PPR 3 Qus 5 Wednesday

Introduction To Parenting Your Toddler, Preschooler, And Young
Child
ANGELA OSWALT, MSW, NATALIE STAATS REISS, PH.D AND MARK DOMBECK, PH.D. JAN 16, 2008
This topic center covers parenting and child development of preschool children (early
childhood aged 3 to 7. For a complete review of the theories of child development
upon which this article is based, please visit ourChild and Adolescent
Development topic center. For coverage of child development and parenting topics
applicable to infant children (ages 0-2) please visit our Infant Parenting and Child
Development topic center.
Congratulations! You have survived the newborn and early infancy stage of your
child's development. Late night feedings, heavy and awkward infant carriers, and
stinky pureed baby foods are things of the past. Now, as your child becomes
increasingly mobile and interactive, there are a new set of concerns and tasks that
you must focus on to ensure that your child remains safe, healthy, happy, and
developmentally on-track. Early childhood is an exhilarating time for both children
and parents. Young ones start to gain increasing amounts of independence. They
move from "toddling" to learning to ride a tricycle or bicycle with training wheels.
They learn to scrub themselves in the bathtub. Better yet (especially for parents!),
they will master using the bathroom by themselves. However, these little people
aren't totally self-sufficient quite yet. Young children still need plenty of adult care
and guidance.
In this article, we provide concrete advice and information on how to care for children
between the ages of 2 and 7 years. Considered in Piagetian developmental terms,
this age range corresponds to the preoperational years. We will be covering areas
such as feeding and nutrition, sleep, hygiene, exercise, love and nurturing, medical
care, and safety. This article will also discuss strategies parents can use to help
children cope with common but difficult age-related transitions such as gaining a new
sibling and starting pre-school and/or kindergarten.
Early Childhood Feeding And Nutrition
Children need a balanced and healthy diet to fuel the amazing rate of growth and
development that occurs during early childhood. For better or for worse, after age 2,
young children eat many of the same foods adults eat. As a result, it's important that
caregivers provide children with a menu that includes a variety of nutrient-dense
choices from all important food groups. Caregivers should also take care to minimize
children's access to "junk foods" that are low in nutrient value and high in sugar, fat,
and salt.
According to the United States Department of Agriculture, adults and children over
the age of two need to eat a daily diet that consists of whole grains, fruits,
vegetables, lean protein, calcium-rich dairy products, and some oils. Whole grains
are important because they retain dietary fiber, and naturally occurring oil, vitamins
and minerals that have been removed from more refined grains like white flour. For
example, bread made with 100% whole wheat flour is more nutritionally sound than
bread made with refined white flour because the latter has had the healthy bran fiber
and natural wheat oil removed during the refining process. In general, whole-grain
selections, such as bread, crackers or pasta made with 100% whole wheat, brown
rice and oatmeal, will be significantly higher in fiber and important nutrients than
white bread, white rice and other refined grain products.
Children can choose from a wide array of fruits and vegetables in the produce
section of the grocery store. Selecting fruits and vegetables based on their color
makes for an easy rule of thumb; select fruits and vegetables with dark and vibrant
colors because these colors indicate the presence of large amounts of vitamins and
minerals. Dark green (e.g., spinach) and dark orange (e.g., carrots) vegetables are
especially nutritionally valuable. Healthy preparation of veggies is also important.
Raw or lightly-steamed vegetables will generally contain more nutrients than fried
vegetables, because too much heat can destroy some nutrients. In addition, frying
veggies in oil adds additional fat and calories to these foods.
Because young children are still learning to perfect the biting, chewing, and
swallowing process, caregivers need to take care to serve fruits and vegetables that
have been cut up into small pieces, to prevent choking. As well, slightly cooking or
steaming vegetables softens them and reduces choking risk.
Selecting vegetables and fruits that are "in-season" is the best way to minimize cost
and maximize nutrition. During the winter or "off-season" months, flash frozen fruits
and vegetables (minimally processed and without added sugars or flavorings) can be
another healthy option. Canned fruits and vegetables are convenient, but, again,
tend to be more processed (and therefore less healthy) than fresh or frozen fruits
and vegetables. Caregivers should take care to monitor children's intake of canned
and other highly processed fruits and vegetables, as they are often high in salt and
sugar, preservatives, and flavor enhancers (e.g., Monosodium glutamate, or MSG).
Protein menu selections can include lean meats (e.g., chicken, turkey, or fish) as
well as chickpeas, beans, and nuts. As with fruit and vegetables, caregivers need to
carefully prepare protein-rich foods by cutting items into small pieces so as to
minimize choking risk. As another choking precaution, very young children should
avoid eating whole nuts and eat nut butters instead. A thin layer of a low-fat nut
butter on whole-grain toast is an excellent kid-friendly protein selection. Be careful,
though... a child who swallows a large glob of peanut butter sandwich can still easily
choke.
Young children should get two to three servings of milk products each day. Milk
selections can include two percent or skim milk, non-fat or low-fat yogurt (try freezing
portable yogurt tubes for a special treat), or cheese. Milk products are filled with
calcium, which is especially important in the early childhood stage, as bones are
rapidly growing.
Lastly, children benefit from a little healthy oil or fat every day. Some fats are
healthier than others. Eaten in moderation, polyunsaturated fats (found in safflower,
sunflower, sesame, corn, and soy oils; and nuts and seeds) and monounsaturated
fats (found in olives, avocados; and olive, canola, and peanut oils) can help reduce
blood cholesterol levels and protect against heart disease. Omega-3 fatty acids
(found in fish such as mackerel and salmon, flaxseed, and walnuts) can help lower
blood pressure, control inflammation, and protect against irregular heartbeat. These
healthy fats can be contrasted with various forms of saturated fat (red meat, milk,
butter and cheese) which tend to cause health problems.
Early Childhood Food And Nutrition Continued
Lately, many articles have been written about the dangers of trans-fats and their link
to an increased risk of heart disease. Trans-fats are a variety of saturated fat that are
created in food laboratories by adding hydrogen to unsaturated fat (which are usually
liquid at room temperature). The addition of hydrogen to unsaturated fat makes it
solid at room temperature (like margarine). This is how vegetable shortening, used
extensively in many commercial cookies and cakes, is created. Because trans-fats
appear to be a health risk, caregivers should make certain that children do not eat a
steady diet containing them. Families should avoid commercially prepared fried
foods, baked goods, and stick margarines, and any foods that have the words
"partially hydrogenated" on their labels. Caregivers should focus on using
polyunsaturated and monounsaturated oils for cooking and baking at home.
Young children (just like adults) need plenty of water to stay hydrated. When they
are babies, children get most of their hydration from breast milk or formula. As
children grow older and move away from breast and bottle feedings, it's appropriate
to provide them with a non-spill "sippy" cup (or regular cup when appropriate) filled
with water or milk at meals and throughout the day to encourage them to drink.
Many caregivers turn to fruit juice as a beverage/hydration option, thinking that it's a
healthy alternative to soda pop or other sweet drinks. However, that's a widespread
misconception. Many fruit drinks aren't 100% juice and have lots of added sugar
(usually in the form of high fructose corn syrup). Even 100% fruit drinks can fill up
little bellies too much, which will prevent kids from eating other nutrient-filled foods
that they need. Moreover, children who drink lots of juice (containing lots of sugar)
may develop dental problems such as cavities and weakened permanent teeth (even
when these teeth are still under the gum line!). Be cautious about purchasing
"healthy" low calorie beverages as well. Many of these drinks contain artificial
sweeteners such as Aspartame or Splenda, which may be harmful to young children.
Though it lacks some of the appeal of sugary drinks, plain old pure water is always
one of the best hydration options.
Parents should also monitor how much their children eat, and watch portion sizes.
Young children's stomachs are relatively small, so they should consume smaller
portions (about 2/3 the size of an adult serving). Particularly at restaurants, modern
Americans routinely consume servings that are "supersized." Therefore, children
should be taught to listen to their bodies, and eat only until they are full. Encouraging
children to clean their plate when they have an oversized portion in front of them is
not healthy. Caregivers can help by not placing too much food on a child's plate, or
requesting that restaurants package half of large portions in "to go" containers. For
more information on portion size and menu planning, consult the United States
Department of Agriculture's website, at http://myplate.gov.
Because young children do not eat as much as adults at one sitting, they frequently
need to nibble on snacks between meals. Caregivers should treat snacks as
nutritious mini-meals, rather than as an excuse to fill up on sugary and/or fatty items.
As with all food choices, the least processed foods are generally the healthiest to
serve. Cut up fruit or veggies will be healthier for children than a piece of candy or a
pile of chips.
There are many menu options and ways to prepare healthful foods appropriate for
children. Here is a sample menu for one day:
Breakfast
 whole-grain toast with a thin layer of peanut butter (cut into small pieces)
 a cup of low-fat milk
 strawberries (also cut into small pieces)
Mid-morning snack
 a few whole-wheat crackers
 a slice of cheese (try to avoid highly processed American cheese singles)
Lunch
 brown rice
 pinto beans
 lightly steamed carrots
 unsweetened applesauce
 a cup of low-fat milk
Afternoon Snack
 sliced skinned peaches
Dinner
 ground turkey burgers on a whole-wheat bun
 baked sweet potato slices
 steamed broccoli chunks
 smoothies made from nonfat yogurt and frozen berries
Early Childhood Food And Nutrition Conclusion
Many parents may look at the above menu and sigh with a combination of
wistfulness and frustration, knowing that their children are far from ideal eaters and
might reject some of these choices. The key is to do what you can to tailor a healthy
diet that capitalizes on what your child will eat. Experiment and mix and match
healthy choices within the different food groups to create meals that are appealing
and nutritious. For example, if your child dislikes (or is allergic to) peanuts, serve an
egg white omelet for breakfast with some blueberries. Or, make a yogurt "parfait" by
layering whole grain oat cereal, berries, and lowfat yogurt in a transparent cup. For a
healthy pizza lunch, toast whole grain pitas or whole wheat muffins with sauce and
sprinkles of organic low-fat mozzarella cheese.
Sometimes, making food visually intriguing by arranging it in "faces" or designs can

