DENTAL

• Encourage brushing of teeth at least 2 times a day; parents should be involved in the brushing. Arrange now for a dental check-up; most regular family dentists feel comfortable with 3 year olds.
• Children may need a fluoride supplementation if they are on well water or bottled water.

IMAGINATION

• Child will demonstrate a peak in imagination and this should be encouraged. Many children will begin to tell "stories" that are not really considered lies. It is reasonable to try to orient to reality and try to help child distinguish reality from fantasy.

CHORES

• Child may begin to have some responsibility around the house. Emphasize that the child is an essential, contributing member of the family and is needed to make bed, set table, pick up toys, etc.

TOYS

• Creative play is important - crayons, paints, playdough, and paper are enjoyed. Child also enjoys blocks, puzzles, beads, and pegs. Preschoolers love to participate in imaginative play - dishes, playhouses and forts, dress-up clothing.

CHADIS- Child Health & Development Interactive System

• Our practice is pleased to announce that we are expanding our use of CHADIS, an interactive online system developed by Johns Hopkins University pediatric specialists, which screens for developmental, social, emotional and behavioral problems.
• This system allows the child's caregivers to provide more in-depth observations of their child to the child's health care providers through the use of confidential online questionnaires. Done prior to the office visit, the information you provide will help in the early identification and treatment of these important issues.
• The use of pre-visit questionnaires like CHADIS is supported by the American Academy of Pediatrics.

We are currently using the CHADIS system for all check-up visits and all behavior visits. For this tool to be successful, we need your help by completing these brief questionnaires a few days prior to your office visit. Please follow these instructions:

1. Go online to http://www.chadis.com and register your child.
2. The "invitation code " for our office is our phone number 3018692292. Create your password.
3. For checkups , when asked visit type, choose "well child/checkup visit." You will see the age appropriate tests for your child. Select "begin" and complete all the questionnaires listed. It is normal for some of the questions to seem too mature for your child.

Your provider will discuss the results at the check-up or behavioral visit. We appreciate your participation as it helps us provide your child with the best care possible.

Next check-up is at 4 years of age.

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4 YEAR CHECK-UP

GROWTH

• Most preschoolers gain about 3-4 lbs. per year and increase about 2 inches per year in height.

DEVELOPMENT
Most 4 year olds:

• Can peddle a tricycle.
• Know colors and can count to 10.
• Dress self.
• Understand concept of opposites and rhymes.
• Use language consisting of 4-5 word sentences and speech is usually understandable.
• Hop, stand on one foot for 3-5 seconds.
• Play cooperatively, although possessiveness and arguments are common.

NUTRITION

• Your child should consume a variety of foods, including meats, dairy, vegetables, and fruits. This amount of variety is hard to achieve every day, but most kids will accomplish it each week. Unless your child is under/over weight, let them eat in accordance with their own appetites. If your child is a picky eater, or does not eat a lot of meats or vegetables, you may want to consider giving them a daily chewable vitamin with iron.
• Don't make food an area of contention. Children need some control over their own life and parents will usually fail in attempts to control what and how much their children eat. Parents should demonstrate healthy nutrition by both buying and eating right. Lead by example!
• It is important to serve a balanced diet. Keep portions small and offer a 2nd helping, if desired: too much food on a plate can be overwhelming. The atmosphere at mealtime should be pleasant. Try to gather as a family for at least 1 meal per day.
• We recommend a daily multivitamin, to ensure adequate Vitamin D for your child.

DISCIPLINE

• Give reprimands privately and give a simple explanation when rules are broken. Consequences should immediately follow the act and should consist of either time-outs or removal of desired object. Try to strike a balance between limits and independence.

GENDER CURIOSITY

• Children may be more curious about items of a sexual nature. Try to answer questions about sex as naturally as possible and use correct anatomical terms for genitalia.

STRANGER PROOFING

• Children should be educated regarding strangers. Child should know their full name, address, and phone number. Practice "get lost" scenarios - child should know to talk to a policeman or a person behind the counter in store. Also, practice what to do if a stranger approaches or if a stranger offers food, a ride, or asks for help.

ACTIVITIES

• Encourage activities that require child to figure things out such as exploratory hikes, outings or shopping trips. Child probably is ready for some board, card, or marble games.

CHADIS- Child Health & Development Interactive System

• Our practice is pleased to announce that we are expanding our use of CHADIS, an interactive online system developed by Johns Hopkins University pediatric specialists, which screens for developmental, social, emotional and behavioral problems.
• This system allows the child's caregivers to provide more in-depth observations of their child to the child's health care providers through the use of confidential online questionnaires. Done prior to the office visit, the information you provide will help in the early identification and treatment of these important issues.
• The use of pre-visit questionnaires like CHADIS is supported by the American Academy of Pediatrics.

We are currently using the CHADIS system for all check-up visits and all behavior visits. For this tool to be successful, we need your help by completing these brief questionnaires a few days prior to your office visit. Please follow these instructions:

1. Go online to http://www.chadis.com and register your child.
2. The "invitation code " for our office is our phone number 3018692292. Create your password.
3. For checkups , when asked visit type, choose "well child/checkup visit." You will see the age appropriate tests for your child. Select "begin" and complete all the questionnaires listed. It is normal for some of the questions to seem too mature for your child.

