3 TO 4 YEARS: PHYSICAL APPEARANCE AND GROWTH

Your child's body should continue to lose baby fat and gain muscle during this time, giving her a stronger and more mature appearance. Her arms and legs will become more slender and her upper body more narrow and tapered. In some children, gains in height occur so much quicker than gains in weight and muscle that they may begin to look quite skinny and fragile. But this doesn't mean they are unhealthy or that anything is wrong; such children fill out gradually as their muscles develop.

Your preschooler's growth will gradually slow from about 5 pounds (2.3 kg) and 3 ? inches (8.9 cm) during the third year to about 4 ? pounds (2 kg) and 2 ? inches (6.4 cm) during the fifth. Measure your child twice a year and record her measurements on her growth charts. If her weight seems to be rising much faster than her height, she may be getting too fat, or if her height does not increase at all in six months, she may have a growth problem. In either case, discuss this with your pediatrician.

Your child's face also will mature during these years. The length of her skull will increase slightly, and the lower jaw will become more pronounced. At the same time, the upper jaw will widen to make room for her permanent teeth. As a result, her face actually will become larger and her features more distinct.

Measuring Your Child

Although your child may visit the doctor only once a year during the preschool period, you might want to measure and weigh him every six months. But you'll need his cooperation to get an accurate measurement of his height, so make it a special event. Start by establishing a special place where you can record the height. For example, you may want to make or buy a measuring scroll that can be fastened to the wall or the back of a door. Such a scroll usually is illustrated and has measurements marked up to about five feet. Space is available to note the child's height along with his age and the date. Alternatively, you can use a doorframe or wall. If you record the measurements there over a period of years; however, you'll have to be careful not to paint over it during remodeling. It's fun for both you and your child to look back and see how he's grown.

To take the measurement, have him back up against the wall, bare feet flat on the floor. His head should be straight so that he's looking directly in front of him. Then use a ruler, book or other firm, flat device to accurately line up the top of his head before making the mark on the wall.

Visiting the Pediatrician

Your preschooler should be examined by the pediatrician once a year. Now that she is better able to follow instructions and communicate, some screening procedures are possible that previously weren't. In particular, her maturity will allow more accurate testing of her hearing and vision.

By around age 4 your child can talk well enough to describe different sounds. A thorough hearing check can be done, using tones at different frequencies. This test should be repeated every year or two.

By age 3 or 4 your child is able to understand directions and cooperate well enough to have a formal vision test. At this age her visual acuity should be 20/40 or better, improving to 20/30 by age 5. If it's not at that level, she'll need to be seen by a pediatric ophthalmologist.