entice finicky children to eat. Purchasing plates and glasses featuring entertaining
characters and shapes may be another way to coax reluctant eaters to the table.
Finally, having children become involved in food preparation and selection (in an
age-appropriate manner with direct supervision) can help them develop an interest in
trying new things (or, at least, eating what is around).
People tend to develop their attitudes and habits around food at an early age, so this
developmental stage is a perfect time for caregivers to positively mold preschoolers'
eating patterns. Just as in all other areas of learning, young children learn by
watching their caregivers' habits. Whatever Mommy eats for lunch is probably what
Janey will want as well. Therefore, the best way for caregivers to teach young
children about nutrition is to make healthy eating part of your family's regular
everyday lifestyle. Caregivers should themselves cook nutritious meals, sip on
healthy beverages, and nibble on healthful snacks.
Unfortunately, caregivers aren't the only influences in a young child's world. Kids will
see cheese doodles, sugary cereals, and chocolate cupcakes on television or in
grocery store displays. They will also inevitably sit next to or play with other children
who eat a mind-boggling array of unhealthy junk foods. Caregivers should continue
to model and encourage their children to engage in positive eating habits by making
healthy choices at the store, restaurants, and friend's homes. Neither children nor
adults should be eating salty fried snacks, fat and sugar-loaded sweets, caffeinated
soft drinks, or greasy fast food as part of their daily menu. However, it's alright for
caregivers to provide an occasional treat or splurge for their children. Allowing such
treats teaches young children an important lesson from an early age that there are
no bad or forbidden foods. Allowing all desired foods to be consumed (if in small
portions and only occasionally) helps to defend children (especially little girls) from
developing eating disorders later on in life.
If young children learn to like healthful foods and to make wise eating choices early
on, they will be more likely to continue healthy eating behavior in adulthood and
consequently to become healthier adults. Healthy eating, combined with adequate
exercise, can protect young children from developing obesity. According to new
research, nearly 25% of American children are obese, which means that their body
weight is 20% more than what it should be for their age, gender, and physical build.
As a result, more and more school-age children are being diagnosed with chronic
diseases such as Type II diabetes, where the body cannot respond properly to
insulin (a hormone that is involved in breaking down sugars in food). Type II diabetes
was once known as "adult-onset diabetes", because this disease was relatively rare
in children. However, the rising numbers of overweight or obese youth have changed
the use of this term.
Children who are obese run the risk of developing social and emotional problems.
For example, obese children are often ostracized or become the targets of bullies.
These children may feel isolated and lonely, develop low self-esteem, and become
anxious or depressed. In addition, children who are obese run a high risk of staying
obese as adults. Adult obesity can lead to a host of additional health problems such
as diabetes, cancer, stroke, and heart disease.
Obesity can often be prevented in today's youth by educating them about positive
lifestyle habits, along with offering encouragement and guidance. If children start to
become overweight and/or obese, take action as soon as possible. Seeking
professional guidance is a good idea, as there are ways to help children regain a
normal weight without using dieting strategies that are physically unhealthy and
mentally damaging (e.g., you do not want further lower a child's self-esteem or set
the stage for an eating disorder). Caregivers should consult with a pediatrician for
any concerns about a child's eating behavior and nutrition habits.
Beyond just providing the fuel and nutrients for growing up healthy, eating can also
be an activity that promotes social development and family bonding. If family meal
times are enjoyable events that encourage talking, sharing, and laughing, young
children will be eager to participate and to become part of the action. This will also
help young children feel connected, loved, and part of the family. Moreover, they can
begin to learn basic manners and social rules. By watching other adults and children
at the dinner act respectfully by saying "please" and "thank you" (and using other
appropriate table manners) they will gradually learn polite table manners too. It's
important for caregivers to remember that young children are in the process of
learning the rules, and don't yet have them perfected. Too much insistence on proper
form, or harshness when manners are temporarily forgotten can be counter-
productive. The goal is to create a family culture involving meals that are relaxed and
fun for youngsters and other participants, rather than an anxious or argumentative
time.
Unfortunately, the dinner table can easily become a prime target for conflict between
caregivers and children. Often, parents want to expand their children's culinary
horizons and make them try new and adventurous foods. Either because they're not
in the mood to eat something new, or because they want a chance to exert their
independence and fierce will, young children will sometimes say "NO!" and crank out
a few tears. There is hope, however, that parents can still salvage the dinnertime
peace. By remaining calm but firm, caregivers can prevent a power struggle that will
lead to everyone's escalating level of anger and frustration. One of the better
strategies for avoiding conflict is to offer children a choice between limited
alternatives (e.g., do you want to eat the rice first, or try the broccoli?). Offering
limited choices can help give children a sense of control but also reins in their more
extravagant tendencies. More information about using choice strategies can be
found in our article on Pre-operational Stage Discipline LINK.
Caregivers shouldn't attempt to force new foods on young children who aren't open
to them. However, by giving children multiple chances to try these foods across
multiple meals, children may gradually become tempted to be more adventurous
eaters. Some parents may be tempted to bribe young children to try a new healthful
food by promising a special sweet reward at the end of the meal. This may get the
child to comply in the short term, but over time this method tends to teach children to
seek bribes (increasing amounts of reward) rather than to seek out new experiences
for their own sake. In addition, children may start to expect sweets at every meal,
rather than for special occasions.
Early Childhood Sleep
A healthy diet is not the only thing that will help children continue to grow and develop
physically, mentally, and socially. Children also need adequate amounts of sleep in order to
allow their bodies time to recharge for each new day. Getting children to want to go to sleep
is not always an easy task. Many young children need quite a bit of coaxing before they will
crawl into bed and shut their eyes for the night. Their compliance can be helped along by
setting up a good bedtime routine.
A well-planned bedtime routine prepares children mentally and physically to move from their
active, exciting daytime adventures to quiet, nighttime sleep. The most important part of a
planned bedtime routine is consistency. When caregivers use a routine consistently every
night, children will learn to expect it. The routine itself will likely cause a calming effect, as
children become comforted by learning to anticipate each step of the experience.
The bedtime routine begins by having children stop engaging in their stimulating daytime
activities. Parents need to make a rule about the cutoff time for television, computer games,
and rough and tumble play. Electronic activities may be less important to preschool-aged
children, but setting this limit now will help enforce it into later years.
Many families find that starting the bedtime routine off with a bath is a good first step. With
the right attitude and some interesting toys or games, bath time can be a lot of fun for
everyone. Meanwhile, warm water and specially scented "calming" bath wash (found in
many grocery and drug stores) can begin to lull little ones toward sleep.
As well, caregivers should carefully plan an evening snack. As mentioned previously, young
children may not be able to eat a large portion at dinner and may, as a result, become hungry
again before bedtime. The appropriate content and size of the bedtime snack will necessarily
vary across children, as a little one who is too hungry or too full at bedtime will have a
difficult time falling asleep. Furthermore, too much fluid before bedtime can cause accidents,
even with potty-trained children. A nighttime wetting accident will rob children and parents
of needed sleep. Tips on helping children to avoid bedwetting episodes can be found in
our Toilet Training article.
Nighttime rituals such as reading offer children a perfect opportunity for one-on-one
caregiver time. Reading together can help calm children down while fostering their love for
books and learning. Some families may also use this time to encourage religious growth or
education through prayers or reading of important texts. Others take this opportunity to sing
soothing lullabies or simply hug and cuddle. Each of these activities can help strengthen
family love and bonds while creating a safe and tranquil space for preschoolers.
Most experts believe that caregivers should not allow children to fall asleep with adults in
their bedroom every night, as this may hinder children's ability to learn to self-soothe and fall
asleep easily on their own. Instead, caregivers should help youngsters relax enough to feel
sleepy and then say, "Goodnight," and, "I love you," while walking out the door. Often,
young children at this developmental stage will feel more comfortable if they have a night
light in their room or a comfort object (e.g., a stuffed animal or special blanket) with them in
bed. Even with these preparations, nightmares and significant fears are relatively common at
this age range. For more information on children's fears and other emotional development
during the preoperational stage, see our article on Preoperational Child Development.
Some families feel fervently that the best way to ensure the best sleep for everyone is by
creating a "family bed" (i.e., allowing young children to sleep in their caregivers' bed or
beside the bed at night). Some families believe that the family bed is a natural way to
promote family bonding, since this is a traditional practice in many developing parts of the
world and was typical during American history as well. Families need to carefully think
through the potential benefits and risks to all parties involved before establishing a family
bed, however. Caregivers' and children's sleep needs, as well as everyone's safety, is
important. Whatever arrangement families choose, they should be consistent every night (in
other words, it is not a good idea to share a family bed on some nights, and then send the
children to their own beds on other nights). Inconsistency will only frustrate young children
and ultimately backfire when it comes to helping them develop good sleep habits.
Usually, caregivers quickly learn to adapt their schedules to their young children's unique
sleep needs. Some children need fewer hours of sleep at night, but must recharge with a long
nap in the afternoon. Other kids rarely need naps, but require a long uninterrupted block of
nighttime sleep. In general, young children ages 2 to 5 years need 10 to 12 hours of sleep
each day. Between the ages of 5 to 7 years, young children need approximately 9 to 11 hours.
Caregivers should try (as much as possible) to keep their children on a relatively consistent
sleep schedule. Allowing children to stay up late or miss naps occasionally due to special
events is okay. However, a chaotic, inconsistent schedule will usually lead to missed sleep
and cranky and lethargic children.
Young children in the preoperational stage eventually reach a point where it becomes time for
them to sleep in a "big bed." Often, this change is prompted by the expected arrival of a new
sibling, who needs to use the crib. If possible, caregivers should attempt to separate these
these two important life-altering events. In other words, move your older child to his or her
new bed weeks in advance of the arrival of the new baby (if that can be accomplished).
Young children who are interested in and able to get out of their cribs should also be
switched to a big bed to prevent accidents and injuries. Parents who are concerned about
young children rolling out of a new bed can install inexpensive bed rails and/or put long body
pillows near the side of the bed.
Most children become extremely excited about moving to a "big bed," as this is an
accomplishment that demonstrates that they're growing up. However, if children show some
uncertainty about moving to a new bed, caregivers can slow down their transition by allowing
them to first nap in the big bed, while continuing to sleep in the crib at night. Later, children
can move to full time sleeping in the big bed as they become comfortable.
Previous Article
Early Childhood Food And Nutrition Conclusion
Early Childhood Toilet Training

