends to boss around the other children without much resistance from them.

It is normal for preschoolers to test their physical, behavioral, and emotional limits. Having a safe, structured environment in which to explore and face new challenges is important. However, preschoolers need well-defined limits.

The child should display initiative, curiosity, the desire to explore, and enjoyment without feeling guilty or inhibited.

Early morality develops as children want to please their parents and others of importance. This is commonly known as the "good boy" or "good girl" stage.

Elaborate storytelling may progress into lying. If this is not addressed during the preschool years, this behavior may continue into the adult years. Mouthing off or backtalk is most often a way for preschoolers to get attention and a reaction from an adult.

SAFETY

Safety is very important for preschoolers.

• Preschoolers are highly mobile and able to quickly get into dangerous situations. Parental supervision at this age is essential, just as it was during the earlier years.
• Car safety is critical. The preschooler should ALWAYS be securely fastened in an appropriate car seat when riding in the car. At this age children may ride with other children's parents. It is important to review your rules for car safety with others who may be supervising your child.
• Falls are a major cause of injury in preschoolers. Climbing to new and adventurous heights, preschoolers may fall off playground equipment, bikes, down stairs, from trees, out of windows, and off roofs. Lock doors that give access to dangerous areas (such as roofs, attic windows, and steep staircases). Have strict rules for the preschooler about areas that are off-limits.
• Kitchens are a prime area for a preschooler to get burned, either while trying to help cook or coming in contact with appliances that are still hot. Encourage the child to help cook or learn cooking skills with recipes for cold foods. Have other activities for the child to enjoy in a nearby room while you are cooking. Keep the child away from the stove, hot foods, and other appliances.
• Keep all household products and medicines safely locked out of the reach of preschoolers. Know the number for your local poison control center. The National Poison Control Hotline (1-800-222-1222) can be called from anywhere in the United States. Call if you have any questions about poisoning or poison prevention. It does NOT need to be an emergency. You can call for any reason, 24 hours a day, 7 days a week.

PARENTING TIPS

• TV or screen time should be limited to 2 hours a day of quality programming.
• Sex role development is based in the toddler years. It is important for the child to have appropriate role models of both sexes. Single parents should make sure the child has the chance to spend time with a relative or friend who is the opposite sex of the parent. Never be critical about the other parent. When the child has sexual play or exploration with peers, redirect the play and tell the child that it is inappropriate. Do not shame the child. This is a natural curiosity.
• Because language skills develop quickly in the preschooler, it is important for parents to read to the child and talk with the child often throughout the day.
• Discipline should give the preschooler chances to make choices and face new challenges while maintaining clear limits. Structure is important for the preschooler. Having a daily routine (including age-appropriate chores) can help a child feel like an important part of the family and enhance self-esteem. The child may need reminders and supervision to finish chores. Recognize and acknowledge when the child behaves, or does a chore correctly or without extra reminders. Take the time to note and reward good behaviors.
• From age 4 to 5, many children backtalk. Address these behaviors without reacting to the words or attitudes. If the child feels these words will give them power over the parent, the behavior will continue. It is often difficult for parents to stay calm while trying to address the behavior.
• When a child is starting school, parents should keep in mind that there can be big differences among children ages 5 to 6 in terms of attention span, reading readiness, and fine motor skills. Both the overly anxious parent (concerned about the slower child's abilities) and the overly ambitious parent (pushing skills to make the child more advanced) can harm the child's normal progress in school.

Developmental milestones record - 3 to 6 years; Well child - 3 to 6 years

American Academy of Pediatrics website. 2022 Recommendations for preventive pediatric health care. Pediatrics. 2022;150(1):e2022058044. PMID: 35921638  pubmed.ncbi.nlm.nih.gov/35921638/.

Carter RG, Feigelman S. The preschool years. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 24.

Marcdante KJ, Kliegman RM, Schuh AM. Normal development. In: Marcdante KJ, Kliegman RM, Schuh AM, eds. Nelson Essentials of Pediatrics. 9th ed. Philadelphia, PA: Elsevier; 2023:chap 7.

Updated by: Neil K. Kaneshiro, MD, MHA, Clinical Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.