Your provider will discuss the results at the check-up or behavioral visit. We appreciate your participation as it helps us provide your child with the best care possible.

Next check-up is at 5 years of age.

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5 YEAR CHECK-UP

GROWTH

• Height increases about 2 inches a year and weight gain averages about 6 pounds a year. Many children will develop a slimmer appearance than they had in the preschool years.

DEVELOPMENTAL SKILLS

• Your five-year-old can usually skip, walk on tiptoes, and broad jump. He can dress self without any help, cuts and pastes, and draws a person with a head, body, arms, and legs. He usually knows his address and phone number, can recognize most of the letters, and can write his name. Most five-year-olds can also ride a bike and are learning to swim.

NUTRITION

• Your child should consume a variety of foods, including meats, dairy, vegetables, and fruits. This amount of variety is hard to achieve every day, but most kids will accomplish it each week. Unless your child is under/over weight, let them eat in accordance with their own appetites. If your child is a picky eater, or does not eat a lot of meats or vegetables, you may want to consider giving them a daily chewable vitamin with iron.
• Don't make food an area of contention. Children need some control over their own life and parents will usually fail in attempts to control what and how much their children eat. Parents should demonstrate healthy nutrition by both buying and eating right. Lead by example!
• We recommend a daily multivitamin, to ensure adequate Vitamin D for your child.

EXERCISE

• Physical activity should be encouraged. Exercise can improve your child's fitness, make them feel better and strengthens their cardiovascular system. There are many city, county, and private organizations for sports such as swimming, basketball, baseball, soccer, football, gymnastics, and tennis.

SCHOOL READINESS
All children differ in the ages at which they develop the psychological and social skills necessary for school. School systems rely on chronological age to determine school entry, but there are other factors for parents to consider regarding when their child will enter school. Your child's preschool teacher can be an excellent resource. By school age, a child should be able to:

1. Play well with other children with minimal crying.
2. Use the toilet without assistance.
3. Know name, address, and phone number.
4. Button and zipper.
5. Remain attentive and quiet during a story.

TELEVISION

• Parents can control the amount and quality of TV their children watch. Limit television time to a preplanned hour or two daily. Encourage homework and chores to be completed before TV. You can provide alternatives to TV, such as after school sports, hobbies, chores, and family activities. It may be helpful to have your child plan his TV viewing time in advance to avoid conflict. Consult the TV listings - this will also help to monitor the quality of your child's TV viewing. Do not permit TV watching while eating. This habit encourages overeating and interferes with quality family time that may only be possible during the evening meal.

DISCIPLINE
Punishments and rewards need to be tailored to the child's age and should be administered soon after the behavior. Timeouts are the recommended way of dealing with a child's impulsive, aggressive, or hostile behavior. Here are some other recommended behavior modification techniques:

1. "Active Ignoring" or "Extinction" works best with children who are whining, sulking, or pestering and consists of "ignoring" the child when the child is participating in a behavior that you want to extinguish. Parents provide alternative behavior for the child to use. When the child adopts this new behavior, the child receives parental attention again.
2. "Positive Reinforcement" involves "catching" the child who is modeling good behavior, and recognizing and rewarding the good behavior as quickly as possible. The rewards can include affection, praise, eye contact, points, material objects, or a special meal or activity. Give specific feedback - "I like the way you shared your toys with your friend."

The American Academy of Pediatrics strongly opposes striking a child. If spanking occurs spontaneously, parents should later explain calmly why they did spank, the specific behavior that provoked it, and how angry they felt. They might also apologize to the child for their loss of control.

SIBLING RIVALRY
-Every parent with more than one child has experienced sibling rivalry. As children grow and mature, the rivalry can worsen. Here are some guidelines for parents to help manage sibling rivalry:

1. Be fair.
2. Avoid making comparisons between your children.
3. Encourage children to work out their own differences.
4. Avoid taking sides on sibling conflicts. Be impartial, and do not show a preference for one child or another.
5. Set guidelines on how children can disagree and resolve conflict.
6. Discourage tattling.
7. When it is necessary to punish, do it in a private place.
8. Use regular family meetings for all members to express their thoughts and feelings, as well as to plan the week's events and give positive reinforcement and rewards.

CHADIS- Child Health & Development Interactive System

• Our practice is pleased to announce that we are expanding our use of CHADIS, an interactive online system developed by Johns Hopkins University pediatric specialists, which screens for developmental, social, emotional and behavioral problems.
• This system allows the child's caregivers to provide more in-depth observations of their child to the child's health care providers through the use of confidential online questionnaires. Done prior to the office visit, the information you provide will help in the early identification and treatment of these important issues.
• The use of pre-visit questionnaires like CHADIS is supported by the American Academy of Pediatrics.