We have dedicated an entire article solely to the issue of toilet training, in recognition
of the huge physical, mental, and emotional change that the move from diapers to
toileting represents for children and parents alike. Leaving the details of actual toilet
training to that other article, the present article instead covers how to encourage
toilet use, how to make this transition easier on caregivers, and how to cope with
common toilet training setbacks.
Mastery of toilet functions is an essential milestone in child development. It is
impossible to become an independently-functioning adult without mastering this skill
set.
Few caregivers relish changing diapers and dealing with children's urine and feces,
and many are anxious for their diaper duty to end as soon as possible. Children pick
up on their parents' anxieties surrounding toilet activities and can easily become
panicked, anxious and ashamed if they perceive themselves to be falling behind. For
this reason, it's very important that caregivers remain calm, patient, and positive
throughout the toilet training period. Children need the space to focus on noticing
and responding to their own body signals as well as mastering the technical aspects
of undressing, dressing, and using the toilet, rather than dealing with emotional
turmoil created by their caregivers.
Caregivers can, in part, reduce some of their own stress around this issue by
preparing an environment that promotes toilet training. Placing a child-size potty in
the bathroom before the child starts to try to use it can create interest. As well, a
locating a sturdy step stool by the sink will encourage hand-washing, and it will also
be handy at tooth-brushing time.
Caregivers can also reduce stress by expecting that accidents will occur en route to
the final goal. For instance, it's a good idea for caregivers to carry an extra change of
clothes (including underwear) in a diaper bag or backpack when the family goes
outside the home. Including a wet washcloth in a plastic sandwich bag or package of
baby wipes in that bag or backpack will also help with accident clean-up. In addition,
many parents like to keep an extra set of clothing at their child's school or day care in
case of accidents (many facilities require this already). Having an extra set of dry
clothes stored at school will eliminate the hassle of having to deliver replacement
clothing to the school during mid-day, and can also help decrease some of children's
embarrassment that often accompanies public accidents.
Caregivers can prepare for nighttime accidents by placing a rubber mat or mattress
cover over the mattress and under the fitted sheet. Just as in a crib, this prevents
damage to the mattress and makes messes easier to clean up. Having a second set
of bedding clean and easily accessible can enable children to quickly return to a dry,
clean bed after an accident.
During the toilet training period, caregivers should dress young children in a way that
allows them to get undressed easily when they need to go to the bathroom. Loose
pull-up pants and skirts with elastic waists are easiest for little kids to handle.
Keeping buttons, zippers, or other snaps to a minimum also decreases children's
frustration at the undressing process.
Caregivers should consider other factors as well when selecting children's clothing,
including clothing size. Caregivers should buy clothes that are slightly too large for
children so they can grow into them during the season. Little kids are still growing
quickly, so an outfit that was too big at the beginning of the summer may be too little
by autumn. It also is important to make sure that young children are dressed
appropriately for the season; neither too hot nor too cold. Having children wear
layers of clothing often provides the best solution, because children can add or
remove garments as necessary to regulate their temperature.
By this age range, young children will begin to communicate their own preferences
and express their developing personality in many areas of their lives, including their
selection of clothing. Youngsters often enjoy being consulted when caregivers
choose outfits at the store. To facilitate this process, caregivers can apply the simple
choice strategy to clothing selection. For example, Mom can hold up a both a blue
and a red tee-shirt and say, "Johnny, which tee-shirt should we buy?" By providing
simple options, Mom keeps the process of buying Johnny's clothing simple, but also
honors his developing independence and need for a sense of control over his life.
Early Childhood Hygiene
Children's personal hygiene needs change dramatically during this early childhood
stage, from something caregivers do for their children to something children learn to
do for themselves.
One of the most important self-hygiene tasks that preschool-aged children need to
master is hand washing. Young children who are beginning to care for their own
toilet needs and who spend time with other young children in a school or daycare
setting can easily spread all sorts of germs. Caregivers should teach little ones in a
very concrete and understandable way how germs are spread, and how hand
washing kills germs. Caregivers also need to teach children how and when to wash
their hands, and to encourage them to practice this skill often.
Frequently, little ones are impatient and barely get their hands wet. Caregivers can
make hand washing more fun (and last longer) by teaching children a song to sing
while they wash their hands. A 15-second song, like a verse of "Happy Birthday," is
an optimal length of time for children to spend washing hands. Hand washing should
be mandatory after using the bathroom, before eating, after playing outside, after
sneezing, or after petting the dog.
In addition to frequent hand washing, small children need to learn other ways to
prevent the spread of germs. Children should be taught to cover their mouths when
they cough and sneeze, and to use a tissue (rather than their shirt sleeve) when they
need to wipe their nose or mouth. Children should also be taught that sharing cups
and eating utensils, particularly at school, is an easy way to spread germs and
become sick, and should therefore be avoided.
Promoting good personal hygiene habits does more than protect children from the
threat of germs and disease. It also helps keep them looking and smelling clean and
fresh, and promotes their general health.
In this vein, dental hygiene is an important part of personal hygiene. Caregivers need
to teach young children the importance of brushing their teeth at least twice a day,
and flossing their teeth once a day. Adult modeling of brushing and flossing is one of
the better ways for caregivers to teach children appropriate dental self-care behavior.
Kids are much more likely to regularly brush and floss their teeth if they see Mom
and Dad doing these things as well.
Toothbrushing should be integrated into both the morning and bedtime routines. To
make disinterested brushers more excited about brushing, caregivers can buy child-
friendly toothbrushes that have cartoon characters on the handle, or that spin and/or
play music. More expensive technology is not mandatory, but for some children who
refuse to pick up a toothbrush, these gadgets can work an amazing trick.
Flossing can occur in the evening (or at another point in the day). Skillful flossing
requires highly developed fine motor control and it can be exceptionally difficult for
young children's little fingers to master appropriate flossing technique. For this
reason, flossing will likely remain something that adults need to help children with for
some time. To make the task of flossing easier, caregivers can have children floss
with pre-flossed holders, which are easier to manage than long pieces of traditional
string dental floss.
Young children also need to bathe regularly. How regularly they need to bathe
depends on each child's individual needs. Bathing every day may be appropriate for
kids that are highly active. However, daily bathing may deplete some children's skin
of natural oils faster than they can be replenished, leaving them with dry and itchy,
uncomfortable skin. In such cases, bathing every other day may be more optimal, or
a gentle after-bath lotion may be useful.
No matter how skilled young children are at bathing themselves, it's mandatory for
an adult to supervise all bath times. Young children can drown quickly in even a
small amount of bath water. As a result, caregivers should always be watching
children while they bathe.
Children should not be allowed to adjust the bath water temperature when
unsupervised, as they may turn the heat up too high and scald themselves. Scalding
risk can be prevented by turning down your water heater's temperature adjustment to
a lower setting. Parents should also personally adjust the bath water temperature at
the bath faucet so as to ensure that their child will not be burned or chilled by
temperature extremes. A good trick caregivers can use to determine how warm to
make the bath water is to test the water stream against the skin on the inside of their
arms (which tends to be more sensitive than other parts of the body). To prevent
irritation of children's eyes and skin, caregivers should pick out gentle soaps,
shampoos and body washes for children to use and put adult bathing products out of
sight so as to make them less tempting. Caregivers who are concerned about any
skin irritations or their children's bathing needs should consult their pediatrician or
family doctor.
Early Childhood Hygiene Continued
Caregivers may be tempted to do bath time scrubbing for their children in order to
speed up the process. However, this is not necessarily a good idea in the long run,
as kids need to learn for themselves how to thoroughly clean their own body parts.
Instead of doing the work for children, caregivers can encourage scrubbing
thoroughness by teaching their children a cleaning routine, perhaps keyed to a silly
song, so as to help ensure that important body areas are not overlooked.
At this age, young girls tend to enjoy bath time, while young boys often resist it. As is
the case with other aversive tasks, adding songs and games to the task can help all
children to look forward to bathing. Bubbles, soapy body paint, washable bath
crayons, pouring and measuring containers, character bath "stickers" (that adhere
with water) and other water-resistant toys can tempt otherwise reluctant children into
the tub. Some children even enjoy wearing snorkels or goggles for pretend
"swimming" sessions (supervised, of course).
Hair care is an important aspect of bath time that may need to be handled on a
different schedule from general bathing needs. While regular hair washing will
reduce the chance of scalp infections and other health problems, over-washing can
strip too much oil from delicate scalps and cause dry, flaky heads. As is the case
with general bathing, children vary in how often they need to wash their hair. Some
young children may need to have their hair washed every day, while others can wait
two days between washings. Children in the latter category may benefit from bathing
without washing their hair on some nights, which is especially good news for parents
whose children hate getting their heads wet.
No matter the frequency of hair washing, many young children will need an adult's
help to lather up and rinse their hair thoroughly, especially if their hair is long or thick.
Rinsing well is especially important, as shampoo residue remaining in children's hair
can cause itching and irritation. Caregivers should use a tear-free formula shampoo
that will lessen the risk of eye irritation. As well, adults can buy a special bath hat for
young children that funnels rinse water run-off away from the eyes. After little ones
get out of the tub, caregivers can use a light conditioner or specially-made detangling
spray to help a comb glide through children's hair with fewer snarls and knots (and
less painful tugging).
Young children can definitely begin to brush and comb their own hair at this age, and
should be encouraged to do so several times a day. To make hair grooming more
fun, children can be allowed to help style their own hair. It's especially fun for young
girls to put barrettes, combs, or other decorations in their own hair.
When selecting appropriate hair styles for young children, remember that shorter and
less complicated (i.e., that don't have to be blown dry or curled every day) cuts are
easier to care for. Frequent hair cuts can help reduce tangles, knots, and daily
grooming time. However, some children (especially little boys) may not enjoy trips to
the hairdresser or barber shop. Caregivers can make hair cuts more pleasant for
children by packing special toys and books for children to play with while they are
waiting. Schedule hair cuts for times when the salon or shop is less crowded, noisy
and busy. Ask around to find a stylist or barber who is experienced and good with
children. Finally, consider taking your child to a shop that specializes in children's
hair cuts. Some salons offer child-friendly seats (e.g., shaped like fire engines) and
show movies especially for their young customers.
The best way to cover a clean little body is with fresh, clean clothes. Caregivers
should teach young children to change their clothes every day, especially when it
comes to socks and underwear. As well, young children should be taught where to
place their dirty clothes, such as putting them in the dirty clothes hamper. This task
can be included in the nighttime routine in order to help it become habitual.
Battles over what children should wear can be a frustrating aspect of parenting.
Children often have firm ideas about what they want to put on, and they may insist
on wearing certain items even when they are dirty or inappropriate. Sometimes early
morning clothing choice battles can be avoided by having children help pick out what
they will wear the night before. However, some children are too tired at night and will
react negatively to this exercise. Caregivers should experiment with the timing of
clothing choice so as to determine the best time to select clothes for their particular
children.
Applying the simple choice strategy to clothing selection can be helpful in reducing
conflicts. Caregivers can offer children 2 or 3 weather-appropriate clothing options to
choose between. Too many choices may be overwhelming, but a couple of options
can provide children with a sense of control over how they look. Once children have
decided on their outfits, they may still need adult assistance in the dressing,
undressing, and shoe-tying process. Behaviors such as tying shoes and buttoning
buttons require good fine motor control that children in this age group may not
master immediately.
Early Childhood Exercise
Beyond just healthful eating, adequate sleep, and proper hygiene, young children
also need plenty of exercise to keep their bodies and minds healthy and happy. Daily
