Advanced Pediatrics

100 East Street SE, Suite 301

Vienna, VA 22180
(P) 703.938.5555

(F) 703.319.8580

3 Years Old

You have probably heard that every child is unique and no two are the same.  Parents who have more than one child can attest to this fact.  While there is a predictable sequence of steps to a child's development, children progress through these steps in different ways and at different times.  Celebrate the differences and as you develop your skills as a parent, know that each child requires an individual approach.

You may also be noting a streak of independence in your little one.   Probably even some self-centeredness.  This is normal at this stage and will require you setting expectations and be consistent in your responses including simply saying "no."

Vaccinations for this visit

We recommend the following vaccines:

  • Flu vaccine (seasonal)

​Recommended Tests

The following tests are only done based upon risk factors being present.  Please take a few moments to help us determine whether these tests are warranted for your child:

What to Expect


  • Naps:  This can be a time of transition for napping.  If your child gets a lot of nighttime sleep and does well during the day, he probably does not need a nap.  On the other hand, if he has frequent melt downs or conks out regularly when in the car, that afternoon nap is probably still needed.  Too ong of naps can also greatly inhibit falling asleep at night.  As a general rule there should be at least four hours between the end of the nap and the bedtime.  

  • Quantity of sleep needed:   The average 3 year old needs 10.5 hours of sleep at night and 1.5 hours during the day.  4 year olds need 11.5 hours at night.  As the nap drops, the nighttime sleep generally increases to compensate.  If the wake time remains the same, it may be necessary to move bedtime earlier in the evening to allow for adequate sleep.

  • Quiet Time:  So your toddler has dropped the nap and you miss that moment of Zen when you had a few moments of quiet to yourself.  You should probably keep that time so your 3 year old can have 45 minutes of structured, alone time for quiet play and time to rest his body.  Activities might include looking at picture books, coloring, or playing with trains.  There should be little to no adult interaction where the child is in a safe place.


  • Compared to infancy and toddlers, 3 year old children have lower energy needs relative to their size.  This means they will likely often get full on a small amount of food.

  • By now you should have switched to skim or 1% milk  Fat should come from other healthier sources of food including nuts.  For those who do not like cow's milk, find an alternative source of calcium such as almond or soy milk.

  • Don't be overly ambitious by trying to get every nutrient in every meal.  Keep a view on the forest, not the trees.  Offer a variety of foods knowing that your child will likely only select one or two items to focus on.  Shift your focus onto the family and not the food.

  • Shift your focus from quantity to quality.  Get away from processed packaged carbs and find foods that pack plenty of nutrients.  Sweet potatoes and nuts are good examples.

  • Share means and model positive eating, from table manners to enjoying the food.  Have your child help out in the kitchen!  She can stir pancake batter, count up an ingredient, and help clean up.  Using a plastic knife they can even cut some soft vegetables.​



  • Language and communicatoin skills your child should have developed:follows instructions with 2 or 3 steps, can name most familiar things,understands words like “in,” “on,” and “under”, says first name, speaks well enough for strangers to understand most of the time, and carries on a conversation using 2 to 3 sentences.

  • Learning, thinking, and problem-solving skills appropriate for a 3 year old includes:  can work toys with buttons, levers, and moving part, plays make-believe with dolls, animals, and people, does puzzles with 3 or 4 pieces, understands what “two” mean, copies a circle with a pencil or crayon and turns book pages one at a time.

  • Social and emotional changes you might find in your child:  copies adults and friends, shows affection for friends without prompting, takes turns in games, shows concern for crying friend, understands the idea of “mine” and “his” or “hers,” often gets upset with major changes in routine and able to dress self.

  • Physical tasks that are usual for  this age:  climbs well, runs easily, pedals a tricycle (3-wheel bike), and walks up and down stairs, one foot on each step.


  • If you choose to keep a gun, keep it unloaded and in a locked place, with ammunition locked separately. Handguns are especially dangerous. Ask if the homes where your child visits or is cared for have guns and how they are stored.

  • Your child will be able to open any drawer and climb anywhere curiosity leads. Your child may swallow anything he or she finds. Use only household products and medicines that are absolutely necessary and keep them safely capped and out of sight and reach. Keep all products in their original containers.  Attach the Poison Help Line number (1-800-222-1222) to your phone. 

  • Correctly USE a car safety seat EVERY TIME your child is in the car. If your child weighs more than the highest weight allowed by the seat or if his or her ears come to the top of the car safety seat, use a belt positioning booster seat.  The safest place for all children to ride is in the back seat. In an emergency, if a child must ride in the front seat, move the vehicle seat back as far as it can go, away from the air bag.


  • Make an adventure path outside. Use a garden hose, rope, or piece of chalk and make a “path” that goes under the bench, around the tree, and along the wall. Walk your child through the path first, using these words. After she can do it, make a new path or have your child make a path.

  • Before bedtime, look at a magazine or children’s book together. Ask your child to point to pictures as you name them, such as “Where is the truck?” Be silly and ask him to point with an elbow or foot. Ask him to show you something that is round or something that goes fast.

  • ​While cooking or eating dinner, play the “more or less” game with your child. Ask who has more potatoes and who has less. Try this using same-size glasses or cups, filled  with juice or milk.

  • ​Make a necklace you can eat by stringing Cheerios or Froot Loops on a piece of yarn or string. Wrap a short piece of tape around the end of the string to make a firm tip for stringing.