We are currently using the CHADIS system for all check-up visits and all behavior visits. For this tool to be successful, we need your help by completing these brief questionnaires a few days prior to your office visit. Please follow these instructions:

1. Go online to http://www.chadis.com and register your child.
2. The "invitation code " for our office is our phone number 3018692292. Create your password.
3. For checkups , when asked visit type, choose "well child/checkup visit." You will see the age appropriate tests for your child. Select "begin" and complete all the questionnaires listed. It is normal for some of the questions to seem too mature for your child.

Your provider will discuss the results at the check-up or behavioral visit. We appreciate your participation as it helps us provide your child with the best care possible.

Next check-up is at 6 years of age.

---

6 YEAR CHECK-UP

GROWTH

• Your six-year-old probably will grow about 2 inches a year and gain about 6 pounds in a year. You may notice a somewhat slimmer appearance, due to changes in the accumulation and location of body fat. Between the ages of 6 and 8 there is even an increase in the normal growth rate!

DEVELOPMENTAL SKILLS

• Most six year olds can bounce a ball 4-6 times, skate, ride a bicycle, skip with both feet, and should be able to swim.

HOMEWORK

• Parents need to help their child develop good homework habits. Choose a regular time and location to work on daily assignments. The location needs to be well lit and quiet, without distraction from the TV, other children playing, or others talking on the telephone.
• There is no absolute right time to do homework. You may have to experiment to see what works best for you and your child. Let your child have some say in this decision. If you can both agree on a regular time and place for homework, you can eliminate much of the homework-related conflicts that occur between parent and child.

STRESS
Although stress is a normal part of life, you may need to evaluate and change some things if you sense that your child is being "overloaded" with too many activities or schoolwork. Here are some characteristics that may be present in a child who is "stressed."

1. Your child develops headaches and stomach pains (not associated with a virus).
2. Your child seems restless, tired, or agitated.
3. Your child appears depressed and does not communicate feelings.
4. Your child seems less interested in an activity that was once extremely important.
5. Your child experiences declining grades at school and less interest in homework and school activities.
6. Your child exhibits antisocial behavior such as lying and stealing or seems more dependent on you than in the past.

IS MY FAMILY NORMAL?
You may wonder if your family life is "normal." Some characteristics of a functional family include loving and caring for family members, providing support, security and a sense of belonging, open communication, and making each person feel important, valued, and respected. Here are some other questions to consider when evaluating your family life.

1. Is there enough humor and fun in your daily lives?
2. Does your family have clearly stated rules and expectations and are these rules flexible and responsive to new situations and changes within the family?
3. Are the personal needs of each family member being met?
4. Do parents and children have genuine respect for one another, demonstrate love, caring, trust, and concern - even when there are disagreements?
5. Is your family able to mature and change without everyone getting upset or unhappy?

NUTRITION

• Your child should consume a variety of foods, including meats, dairy, vegetables, and fruits. This amount of variety is hard to achieve every day, but most kids will accomplish it each week. Unless your child is under/over weight, let them eat in accordance with their own appetites. If your child is a
• picky eater, or does not eat a lot of meats or vegetables, you may want to consider giving them a daily chewable vitamin with iron.
• Don't make food an area of contention. Children need some control over their own life and parents will usually fail in attempts to control what and how much their children eat. Parents should demonstrate healthy nutrition by both buying and eating right. Lead by example!

• We recommend a daily multivitamin, to ensure adequate Vitamin D for your child.

EXERCISE

• Encourage physical activity. Exercise can improve your child's fitness, make them feel better and strengthens the cardiovascular system. There are many city, county, and private organizations for sports such as swimming, basketball, baseball, soccer, football, gymnastics, and tennis.

TELEVISION

• Parents can control the amount and quality of TV their children watch. Limit television time to a preplanned hour or two daily. Encourage homework and chores to be completed before TV. You can provide alternatives to TV, such as after school sports, hobbies, chores, and family activities. It may be helpful to have your child plan his TV viewing time in advance to avoid conflict. Consult the TV listings - this will also help to monitor the quality of your child's TV viewing. Do not permit TV watching while eating - this habit encourages overeating and interferes with quality family time that may only be possible during the evening meal.

CHADIS- Child Health & Development Interactive System

• Our practice is pleased to announce that we are expanding our use of CHADIS, an interactive online system developed by Johns Hopkins University pediatric specialists, which screens for developmental, social, emotional and behavioral problems.
• This system allows the child's caregivers to provide more in-depth observations of their child to the child's health care providers through the use of confidential online questionnaires. Done prior to the office visit, the information you provide will help in the early identification and treatment of these important issues.
• The use of pre-visit questionnaires like CHADIS is supported by the American Academy of Pediatrics.

We are currently using the CHADIS system for all check-up visits and all behavior visits. For this tool to be successful, we need your help by completing these brief questionnaires a few days prior to your office visit. Please follow these instructions:

1. Go online to http://www.chadis.com and register your child.
2. The "invitation code " for our office is our phone number 3018692292. Create your password.
3. For checkups , when asked visit type, choose "well child/checkup visit." You will see the age appropriate tests for your child. Select "begin" and complete all the questionnaires listed. It is normal for some of the questions to seem too mature for your child.

Your provider will discuss the results at the check-up or behavioral visit. We appreciate your participation as it helps us provide your child with the best care possible.

We recommend yearly check ups.