physical activity is necessary for building strong bones and muscles as well as
strengthening hearts and lungs. Exercise also helps young children to improve their
gross motor skills, including running, kicking, throwing, and swinging. Regular
physical activity can greatly decrease children's risk of becoming obese and
developing associated health problems, as well as promoting better sleep. As well,
since many young children play with other kids, exercise time can also help young
children to develop good social skills such as sharing, communicating, and
empathizing.
Play time can also become a family experience which serves to bond family
members together and allow adult members an opportunity to model healthy
exercise habits for children. Exercise also helps young children develop a healthy
self-image and positive self-esteem as they take pride in their physical
accomplishments. The exhilaration that comes with running, laughing, and playing
can also boost a child's mood. This leads to one of the most important reasons kids
should play outside: it's fun!
The USDA recommends that children of all ages get at least 60 minutes of physical
activity on most days. However, exercise doesn't have to be boring and monotonous.
Families can take walks together, ride bicycles, play baseball, basketball, football,
catch, or engage in numerous other sports in the backyard. Little ones can spend
hours playing on the jungle gym at the playground with their friends. Adults can
create and supervise races, obstacle courses, etc. that are age-appropriate and
safe. Children may also be entered into developmentally appropriate community-
based sports leagues and activities. Whatever form children's physical activity takes,
caregivers should do what they can to make sure appropriate safety precautions are
taken so as to reduce the risk of injury, including skin damage from overexposure to
the sun. See our safety information section later in this article for more information
on how to help children remain safe.
Summertime offers children the widest array of opportunities for physical expression.
However, physical activity can still take place in the winter. Little ones can join in a
"dance party" in the living room or "work out" with Mom while she does an exercise
video. Some newer video game consoles or games encourage physical activity by
making the player stand up and move around to win the game. In addition, families
can enjoy indoor fun nights at a bowling alley or skating rink. Children can take
indoor lessons (e.g., swimming, ice skating, gymnastics, karate, or dance) or join
indoor sports teams (e.g, soccer, basketball, volleyball, ice hockey). Many facilities
offer scholarships or reduced fees to families who otherwise cannot afford to pay for
these activities.
Early Childhood Love And Nurturing
Beyond having their physical needs for food, water, shelter, and hygiene met, young
children also need plenty of emotional and cognitive support, love, and nurturing.
Adult caregivers should make it a point to express love and affection for their
children every day. Doing so helps young children to feel safe, comforted, and
included in a warm, bonded relationship. Such feelings of security actually increase
children's capacity to learn and to develop mentally and physically.
Caregivers can show love to their children in many different ways. Cuddling,
hugging, tickling, or (safely and gently) wrestling can all be used to communicate
physical affection. Families can also verbally nurture their children through
statements of unconditional love, such as a daily, "I love you." Reinforcing words of
praise can be offered any time caregivers notice their young children making a
positive choice, displaying a new skill or ability, or being loving towards others. For
example, Mom can say, "Jimmy, thank you so much for helping us set the table for
dinner." This statement of praise shows Jimmy that he (and his behavior) is
important to Mommy. Furthermore, he'll start to internalize such affirmations and they
will encourage him to engage in helpful behavior in the future. Love and nurturing
can also be shown through thoughtful gestures. Dad can make a point to remember
that Katie enjoys helping him whenever he works around the house. By asking her to
join him in building new shelves, Dad shows Katie that her presence is enjoyed and
wanted.
Overall, caregivers communicate love and nurturing through how they live their own
lives. If caregivers keep an upbeat positive attitude, smile, and stay as calm and
patient as possible during difficult situations, they will create a peaceful and positive
environment for their children, young and old. However, this doesn't mean that
caregivers should neglect appropriate discipline and guidance. Maintaining age-
appropriate expectations of children and setting consistent consequences and
privileges based on their behavior will actually help to show children that they are
loved in addition to helping keep them safe and secure. More information about
disciplining young children can be found here .
It's important to remember that no adults, and especially parents and caregivers, are
perfect. Everyone has a bad day now and then. Caregivers need to expect and to
accept that they will make mistakes. However, if caregivers find that they are
consistently grouchy, irritable, negative, or sad, they need to get assistance to help
them be as healthy and as happy as possible for themselves and for their children.
Depressed or otherwise troubled parents can reach out to their support system:
friends, grandparents, religious group members, neighbors, etc for encouragement
and assistance. Sometimes though, talking to friends and family members isn't
enough. If caregivers have symptoms of low mood, excessive irritability, sleeping or
eating problems, or other issues that affect work and interpersonal relationships,
obtaining help from a mental health professional is a good idea. Admitting that you
need professional help is not a sign of weakness. It's one of the bravest things
caregivers can do to show their children how much they love them and to model
good self-care.
Mental health clinicians in the United States can be found in our online therapist
directory, or by looking up "mental health" in your local telephone directory. If money
is tight and you are worried that you may not be able to afford care, let the agency or
therapist know that during your initial contact. Many mental health agencies and
practitioners offer sliding-fee scales (reduced fees that are based on a family's level
of income) to people without insurance or when money is tight.
Beyond showing love and affection, caregivers can nurture young children's growing
minds by providing interactive and stimulating activities. While it may be tempting to
allow young children to watch lots of television, especially educational or age-
appropriate cartoons, it's not healthy. Young children should watch a maximum of
one to two hours of educational television a day. More than this can rob important
time away from physical exercise, creative activities, or family time that will help
children grow and develop. In addition, preschool-aged children are especially
sensitive to the effects of media, as they are not yet capable of separating fantasy
from reality. As a result, excessive violence or other intense programs can frighten
young children. For more information, see our article on the effects of media on
children and adolescents (coming soon!).
Instead of allowing their children to watch endless amounts of television, caregivers
can read stories, sing songs, play board games, or put puzzles together with their
young children. Children can also use different art mediums such as drawing,
coloring, molding clay, or painting. Encouraging make-believe games and play, such
as dress-up, "auto shop," or "house" can also provide hours of entertainment. Young
children can get their exercise through outdoor games or trips to the playground or
park. Furthermore, caregivers can arrange fun trips to the zoo, museums, or other
places where educational and entertaining activities for children take place.
Even though parents often have busy schedules of their own, they should make it a
daily priority to spend time with their families. It's also important in homes with
multiple children that each child get some one-on-one time with each parent on a
regular basis. Even unstructured activities can provide this needed one-on-one time.
For instance, allowing children to go to the pharmacy with Mom or sit in the kitchen
while Dad washes dishes can provide an opportunity to share feelings, catch up on
news, and laugh together. The important goal accomplished here is that young
children feel included and part of the larger family home. For more information, on
nurturing activities appropriate for young children, see our article on Preoperational
Stage Child Enrichment .
Early Childhood: It's Important To Encourage Reading
There is a magical time between ages 3 to 7 when children expand out beyond
verbal communication and start to develop written language skills as well. It's an
amazing transformation. Very young children can identify letters and sound them out.
Eventually, older children learn to identify common words, and then start to write and
read on their own.
One of the most lasting ways caregivers can impact their children's overall success
and joy is by instilling in them a love and passion for reading. Learning how to read
and write opens up limitless opportunities for children, giving them an entirely new
way to communicate, to expand their imagination, and to learn new information.
Moreover, if children learn to enjoy reading, they will further develop reading skills on
their own and not see it as a chore or difficult task to avoid.
Caregivers can encourage the love of reading in their children in many ways. First
and foremost, adults should read in front of and to their children. Kids should see
Mom and Dad reading pleasure books, recipes, how-to manuals, magazines,
newspapers, and signs out in the community. Once children have started learning to
read on their own, caregivers can encourage them along in this process by asking
them to help identify street names, addresses, food labels, store signs, and so on.
Next, books and reading should be incorporated into the daily life of the family. A
nightly bedtime story or a weekly library trip can be a fun "reading ritual". In addition,
many libraries also host free or low cost literacy events such as story readings and
summer reading programs. Finally, age-appropriate books should be easily
accessible to everyone in the home. For example, simple board books with lots of
colorful pictures should be stored on low shelves within easy reach of toddlers. Older
children should have bookshelves in their bedrooms (or other dedicated yet
convenient book areas) for current reading material and library books that are next
on the reading list.
Caregivers should not worry about buying the latest books at expensive prices. Free
or inexpensive children's books can be obtained at used bookstores, thrift stores, or
garage sales. As well, all families (and children who are old enough) should have
library cards which offer free access to library books and media. As much as
possible, trips to the library should allow children time to roam and explore the aisles
and select materials that are new and interesting (as well as selecting favorite stories
or authors).
Parents should not push their children too hard when they're learning to read. Many
caregivers care so much about helping their children to read that they may give their
children extra reading homework assignments or mandate a certain number of
minutes that children must read every day. Though well intentioned, such
assignments can backfire and end up causing reading to be seen by children as an
onerous chore. Caregivers need to gage children's receptivity to reading and
respond appropriately. While it is good to try to motivate children to be interested in
important activities like reading, their enthusiasm for such activities needs to be kept
as genuine and internally motivated as possible. Should they start feeling pushed,
rushed, or otherwise forced to engage in cognitive tasks like reading, their
enthusiasm may be squashed. As is the case when helping to promote other aspects
of children's development, caregivers should take care to stay calm and relaxed
while working with their children.
Caregivers who have concerns about their children's reading or writing skills should
talk to their children's teachers for support and ideas about how to help. They should
also make certain that children are not having problems due to a medical or physical
problem such as poor eyesight or hearing difficulty. Children who continue to
struggle with or to resist reading and writing even after their vision and hearing have
been tested and corrected (if necessary) may have a learning disability. Testing
conducted by an appropriately trained psychologist may be necessary to pinpoint the
source of a particular child's problem.
Having a learning disability doesn't mean that a child is unintelligent. Children with
learning disabilities have average or above-average IQ (intelligence) scores as often
as do non-disabled children. What makes them different is that their brains simply
process written or spoken information differently than other children. As a result,
these children may benefit from specific non-mainstream teaching strategies and/or
special classroom environments that are adapted to the unique ways they process
written information. In many states, local public school districts are mandated to
provide such special education to children who need it (although the quality of such
special programs varies dramatically district by district). Talk with your children's
teachers and with the school psychologist for more information.
Early Childhood Medical Care
Even into the preschool years, it's important for young children to have routine well-
child check-ups and scheduled immunizations. Routine medical care is important for
several reasons. First, it is important to "catch" illnesses as soon as possible, so
children can receive appropriate treatment, and often, prevent these illnesses from
becoming more serious. Second, routine appointments allow
pediatricians/physicians to ensure that children are growing and developing
appropriately. Children who seem to be experiencing delays can obtain appropriate
treatment, which can help lessen the negative impact of these delays on both kids
and their caregivers. Next, taking children to the doctor for both "well-child" as well
as sick visits reinforces the idea that visiting the doctor as necessary is an important
part of being (and staying) healthy. Finally, routine visits are used vaccinate children
and to protect them from developing a host of serious diseases.
Vaccinations (or their synonym, immunizations) are of particular concern to many

