Topic Overview

How does a child grow and develop between the ages of 2 and 5?

The ages between 2 and 5 are often called the preschool years. During these years, children change from clumsy toddlers into lively explorers of their world. A child develops in these main areas:

• Physical development. In these years, a child becomes stronger and starts to look longer and leaner.
• Cognitive development. A child this age makes great strides in being able to think and reason. In these years, children learn their letters, counting, and colours.
• Emotional and social development. Between the ages of 2 and 5, children gradually learn how to manage their feelings. By age 5, friends become important.
• Language. By age 2, most children can say at least 50 words. By age 5, a child may know thousands of words and be able to carry on conversations and tell stories.
• Sensory and motor development. By age 2, most children can walk up stairs one at a time, kick a ball, and draw simple strokes with a pencil. By age 5, most can dress and undress themselves and write some lowercase and capital letters.

Each child grows and gains skills at his or her own pace. It is common for a child to be ahead in one area, such as language, but a little behind in another.

Learning what is normal for children this age can help you spot problems early or feel better about how your child is doing.

Why are routine medical visits needed?

Routine checkups usually are scheduled several times during ages 2 to 5. They are important to check for problems and to make sure that your child is growing and developing as expected. In some areas, your child may see a public health nurse for routine checkups and immunizations.

During these visits, the doctor will:

• Give your child a physical examination.
• Give your child any needed shots.
• Weigh and measure your child to see how he or she compares to other children of the same age.
• Ask questions about your child's behaviour and your family.
• Ask about your child's favourite activities or friends.

Routine checkups are a good time to talk with your doctor about any concerns you have about your child's health, growth, or behaviour. Between visits, write down any questions you want to ask the doctor next time.

When should you call a doctor?

Call your doctor anytime you have a concern about your child's physical or emotional health. Be sure to call if your child:

• Is not reaching developmental milestones as expected.
• Is not growing at a steady pace.
• Has lost skills he or she used to have, such as talking or running.
• Is overly aggressive, violent, or abusive.
• Doesn't seem to be doing well, even though you can't pinpoint what makes you uneasy.

How can you help your child during these years?

It's important to learn about some of the behaviours you can expect during these years of rapid change. Temper tantrums, thumb-sucking, and nightmares are common issues in children this age. Knowing what to expect can help you to be patient and get through the stressful moments.

The best thing you can do for your child is to show your love and affection. But there are also many other ways you can help your preschooler grow and learn.

• Offer your child healthy foods. Keep lots of fruits, vegetables, and healthy snacks in the house.
• Make time for your child to be active. Limit TV and computer time to less than 1 hour a day for children 2 to 4 years old and 2 hours or less a day for children older than 4.
• Read and talk to your child. This helps children learn language and opens them up to new ideas.
• Help your child get enough rest. Between the ages of 2 and 5, children need about 11 to 13 hours of sleep each day.
• Help your child play with other children. Preschool or play groups can be a great way for children to learn to interact.
• Teach skills, such as how to get dressed and how to use the toilet.
• Set limits that help your child feel safe and secure but that also allow your child to explore.

Raising a preschooler can be challenging. What works or is right for a 2-year-old may not be right for a 5-year-old. Taking a parenting class can help you learn how to deal with issues as they arise. To find a class, ask your child's doctor or call a nurse call line.

What to Expect

General development between ages 2 and 5 years

Children grow in natural, predictable steps, moving from one milestone to the next. You will see gains in five major areas.

• 
  Emotional and social development
  begins at age 2 with excitement about being around other children. But most children at this age play near each other rather than with each other (parallel play). By age 5, most children seek and enjoy friendships.
• Physical development slows down from the rapid growth during infancy. Healthy growth is different for every child, and your child will grow at his or her own pace.
• Cognitive development, or thinking and reasoning skills, progresses from a simple to a more complex understanding of time, letters, counting, and colours. Children are able to follow increasingly more detailed commands.
• Language develops rapidly between ages 2 and 5. By age 3, children can speak at least 200 words and can follow two-part directions, such as "Wash your face and put your shoes away." Most 5-year-olds can carry on a conversation.
• Sensory and motor skills become more refined, from being able to walk up stairs, kick a ball, and draw simple strokes to being able to do basic tumbling and draw rough figures of people and other recognizable objects.

