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The normal social and physical development of children ages 3 - 6 years old includes many significant milestones.

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

• Gross motor development in the 3- to 6-year-old should include:
  • Becoming more skilled at running, jumping, early throwing and kicking
  • The ability to catch a bounced ball
  • The ability (at 3 years) to pedal a tricycle; becoming able to steer well at around age 4
  • The ability (at around 4 years) to hop on one foot, and later balancing on one foot for up to 5 seconds
  • The ability to perform a heel-to-toe walk (at around age 5)
• Fine motor development milestones should include:
  • At about age 3:
    • The ability to draw a circle upon request
    • Drawing a person with three parts
    • Beginning to use children's blunt-nose scissors
    • Self-dressing (with supervision)
  • At about age 4:
    • The ability to draw a square
    • The use of scissors, and eventually cutting a straight line
    • The ability to put clothes on properly
    • Managing a spoon and fork neatly while eating
  • At about age 5:
    • Spreading with a knife
    • The ability to draw 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 three-step command
  • Count to four
  • Name four 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 - 4 years. It occurs because ideas come to mind faster than the child is able to express them, especially if the toddler 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 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 necessary 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 participating in games that have rules, the rules are likely to change frequently at the whim of the more dominant child.

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

It is normal for preschoolers to test their limits in terms of physical abilities, behaviors, expressions of emotion, and thinking abilities. 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 develop the desire to please parents and others of importance. This is commonly known as the "good boy" or "good girl" stage.

Elaborate story-telling may progress into lying, a behavior that -- if not addressed during the preschool years -- may continue into the adult years. Mouthing-off or backtalk in the preschooler is usually a means of getting attention and attempting to get a reaction from an adult.

SAFETY

Safety is extremely important for preschoolers.

• The preschooler is 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 in a seatbelt and appropriate car seat when riding in the car. At this age children may be riding 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 for the preschooler. Climbing to new and adventurous heights, the preschooler may fall off playground equipment, bikes, down stairs, from trees, out of windows, and off roofs. Lock doors that access dangerous areas (such as roofs, attic windows, and steep staircases) and provide 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 safe, cool recipes. 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 Center (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

• Because 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 assure that the child has the opportunity to spend significant time with a relative or friend who is the opposite sex of the parent. It is important for divorced parents to not be openly critical or make degrading comments about the other parent. When the child exhibits sexual play or exploration with peers, redirect the play and tell the child that it is inappropriate, but do not shame the child for this natural curiosity.
• Because language skills develop quickly in the preschooler, it is important for parents to read to the child regularly and talk with the child frequently throughout the day.
• Discipline measures for the preschooler should provide opportunities for making choices and facing 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. Reminders and supervision may be necessary for chores to be accomplished. Recognize and acknowledge good behavior or a chore performed correctly or without extra reminders. Take the time to note and reward the good behaviors.
• From age 4 to 5, many children backtalk. Address these behaviors without reacting to the words or attitudes presented by the preschooler. If the child feels such words provide power over the parent, the behavior will continue. It is often difficult for parents to remain calm while trying to address the behavior.
• When a child is starting school, it is important for parents to keep in mind the wide diversity among children at 5 - 6 years 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 be detrimental to the child's normal progress in school.

Feigelman S. The preschool years. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 10.

Updated by: Jennifer K. Mannheim, CPNP, private practice, Seattle, Washington. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.