caregivers. While most people appreciate that vaccinations help prevent children
from being vulnerable to serious diseases, some are concerned that vaccinations
may also make children less healthy. Some parents worry that vaccines may expose
their children to mercury, and worry that this exposure can cause their children to
develop autism.
At this time, the best evidence available suggests that childhood vaccinations are
safe and effective. Few, if any, current vaccines contain mercury-based
preservatives such as those which were once thought to be a cause of autism.
What's more, no scientific study has ever convincingly established a causal link
between immunizations and the rate of autism. Instead, researchers have found that
other factors, such as the improvement in diagnostic tools and the broadening of
diagnostic criteria, are responsible for the increase in the numbers of children
developing autism. In other words, because we are more skilled at determining who
has autism, and because there are more people who fit the symptoms, we currently
have a higher rate of children diagnosed with this disorder. In scientific language, the
relationship between vaccines and autism is called a "spurious relationship". These
two factors (vaccinations and autism) aren't really related to one another. They only
seem to be causally related because they are both associated with a third invisible
factor such as enhanced diagnostic procedures.
While no vaccine has an 100% effectiveness guarantee against children getting a

particular disease, vaccines are effective 80-95% of the time, which is pretty darn
good. Caregivers should contact their doctor immediately if they notice their child has
a fever of 105 degrees F or above after being vaccinated. Caregivers should also
contact their doctor if their child is crying inconsolably, is lethargic, cannot be
aroused, or goes into convulsions. All of these negative side-effect symptoms
associated with vaccination are extremely rare.
A general list of vaccinations young children should receive between the ages of 3
and 7 years is summarized below, along with a list of the diseases each is designed
to protect against, when each should be administered, and any possible side effects.
The list below is only a general guideline; caregivers should talk to their pediatrician
or family doctor to discuss exactly when children should receive these shots, or if
they need any other region-specific immunizations.
 Diptheria-tetanus-pertussis (DTP or Dtap):
This immunization protects children from Diptheria, a severe but rare respiratory
disease; Tetanus, a disease that can cause paralysis from deep, dirty wounds; and
Pertussis, otherwise known as whooping cough. DTP immunizations are first
administered at age 2 months, 4 months, 6 months, and 12-18 months. DTP should
be administered again between age 4 and 6 years. After that, children should receive
the DTP booster for Diptheria and Tetanus every ten years.
After DTP injections, some children may experience injection site tenderness
including redness and swelling, and sometimes, fever. One myth about DTP
vaccinations is that they cause brain damage. While the older version of this vaccine
was associated with a relatively large occurrence of severe reactions, the modern
form of the vaccine (available since the 1990's) is significantly less likely to result in
side effects.
 Measles, Mumps, Rubella (MMR):

This immunization protects against Measles, a rare disease that can cause rash,
fever, and coughing; Mumps, a disease that causes swollen glands, fever,
headache, and possibly, deafness, meningitis (an inflammation of membranes
covering the brain and spinal cord), sterility, and death; and Rubella, a disease that
causes fever and rash which is relatively harmless to babies and children, but which
can cause birth defects in non-immunized pregnant women. This immunization is
given twice, once between 12 and 18 months, and once between ages 4 to 6 years.
For 5 to 12 days after the shot, children may experience low-grade fever, rash, joint
swelling, and drowsiness.
 Polio (IPV):
This immunization protects against Polio, a disease that can cause paralysis. Due to
an effective vaccination program, there have been no cases of polio in the United
States for 20 years. The older oral form of the polio immunization is no longer given
because it can rarely (one in a million times) cause paralysis itself. The injection form
of the IPV immunization used today does not cause paralysis and is given at age 6
months, 9 months, 18 months, and again between ages 4-6 years. Children who
receive this immunization may experience soreness at the injection site.
 Chicken Pox (Varicella zoster):