Milestones by age

By 3 years of age
, most children:

• Look leaner and longer compared to the early toddler years. Most children have gained about 2 kg (4.4 lb) and grown about 7.5 cm (3 in.) since their second birthday. Healthy growth is different for every child, and your child will grow at his or her own pace. Your child's natural growth rate may be slower or faster.
• Play pretend, understand 3-step instructions, enjoy simple puzzles, and know their name, age, and gender.
• Enjoy playmates, although "sharing" is often still a challenge.
• Separate from you easily.
• Are interested in or have finished toilet training.
• Can jump, run, climb, pedal a tricycle, and kick a ball.

By 4 years of age
, most children:

• Have gained about 2 kg (4.4 lb) and grown about 7.5 cm (3 in.) since turning 3. Healthy growth is different for every child, and your child will grow at his or her own pace. Your child's natural growth rate may be slower or faster.
• Can say their name, identify some basic colours, and match things that are the same (such as a pair of socks).
• Can tell the difference between fantasy and reality.
• Can speak in sentences with at least 5 or 6 words, tell stories, and sing songs.
• Can stand on one foot, ride a tricycle, throw a ball overhand, and go up and down stairs without holding on to anything.

By 5 years of age
, most children:

• Have gained about 2 kg (4.4 lb) and grown 4 cm (1.5 in.) to 5 cm (2 in.) since turning 4. Healthy growth is different for every child, and your child will grow at his or her own pace. Your child's natural growth rate may be slower or faster.
• Know their address and phone number, most letters of the alphabet, how to count up to 10, and basic concepts of time.
• Like to please others and have friends. But it is normal for children this age to sometimes act unkindly.
• Can carry on conversations and use more advanced grammar, such as the future tense.
• Can hop on one foot, somersault, and possibly skip. Most 5-year-olds can dress and undress themselves.

Common Concerns

It's common for parents to have questions about their child's sleep, safety, toilet training, and difficult emotions and behaviour.

Sleeping

Preschool children need about 11 to 13 hours of sleep each day. Your child may go through phases when he or she resists resting.

To help foster good sleep habits, you can:

• Set bedtime routines. Do things in the same order each night so that your child understands what to expect and associates these steps with going to sleep.
• Handle sleep disturbances. Sometimes young children wake up and want attention or reassurance. Keep your response the same each time your child wakes up. If you go into your child's room, make the visit quick.
• Help prevent nightmares. Preschool-age children's rich fantasy lives and active imaginations make them prone to nightmares. These tend to occur toward the end of the night or very early in the morning. You can help prevent nightmares by controlling what your child watches on TV. Also, encourage your child to talk about daily events to help him or her not feel confused or afraid.
• Manage night terrors. Night terrors are different from nightmares because the child remains asleep and doesn't remember the episode in the morning. Night terrors tend to occur about 3 to 5 hours after the child goes to sleep. Your child may cry intensely and may be short of breath. Do not try to wake a child during a night terror. Instead, reassure your child and hold him or her to prevent injury.

• Sleep: Helping Your Children—and Yourself—Sleep Well

Safety

To help keep your child safe, it's very important to be aware of your child's abilities and the environment, whether it is the home, a playground, or a public place. These abilities change as your child grows and gains new skills.

