Nutrition

Swati Pandya, M.D., a pediatrician at the Palo Alto Medical Foundation, often gets questions about nutrition from parents of her preschool-age patients. Although your child may prefer to play with veggies or feed them to the family dog, this is an important time to help your child establish healthy eating habits for life, she says.

Follow Dr. Pandya’s simple steps to work toward that goal:

• Use the food pyramid as your guide. Your child should eat six portions of grains (preferably whole grains), three portions of vegetables, two portions of fruit, two portions of protein (lean meats, fish, dried beans or peas), two portions of dairy or dairy substitutes (low-fat regular or soy milk, cheese and yogurt) and limited fats and sugary foods every day.
• Set a good example. Your child wants to be like you so buy, prepare and eat healthy foods yourself and your child is more likely to do the same.
• Eat together as a family to encourage healthy eating habits, socializing and bonding.
• Limit juice to four ounces and milk to 16 to 24 ounces a day. When your child turns 2, switch to low-fat (2 percent) milk.
• Stick to three meals and two snacks a day.

Exercise

Doctors recommend that both adults and children get 60 minutes of exercise most days of the week. To encourage your child to be active, be active yourself. Encourage your child to develop healthy exercise habits by:

• Enjoying active pastimes together as a family that will benefit everyone, like a weekend walks outdoors and playing ball, tag or jump rope.
• Find activities that are age appropriate and fun for your child. Between the ages of 3 and 5, your child can begin taking part in team sports such as soccer or baseball or enjoy individual sports such as gymnastics.
• Leave time for your child to enjoy unstructured, free play, which is also very important for your young child’s mental and physical development.
• Most importantly, limit screen time. The American Academy of Pediatrics recommends that your child should watch no more than one to two hours of quality television programs a day. Learning apps and games are still so new that they have not been well studied. However, we do know that time spent on interactive screen activities still comes at the expense of time spent in active play that exercises both body and mind.

Preschool Readiness

Is my child ready? Many parents approach preschool with a mix of excitement and apprehension, eager and proud to see their little one growing up, but also wanting to protect their child from situations that may prove too challenging. There are many simple steps you can take to ensure your child eases into preschool. These include:

• Let your child mix and interact with other little ones at library reading times, play dates and at the park.
• Encourage your child to work on activities at home alone, such as playing with play dough, painting or building with bricks.
• Help your child get used to separating from you for a short time – arrange or swap play dates with other parents or family members.
• Establish a daily routine.

As your child nears the end of preschool, you’ll be considering the next big milestone – kindergarten! Look for these signs to ensure he or she is ready for the ABCs, and more:

• Able to listen to and follow instructions.
• Is curious and wants to learn, for example, about letters and numbers.
• Has the fine motor skills to hold a pencil and use scissors.
• Is socially ready – plays and interacts with his or her little peers at preschool.

Remember that children will face challenges in kindergarten – some children are very shy, while others find it hard to sit down and pay attention. Be patient and work with the teacher to assist your child. Reassure your child that it is OK to feel shy and help him or her feel more confident around others. Some children may also be aggressive until they learn to use language skills to resolve problems. The goal of kindergarten is not for your child to be a perfect student but to be prepared for first grade by the end of the year.

Toilet Training

This is a developmental milestone, and each child will be ready for toilet training at a different time. Wait for your child to be ready before beginning the trip to the potty and don’t put any pressure on him or her to start too soon. Some of the signs that your child may be ready for toilet training include:

• Regular bowel movements
• Dry for two hours or more (for example, dry after a nap)
• Can follow simple directions
• Wants to sit on the potty or toilet

Night time dryness is a completely separate developmental milestone that may take a lot longer to reach. Many 4- and 5-year-olds will still wet the bed at night. Speak to your doctor if you are at all concerned.

Choose a preschool that supports wherever your child is in the toilet training process.

Vaccinations

Vaccinations protect your child, as well as other children and adults in your community that could catch a disease carried by an unvaccinated child. When your child starts kindergarten, there are some important vaccinations to take care of. These include:

• DTap (diphtheria, tetanus and pertussis, also known as whooping cough)
• Polio
• Second dose of MMR (measles, mumps and rubella)
• Tuberculosis screening
• Second dose of chickenpox, varicella vaccine (VZV)

It’s important not to skip any of your child’s vaccinations to protect him or her against dangerous and life-threatening diseases. Remember that to protect everybody effectively against an outbreak of such a disease, at least 90 percent of the population needs to be vaccinated.

If the number of vaccinations seems overwhelming to you or your child, you can split the vaccines between the 4- and 5-year checkups or arrange a separate doctor’s visit for some of the immunizations. The downside of a modified vaccination schedule is that it creates a slightly larger window of time when your child is at risk for some of these potentially serious diseases.