This immunization protects children from chicken pox, a contagious disease that can
cause fever and a blistery rash. This shot is administered once between the ages of
12 and 18 months, and again between the ages of 4 and 6. Side effects of this shot
can include a sore injection site, fever, irritability, fatigue, and nausea.
 Influenza:
This vaccine protects children and adults from influenza, a virus that can cause
respiratory distress and even death in extreme and rare cases. When children
receive a flu vaccine before the peak of flu season, they are more likely to be
protected from this virus. After toddlerhood, young children should get a yearly flu
vaccine, just like their older siblings and their caregivers. Side effects may include
injection site soreness or low-grade fever, which can be treated with a child-strength
over-the-counter fever reducer (e.g., acetaminophen). Recently, another type of
influenza vaccine, the nasal mist, has been approved for some children. Caregivers
should talk to their doctor about which type of vaccine is most appropriate for their
child.
Beyond regular physical check-ups and immunizations, children need other

preventative health care. Parents should take their young children to the dentist
twice a year for professional teeth cleaning and checks for cavities and other oral
health problems. Young children should also get their vision and hearing checked
regularly. Most children will be required to have vision and hearing screens before
entering preschool or kindergarten, and most schools require elementary grade
students to be checked yearly.
If not caught early, research suggests that problems with hearing or seeing can
hinder children's physical, emotional, or cognitive development. Affected children are
not able to take in information as easily and as efficiently as their peers, and they
may fall behind as a result, and become quite frustrated and upset at themselves for
doing poorly. In addition, children who have difficulty seeing or hearing may avoid
participating in sports (where they may do poorly), or may seem unusually clumsy.
Children will not necessarily know they have a deficit because they will lack the
experience of having intact sight or hearing necessary for comparison. Regular
screenings by a trained professional are the best way to identify and correct deficits
early.
Another vital part of preventative health care for young children is protecting them
from the damaging ultraviolet rays of the sun. Children should wear protective light-
colored clothing and hats when spending time outdoors. Children should also
regularly use a protective sunscreen whenever they're out in the sun, even on cloudy
days (ultraviolet radiation from the sun easily penetrates clouds). Sunscreen should
be applied liberally (as directed on the bottle) and should be reapplied frequently if
children are sweating a lot or swimming. Using sunscreen from an early age can
prevent lifelong sun damage and reduce children's risk of skin cancer as they
become adults.
Early Childhood Mental Health Care
Preoperational age children, just like adolescents and adults, can have disorders that
affect their thoughts, behaviors, and feelings. Common childhood mental illnesses
and developmental disorders include Depression, Bipolar Disorder and Anxiety
Disorders, Autism and similar Pervasive Developmental Disorders, Attention Deficit
and Hyperactivity Disorder, Learning Disabilities, Adjustment Disorders, Oppositional
Defiant Disorder, and Conduct Disorder. Each of these disorders is defined and
described in detail in our Childhood Mental Health topic center.
Mental health illnesses are associated with a long standing social stigma such that
many people feel too ashamed to admit that they might have a mental problem,
much less go for help. Adult caregivers who have internalized this stigma will often
apply it inadvertently to their children and fail to get them the help they need simply
because, at some level, the caregivers are too embarrassed to arrange it. One of the
bigger obstacles to getting children help for mental health issues is, then, the issue
of helping caregivers to overcome their fear or embarrassment of having a child with
a mental illness issue. It is unfortunate that this stigma continues to be an issue for
so many people, as untreated mental disorders can have serious long-term effects.
Social, academic and occupational difficulties, addictions, poor self-esteem, suicide
attempts, self-harm (cutting or burning one's self) and the like can result. Only 1 out
of 5 children with symptoms of mental illness receives proper early assessment and
treatment. If you have any questions or concerns about your child; if he or she
seems to be lagging behind others in terms of cognitive, social, emotional, or
academic skills, please share your concerns with your pediatrician or with a
professional mental health clinician who specializes in the treatment of childhood
disorders. For more information on childhood mental health, please consult
our Childhood Mental Disorders topic center.
Early Childhood Safety
Caregivers can help their children to stay healthy by taking them for immunizations
and regular preventative health care and also by making sure certain safety
precautions have been taken as children and families go about their daily business.
One of the things responsible caregivers should do is to childproof their home. We

covered steps new parents can take to childproof their home in an earlier
article which we now encourage you to look at again. The childproofing information
contained in that article continues to be of use in helping keep children safe through
the pre-operational preschool years. Sections of the article concerned with fire
safety, pet safety, outdoor safety and car safety; and First Aid are particularly
relevant. Even though preschool children are now older, more physically capable,
and more mentally mature than infants, they still need quite a bit of protection. In
fact, pre-school children may be at greater risk for harm than infants because of their
newly developed abilities and interests.
Learning how to ride a bicycle or to use roller skates can be an exciting development
for children. It's important that kids always wear properly-fitting helmets and
appropriate safety pads whenever they get to use this equipment, however. Children
many easily fall and hurt themselves if they are not protected by safety gear. Adults
can help motivate children to wear appropriate safety equipment by modeling the
use of these protective items themselves. For instance, caregivers should always
draw attention to the fact that they wear a protective helmet when they ride a bicycle.
If Grandma and Dad wear helmets when they ride a bike, little Danny will be more
likely to want to wear one too. Caregivers can further enhance children's safety while
using wheeled toys like bicycles by insuring that they are properly maintained and
sized appropriately for the child. Adults should read all manufacturer instructions and
warnings for wheeled toys, and follow the safety guidelines offered therein, so as to
best protect their children as they use those toys.
The best way to make sure young children remain safe while trying new activities is
to monitor and set limits on what they are allowed to do so as to avoid their getting
into a situation which is too physically or emotionally demanding. For instance,
preschoolers should never be allowed to ride in or near busy streets (or even near
not-very-busy-streets!), as drivers on such streets may not anticipate the presence of
young children, and a serious accident might occur. Instead, young bicyclists should
remain in driveways and on quiet residential streets with supervision until they learn
proper traffic safety rules and can masterfully maneuver their wheels. No matter
where children are allowed to play during this stage of life, they always require
careful adult supervision of their activities and strict limitation of what sort of activities
they may engage in so as to best protect them from dangers they are not yet able to
anticipate or respond to.
Traffic safety is a topic that should be taught to all children, not just to children who
are riding bikes. Children need to learn safety rules for how to conduct themselves
while walking around the neighborhood, too. For example, they need to be explicitly
taught that cars are seriously dangerous, that they must never play in the street, and
that they must always look out vigilantly for cars and other vehicles and stay out of
their way. Young children should be taught to stay on the sidewalk, whenever one is
available, and to walk on the side of the road facing traffic when there is no sidewalk,
so as to be more aware of vehicles coming toward them. Children need to be taught
to cross the street only at an intersection, to look both ways before crossing, and to
obey basic traffic lights and signs (e.g, "STOP," "WALK", and "DO NOT WALK") that
may be present at the crosswalk. Caregivers should make every walk outside a
learning experience.
Learning the "rules of the road" can be difficult for young children; it's a lot of
information for young minds to remember. Because even one mistake can result in
serious injury, caregivers should require their young children to hold their hands
when crossing the street. Caregivers should also "practice what they preach" by
following all traffic rules that children are being taught to follow. If little Cara sees
Daddy and Mommy obey the traffic signs and look both ways before crossing the
street, she will be more likely to repeat those behaviors as well. Caregivers who
teach their children one thing and then model the opposite behavior only confuse
and frustrate their little ones.
Because of their expanded mobility and increasing social awareness, preschool

children end up spending more time in the community. As a consequence, preschool
children need to be taught how to respond to and interact safely with strangers.
Teaching children about strangers is a difficult task as it requires parents to balance
the need to keep children safe from unknown threatening people, while also not
encouraging them to fear every new person they meet. Caregivers need to provide
close supervision while in the community with young children. In the store, mall,
park, or front yard, kids should always be within a responsible adult's line-of-sight.
This can be difficult, because curious children can quickly wander away as Mom is
studying prices on the grocery store shelf. Adults who find that their children have
wandered off should round them up as quickly as possible. Moreover, caregivers
should teach young children that it is never okay to follow or to go somewhere with a
stranger. Caregivers should emphasize that even if the stranger is offering candy,
carrying a puppy, or asking for help, children should yell "No!" as loudly as possible
and run back to the nearest trusted and known adult.
Caregivers should not put young children's names on jackets, backpacks, or clothing
where it is visible to strangers. Potential predators can use this knowledge to make
the child feel more comfortable and safe. For example, a stranger may see Jack's
name embroidered on his backpack, and say, "Hey Jack, I'm a friend of your Mom's.
She thought you might like to help me find my puppy. Why don't you come help me
find my lost puppy?" Instead, identifying labels should be placed inside the item or
garment (e.g., on a tag). More information on how caregivers can protect their young
children from the threat of child abuse, both from strangers, as well as from trusted
friends and family, can be found in our Child Abuse Prevention article.
If You Or Your Children Are Currently Experiencing Abuse...
KATHRYN PATRICELLI, MA DEC 15, 2005
If You or Your Children Are Currently Experiencing Abuse