Behaviour

Children ages 2 to 5 have many intense emotions that they do not fully understand. As a result, expect your young child to not always listen to you. Be patient, and do your best to be consistent about setting limits to avoid some common issues. These may include:

• Temper tantrums. These emotional outbursts are perhaps the biggest behaviour challenge for this age group. Many 1- to 4-year-olds have temper tantrums at least once a week. For more information, including help on how to respond to tantrums, see the topic Temper Tantrums.
• Thumb-sucking. Thumb-sucking in children younger than 4 years of age is not usually a problem. Most children stop sucking their thumbs sometime between ages 3 and 6. But children who suck their thumbs often or with a lot of force after the age of 3 or 4 may develop emotional, dental, or speech problems. For more information, see the topic Thumb-Sucking.
• Breath-holding spells. These are periods when young children stop breathing, often causing them to pass out (lose consciousness). Breath-holding spells typically happen when a young child is angry, frustrated, in pain, or afraid. The spell is a reflex, not a deliberate behaviour. For more information, see the topic Breath-Holding Spells.
• Aggression. Some preschool children become aggressive and may hurt other children. Hitting, biting, pushing, and shouting are all common forms of aggression. Children's aggressive behaviour usually is a normal variation of their temperament. Parents can encourage self-control by teaching positive behaviour and how to channel feelings into words. For example:
  • Do not spank or hit your child. It usually doesn't work and only makes the child afraid.
  • Help your child calm down. Then you can talk about better ways to handle feelings.
  • Don't expect changes in behaviour right away. It takes time, repetition, and supportive comments for a child to learn.

Toilet training

Each child learns to use the toilet at his or her own pace. Most children are ready for toilet training when they are between 22 and 30 months of age.

It can be hard to know when to start toilet training. Your child's physical and emotional readiness is the most important aspect of the timing. You and your child will likely become frustrated if you try toilet training before your child is ready.

Promoting Healthy Growth and Development

You can help your child grow by showing love and affection, by talking with and reading to your child, and by letting your child play. It's also important to set boundaries and limits.

Physical development

• Offer plenty of opportunities for exercise. Going to the playground, joining a gymnastics or dance class, or simply running races in your backyard allows your child to release excess energy and encourages new physical skills. For more information, see the topic Physical Activity for Children and Teens.
• Help your preschooler learn healthy eating habits. Although you control what, when, and where your child eats, realize that he or she chooses whether to eat and how much. As long as you offer nourishing foods from the major food groups and focus on the big picture—how much is eaten throughout the day or over a few days—your child should not have problems. For more information, see the topic Healthy Eating for Children.

Cognitive development

• Encourage safe exploration. Children who explore learn to master new skills and solve problems. Offer a variety of things to play with, read, create, and build. Take basic measures to minimize risks. For more information about preventing accidents and injuries, see the topic Health and Safety, Ages 2 to 5 Years.
• Encourage a sense of security. This sense of trust lays the foundation for learning, social skills, adaptability, and emotional development. Your child is more likely to feel safe and secure if you are dependable, consistent, respectful, and responsive. Secure children also keep and strengthen their attachment to their parents.

Emotional and social development

• Provide peer contact. Playing with other children even 1 day a week gives children opportunities to practice and develop important social, emotional, and language skills.
• Promote self-control. Children need guidance, clear limits, and patient parents during this time of behavioural and emotional struggles. Help your child by modelling and teaching proper behaviour. Time-outs can help, when they are used properly and sparingly. Encourage your child to think about the feelings of other people to develop empathy.
• Help your child build self-esteem. Parents have the greatest influence on a child's belief about himself or herself. Let your child know that he or she belongs, is doing well, and is contributing.

Language development

• Read to your child at every age. Reading exposes your child to the sounds and rhythm of language.
• Help your child talk with others. Listening to and talking with other children and adults helps a child to understand and use language.

Sensory and motor development

• Provide a variety of experiences and play environments. Schedule time each day for either indoor or outdoor physical activity, such as dancing or going to a playground. These activities improve coordination and other large muscle skills. Fine motor skills develop through things such as art projects (like painting or using scissors) and playing musical instruments.

Nurturing your relationship with your child

Your relationship with your child will constantly change as your child gains new skills and develops independence. You can help your child through each stage by looking at your relationship from time to time. Ask yourself:

• What do I like most about my child?
• What could be triggering problem behaviour? Are any of these new triggers?
• What new skills has my child learned within the past 3 months? 2 months? 1 month?
• What tasks can I encourage my child to do for himself or herself? How can I encourage him or her?
• When am I happy about how I treat my child?
• What don't I like about some of our interactions? When do these episodes tend to occur?