It may seem like you are alone in your pain and that there is nowhere
to turn for help. To combat the abusive situation in your life, you
must learn how to develop an effective plan for escaping abuse and
getting help to put yourself into a better situation.
Many people feel helpless, overwhelmed, and vulnerable when they are in
an abusive situation. You are likely to feel emotionally tied to the
abuser and ambivalence about leaving. While ambivalent feelings are
understandable, you must realize that abuse is not healthy or safe, and
that it will continue indefinitely unless you find the courage to get
out.
The first thing to do is to determine whether your situation is
life threatening or if you have the luxury of time to plan a careful
exit. If your situation is life threatening, just pack a bag and leave immediately. Do
whatever you have to do to remove yourself from the situation.
If you have the luxury of time, spend some time developing a careful
and realistic plan that details how you will get away from your abusive
situation and into a better situation. Generating a realistic plan
helps you to have a better chance of actually escaping abuse and
getting to a better place.
 Learn what abuse is and isn't, and what your legal
rights are with regard to abuse. Contacting a lawyer is a good idea if
you can afford that. If you can't afford that, contacting a domestic
violence shelter worker or social worker familiar with domestic
violence and abuse is also helpful. These sources may be able to point
you to a legal advocate who can help to support, defend, and protect
you, and any children who are involved.
 Locate and contact domestic violence shelters
in your area. The people who staff such shelters are familiar with
helping abuse victims and will be able to advise you how to best go
about getting to safety. They may also be able to offer temporary
shelter for you and your children if you need to escape quickly.
 If children are involved, consider getting
your state's Child Protective Services involved by making an abuse
report. A CPS caseworker may be able to get your your children to
safety. The downside to this approach is that your children may need to
be removed from your custody in order to get them to safety (if you are
ambivalent about leaving the abusive situation yourself).
 Call the police whenever abuse is threatened or seems likely. There are several
reasons for doing this:
o The police can help keep you safe. If they come while abuse is happening they will
be able to defuse the situation.
o The police will document that abuse is happening.
o The police can help you get a restraining order.
A restraining order is a legal document that prohibits an abusive
person from getting near you or your living arrangements. You can also
ask the local court that handles domestic violence cases for a
restraining order, but it is easiest to ask for police assistance with
this process.
 Get yourself or your children a medical exam
to document any injuries resulting from abuse and to receive treatment
for those injuries.
 Seek out counseling services with a therapist
who specializes in areas of abuse to help you deal with your conflicted
feelings about leaving and to help you find community resources and to
help you generate your plan to leave. Seek out supportive group therapy
to talk with those who have been in your situation and understand what
you are feeling. Domestic violence shelters often sponsor support
groups.
 Make a step-by-step plan that details how you will care for yourself
when you leave the abusive situation. A social worker or domestic
violence shelter staffer may be able to help you problem solve these
issues. The most important questions to answer are where will you live
and how will you support yourself?
o Can someone put you up temporarily? Can you get an apartment on your own?
o Plan a way to achieve financial independence if
this is a problem for you, such as finding employment or receiving
temporary financial aid from others. Financial dependence can seem like
a huge obstacle to getting away from an abusive situation, but there
are resources out there to help you. Don’t allow a lack of money to
stop you from being safe and healthy.
 When your plan is defined and you've worked
out the details of how you will manage, put that plan into action.
Separate yourself from your abusive partner.
For children who are currently being abused, the main goal is to remove
the child from the abuser. The following is a list of possible
solutions:
 Get the child away from the abuser, even if this
involves sending the child to live somewhere else (e.g., with other
family members or friends).
 Get abuse to stop by making police reports or
anonymous reports to your state's Child Protective Services department.
Please know that reports may need to be made repetitively (many times
in a row) before any action gets taken.
 Get the child a medical exam to ensure that child is being treated for any physical
injuries and so that abuse is documented.
 Get the child into counseling with a therapist who specializes in working with abused
children.
Coping With Transitions In Early Childhood: Getting A New Sibling
Or Remaining An Only Child
In America, about 80% of families with children are composed of more than one
child, meaning most children have brothers and sisters. Many children get a new
sibling during their preschool years, either through birth or adoption. The addition of
a new sibling can be a huge transition for young children to go through, as they must
start to share attention, affection, and space with another young person for the first
time.
Parents can ease this change by preparing children well in advance for the
upcoming birth or adoption. Caregivers should try to explain to kids, in age-
appropriate language, what to expect and how their situation will likely change.
Books and videos written in kid-friendly language and covering the topic of sibling
introductions are available at many libraries and bookstores. Above all, caregivers
should try to make existing children feel important and involved during this exciting
time in the family's life. Young children can hold Mommy's hand during an ultrasound
procedure, or draw pictures to decorate the new child's bedroom. Families can play
games to come up with silly and serious names for the new arrival. Caregivers
should also repeatedly emphasize that with the introduction of new family members
comes new roles, which offer additional opportunities for purpose and meaning. For
instance, caregivers can tell little Devon that he is now "Big Brother Devon" and that
this means he will gain a playmate, and also someone new to love and care for.
Although it's not necessary, caregivers can buy a small token (a new tee shirt, small
toy, etc.) to present to older children when the new arrival first comes home, while
reminding them that they are still special and important.
No matter how well caregivers prepare their existing children for the arrival of a new
child, they should expect some resentment and acting-out behavior to occur when
the new child actually arrives. Especially if the new child is an infant requiring
exhausting and continuous feedings, caregivers will have less time to give to older
children and will necessarily have to split their attention up more. To regain this
attention, young children may regress and act in more baby-like ways. For instance,
they may become clingy, whiny, or start misbehaving on purpose so as to regain
parental attention that they have lost. To combat this behavior, and reinforce the
notion that older children are still valued, caregivers should make it a priority to
spend some individual time with older children each day. Even a few minutes of
alone time with an older child can make a big difference. Caregivers should also
verbally acknowledge and empathize with their "big kids" about the difficulties
associated with the change. Another strategy is to make older children feel like they
have an important role in helping to care for their new siblings (e.g., getting diapers,
rubbing the baby's back, singing to him or her).
As time goes by, and the children are able to interact and start to play together,
feelings of resentment usually tend to fade away. However, some sibling rivalries
may continue throughout childhood. Caregivers can help decrease sibling rivalry in
several different ways. First, it's important to avoid making comparisons among
children. This is especially important to avoid when one child is more skilled or more
easy-going than another. For instance, saying "I don't understand why you can't be
calmer like your big brother" can be demeaning and insulting to a younger child, and
leave him or her feeling less unique and important. It's important to acknowledge
feelings of resentment or disparity between siblings. Saying "I know you don't like
your sister right now, but it's not okay to shove her" can help meet a child's need to
be heard and understood, without condoning inappropriate behavior. Finally,
whenever possible, caregivers should allow children to solve their own conflicts.
However, careful supervision and monitoring of this coming-to-terms-with-one-
another process is vital so as to make sure children are not using physical violence
or abusive language with one another.
The ideal and desired outcome is that sibling children develop positive, nurturing
relationships with one another. Younger children will benefit from having an older
sibling model relatively advanced social, emotional, and cognitive skills and abilities.
In turn, older children experience enhanced self-esteem and gain pride from being
"experts". In many families, a strong sibling bond will continue through childhood,
adolescence, and into adult years.
Each family needs to determine the best number of children for their own unique
circumstances. Some caregivers choose to focus their time, energy, and other
resources on a single child rather than trying to raise multiple children. There can be
several benefits to having a single child. Only children often enjoy more privacy and
alone time with their parents, resulting in closer relationships. Children and parents
also avoid any sibling rivalry and resulting conflict. Often, only children and their
parents are able to enjoy more expensive leisure and educational activities, such as
lessons, summer camp or vacations involving travel, since there are fewer children
to spread resources across.
There are also disadvantages to being an only child. Single children do not get the
opportunity to develop close sibling relationships; something they may wish for as
they get older. Also, only children may feel more pressure from parents to succeed,
because caregiver discipline and focus will not be spread across multiple children. It
is difficult to say whether growing up as a single child is better or worse than growing
up with siblings. Each experience is different in its own ways, and each family's
experience will be unique.
Many families will use some form of routine daycare while parents fulfill other work
and personal needs outside the home. There are many different forms of child care.
Some families depend on nearby relatives (e.g., grandparents, aunts, or uncles) to
provide care for their children. Other caregivers look outside the family for child care
where there are a confusing array of expensive care options, including in-home
babysitters, nannies; small home-based child-care arrangements; and larger, more
formal and organized daycare centers which may be sponsored by private, public, or
religious organizations. For more information on the pros and cons of these various
types of child care, please refer to our article on finding appropriate child care.
There are many benefits to placing children in child care for a portion of each day.
Most centrally, child care allows caregivers to continue to work and earn money they
may need to support their family. In the United States, caregivers may need to
continue working at all costs because only through their employment can they gain
access to reasonable health insurance for themselves and their children. The need
to remain employed to continue access to health insurance may be less of a concern
for caregivers living in other countries with a more sane health insurance system.
Some caregivers are in the midst of career paths when they find themselves with
children. Childcare arrangements can make it possible for them to continue their
ongoing career path with only minimal interruption.
Quite apart from the motivation to use childcare out of economic necessity, child
care confers other benefits upon children. Children in child care are exposed to
peers on a regular basis at an earlier age than children who are cared for at home.
Consequently, they begin to learn important social skills such as how to share, follow
directions, and cooperate at an early age. In addition, paid or family child care
providers may offer children access to resources that primary caregivers cannot
provide. For instance, an aunt may be very skilled at teaching arts and crafts, or a
day care center may have a wealth of different educational toys that can help foster
a child's development which are not available inside the home.
There are some negative aspects to formal out-of-the-home child care as well as
benefits. Because children are exposed to peers their age, they are also exposed to
a multitude of germs and diseases. Families utilizing child care should plan for their
children getting sick far more often than families caring for children at home.
Caregivers may have to arrange for a back-up babysitter or make other secondary
child care arrangements on days when their children are ill, as many daycare centers
don't allow sick children to attend. Some centers may not be compatible with a
particular child's personality or approach to life, and should this happen, parents may
have to do more research (and/or pay more) to find an arrangement that works.
Finally, there is always the possibility of accidents and problems that can occur in a
childcare setting. Such problems may occur at a physical plant safety level, may
involve staff, or may involve problems between children. Accidents can happen,
supervision can fail, and even abuse does occur occasionally. Caregivers should
continually monitor their child care arrangements so as to make sure that their
children are being well-taken care of in terms of their physical, emotional, and social
needs. See our article on finding quality child care, and our other article
on preventing child abuse and mistreatment for more ideas about how to find a child
care arrangement that works for your family.
Experts continue to discuss and study the effects of long-term child care on children
as they age across the lifespan. Some early research suggested that children who
spent a significant portion of their infancy and early childhood years in child care
settings were more likely to exhibit anti-social, aggressive, and other negative
behaviors than peers who were cared for at home. However, newer research
suggests that the quality of the child care arrangements are key. Young children
placed in high quality day care settings show more evidence of well developed pro-
social behaviors such as sharing and the capacity for empathy, then their home-
cared peers.
For caregivers who have the luxury of choice (and it is important to realize that not all
caregivers do have a choice), the decision whether to stay at home with young
children or place them in child care can be very difficult to make. Caregivers may feel
tremendously guilty when they think about working during the time when their
children are small. Such caregivers may find themselves torn between a desire to be
stay-at-home caregivers and a desire to continue working, either out of necessity (so
as to provide necessary income and insurance), or because they find great personal
fulfillment through their careers. This sort of decision is very personal and needs to
be made in a holistic manner, taking all competing career and family demands into
account. There is no single path through this choice that is always right in every
circumstance. No matter what decision caregivers ultimately come to, it should be
kept in mind that caregivers who are happy with their life situation (whether that
means working full or part-time outside the home, or being a full-time caregiver in the
home) will be better parents.
A special note is appropriate concerning families who ask other family members to
provide child care services. This type of arrangement can encourage close family
relationships, but can also become a recipe for disaster if expectations and rules for
how care will be provided are not specified in detail, in advance. Family members
should have an open and honest discussion about what daily activities, discipline
strategies and foods for meals and snacks are acceptable. As part of the discussion,
all financial arrangements should be openly discussed. Both parties should agree on
an hourly/daily rate (if applicable), and if and how caregivers will be reimbursed for
food, diapers, activities, etc. Having this discussion in advance should hopefully help
prevent disagreements or power struggles between family members at a later date.
Also, it can allow caregivers to choose alternative arrangements should other family
members be unwilling to follow the outlined plan. Rather than placing children with
family members who will not honor agreements, caregivers may be better off using a
commercial service which does promise to provide acceptable care, even if this
proves to be a more expensive option.
Coping With Transition: Starting Preschool Or Kindergarten And
Final Conclusions
At some point during the pre-operational years, most young children (in the United
States, at least) will transition into their academic career starting with preschool, or
kindergarten. Some children may start in preschool programs as early as age 3,
while others will enter preschool at age 4 or 5. Most children are 5 or 6 years old
when they start kindergarten.
Caregivers should carefully consider several factors (beyond chronological age)

when determining whether children are ready for preschool. A wide range of
behaviors are necessary in order for children to have a successful experience in a
preschool setting. For example, children should be able to participate in group
activities; listen to a story and then recall and explain the simple plot line; follow
simple directions for a new game or activity; and be able to clearly express their
wants and needs, and ask questions using verbal (or sign if the child is deaf)
language. Physically, they should be able to hop, skip, and jump. Cognitively, they
need to recognize basic colors and shapes, as well as recognize when sounds are
similar and different. Another sign of children's school-readiness is their ability to join
in during song singing and have some of the lyrics or melody memorized. As far as
fine motor skills are concerned, young children should be able to cut paper with blunt
scissors and to be able to draw simple shapes. Most importantly, kids should be
toilet trained and able to take care of simple bodily needs, such as washing their
hands, and getting dressed and undressed.
There are different types of preschools that caregivers can choose from. Some
preschools focus more on teaching children social and emotional skills, others focus
on cultivating academic skills, and still others are designed to promote children's
creativity and self-expression. Head Start programs are another form of preschool for
families with children who are deemed to be at risk for having difficulties in
elementary school. Head Start programs work with children and their families to help
ensure that children obtain skills and resources they will need to succeed.
Attendance at preschool programs is optional in most cases in the United States.

Kindergarten marks the beginning of formal required schooling. Kindergarten classes
are offered in the public school system (e.g., publicly funded schools), but some
caregivers choose to send their children to a private school (e.g., where tuition is
paid out of pocket). Caregivers' motivations for sending children to a private school
vary. Some like the special religious focus of particular private schools, while others
like it that particular private schools may teach at a more advanced level than local
public school classrooms. The quality of public schools in the U.S. varies
considerably, generally following local property values; richer areas tend to have
better schools.
Many caregivers debate whether to "hold back" their child a year before starting
kindergarten, particularly if the child's birthdate is close to school admissions cut-off
dates (e.g., some schools require that children must be at least 5 by October 31 of
the year they enter kindergarten). The idea behind holding children back a year is
that the extra year of emotional and social development children will experience will
give them an advantage in their later academic career. Widespread though this idea
is, the research suggests that holding kids back usually does not improve their
school success in the long-term. Also, some children interpret being "behind" a
grade as evidence of their inferiority and come to feel badly about themselves. This
is of particular concern when children are left back a grade after having already
started school, as their peers advance when they do not. Being left back a grade is
easier on children when it occurs before they ever enter school in the first place.
Whether starting preschool or kindergarten, the start of school is typically a major

transition for children. The start of school can involve dramatic changes in children's
routine, structure, and expectations. This is particularly true for children without
previous experience in a child care or preschool setting.
It's normal for young children to be both excited and fearful about the idea of going to
school. On the one hand, going to school is what the "big kids" do, and as such it is a
mark of children's advancement. On the other hand, school represents a big
unknown, which can be frightening. For some children, going to school is the first
time they are separated from their caregivers for any length of time. Children can be
helped to mentally and emotionally prepare for this transition to school by talking
about what to expect in the school environment. Caregivers can check out books or
videos from the library which deal with this subject, and read or watch them with their
children. In addition, visiting the school and meeting the teacher ahead of time can
also make the transition less traumatic for everyone involved. No matter what
preparation occurs, it is normal for both children and caregivers to cry a little bit on
the first day or two.
Caregivers should strive to give their children extra love and support during their
early transition to school. Children may also require additional reassurance after long
holidays from school are over and they must return to school. Throughout the year, it
is important that caregivers show interest in what kids are doing at school, and
become involved in school-based activities as much as is practical. Doing so helps
children take school seriously and reinforces the idea that learning is important and
fun.
It is also important for caregivers to think carefully before they jump into pushing
children to excel in the school environment. Pushing children too hard does not
make them better students. Instead, it makes them anxious, fearful and depressed
students and actually may hurt their performance. Spending a few minutes at night
or on the weekends reviewing things that kids are learning at school is okay, but
relentlessly drilling kids on facts is an easy way to drive children to dislike
academics.
Caregivers should remember that children are naturally energetic, and that it
requires great discipline for them to sit still and pay attention all day at school. Make
sure to reserve some unwinding time in the evenings and weekends for family and
fun time. It is also important that parents do not allow children's extracurricular
activities to conflict with school lessons. Children who are over-scheduled with
lessons and play dates can become exhausted and stressed out, and may start to
perform poorly in school.
Maintaining an open relationship with children's teachers is an important caregiver

responsibility. Teachers can provide parents with direct feedback on many different
aspects of children's growth and development, including academic, social, and
emotional growth and maturity. Teachers are also great sources of ideas for how
caregivers can support young children's learning at home. For children who are
experiencing difficulties in school, teachers are a vital part of planning any additional
tests or services or tests that may be necessary. This is particularly the case when
children show evidence of learning disorders or other mental health issues that
negatively impact their school performance. The earlier such issues can be identified
and corrected for, the less damage they will cause. You can read more about
learning disorders here, in our Learning Disorders topic center.
Conclusion
This document provided caregivers with concrete knowledge for raising pre-
operational stage children between 2 and 7 years old. We have provided information
on how caregivers can safely and expertly meet their children's basic needs such as
nutrition, sleeping, clothing, hygiene, medical care, and discipline. We have also
discussed how caregivers can help children to cope with big but necessary life
transitions characteristic of this stage of life, such as gaining a new sibling and
starting school. Caregiving is not rocket science. However, it does require
dedication, time, patience, and sharing lots of love and support with children. With
these characteristics and a little knowledge such as the information we have tried to
communicate here, even the most novice parent or caregiver can feel confident and
secure as they help steer their children during their exciting early childhood years.

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Introduction To Parenting Your Toddler, Preschooler, And Young

Early Childhood Feeding And Nutrition

Early Childhood Food And Nutrition Continued

Sometimes, making food visually intriguing by arranging it in "faces" or designs can

Early Childhood Food And Nutrition Conclusion

Early Childhood Toilet Training

Early Childhood Hygiene

Early Childhood Exercise

Early Childhood Love And Nurturing

Early Childhood Medical Care

Vaccinations (or their synonym, immunizations) are of particular concern to many

While no vaccine has an 100% effectiveness guarantee against children getting a

 Measles, Mumps, Rubella (MMR):

 Chicken Pox (Varicella zoster):

Beyond regular physical check-ups and immunizations, children need other

Early Childhood Mental Health Care

One of the things responsible caregivers should do is to childproof their home. We

Because of their expanded mobility and increasing social awareness, preschool

KATHRYN PATRICELLI, MA DEC 15, 2005

If You or Your Children Are Currently Experiencing Abuse

Or Remaining An Only Child

Coping With Transition: Starting Preschool Or Kindergarten And

Caregivers should carefully consider several factors (beyond chronological age)

Attendance at preschool programs is optional in most cases in the United States.

Whether starting preschool or kindergarten, the start of school is typically a major

Maintaining an open relationship with children's teachers is an important caregiver

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