If you are the parent or caregiver of children, it is also important for you to:

• Learn and use effective parenting and discipline techniques and avoid the use of corporal punishment. Parenting classes are offered in most communities. Ask your doctor or call a nurse call line for more information.
• Learn healthy techniques to resolve conflicts and manage stress. For more information, see the topic Stress Management.
• Ask for help when you need it. Call a family member or friend to give you a break if you feel overwhelmed. Find community resources to help you with child care or other services that you need. Call a doctor or nurse advice line for a place to start. Some communities have respite care facilities for children. They provide temporary child care during times when you need a break.
• Get help from school programs if your child has special needs.
• Seek help if you think you have a problem with alcohol, drugs, anger, depression, stress, or other issues that affect your mental health.

Going to kindergarten

It is a good idea to send your child to kindergarten. Kindergarten teachers know how to help young children with different skills and backgrounds. They will help your child enjoy school and get ready for grade 1. Most children start kindergarten between 4½ and 6 years old. Kindergarten will help your child:

• Learn about school.
• Make new friends.
• Prepare for grade 1.

When to Call a Doctor

Call
911
or other emergency services if you become so frustrated with your child that you are afraid you might cause your child physical harm.

In general, talk to a doctor anytime your child:

• Does not seem to be reaching developmental milestones as expected.
• Is not growing at a steady pace. Each year between ages 2 and 5 years, expect your child to gain about 1.5 kg (3 lb) to 2.5 kg (6 lb) and grow as much as 7.5 cm (3 in.). Your child's height and weight are measured at routine checkups. But call your doctor if your child's growth pattern concerns you in between these visits.
• Is not able to do some of the things that they used to do, such as talking or running.
• Acts overly aggressive, violent, or verbally abusive.
• Doesn't seem to be doing well, even though you can't pinpoint what makes you uneasy. Friends and other caregivers may also be concerned.

Although children grow at their own pace, be aware of signs of a developmental delay. The earlier you identify a delay, the better chance you have of getting the right treatment for your child that can prevent or minimize long-term problems.

Routine Checkups

Routine checkups allow your child's doctor to keep a close eye on your child's general health and development. You also can discuss any concerns you have at these appointments. It may help you to go with a prepared list of questions . In some areas, your child may see a public health nurse for routine checkups and immunizations.

Physical examination

The doctor typically will:

• Measure your child's weight and height. These measurements are plotted on a growth chart to see how your child compares to other children of the same age. This chart is updated at each routine examination to document the child's growth pattern. You can check your child's body mass index (BMI) at home to estimate whether your child is at a healthy weight for his or her height, age, and gender. To find out your child's BMI, use this Interactive Tool: What Is Your Child's BMI?
• Check your child's blood pressure.
• Examine your child for any visible problems.
• Ask you about your child's eating and sleeping habits.
• Review your child's immunization record . Needed immunizations are given or scheduled.

Routine screening tests for hearing and vision take place during the preschool years. A specialist may do formal tests if your child's screening results are poor or if there are any developmental concerns at ages 2 to 5.

Mental and emotional health

The doctor will talk with both you and your child to get a sense of your child's mental, emotional, and social development. Questions typically cover:

• Whether any noticeable behavioural changes have occurred.
• Your child's and family's general well-being. The doctor also observes how you and your child interact.
• How your child reacts to strangers.
• How your child plays and interacts with peers.
• Whether you have any concerns about issues such as toilet training, preschool, or troubling behaviours.
• Your child's language, hearing, and social skills. The doctor asks your child questions to briefly assess these and related developmental issues. For example, the doctor may ask your child about his or her favourite activities and the names of his or her friends.

In addition to the above assessments, doctors usually ask questions specific to a child's age.

Caring for your child's teeth is also important for your child's health. Schedule regular visits every 6 months or as your dentist recommends. For more information, see the topic Basic Dental Care.