3 is a Magic Number?

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Patient Presentation
A 3-year-old female came to clinic for her health supervision visit. The father had no concerns about her growth or development. He proudly shared that she was riding a tricycle and was “wearing big girl pants” instead of diapers. He said she also liked to draw and tell stories.

The pertinent physical exam showed normal vital signs and she was growing along the 24-50% for age. The examination was normal and the diagnosis of a healthy 3 year old was made. During the visit the child independently climbed onto the examination table, was easily compliant with the exam and all the while was telling the pediatrician about how she was the mother to the doll she brought to the appointment. “I feed her. She is messy sometimes. I change her diaper too, See….” she demonstrated.

Discussion
Three year olds (3YO) are hard at work figuring out the world and how they fit into it. They talk and play with a finesse that they have not been able to accomplish before. Adults who “don’t like the baby stage” often really enjoy having 3YOs around as they can relate to them better because they now talk and act more like adults. What 3YOs do and say may be necessarily more juvenile, but adults can really see the beginnings of older or adult child in the 3YO.

3YOs can:

  • Gross motor
    • Run and climb (objects and stairs) with balance and some agility
    • Kick a ball and throws overhand
    • Ride a bike
    • Dress and undress self
    • Toilet self (during daytime)
  • Fine motor
    • Feed self with utensils
    • Copy a circle
    • Make a line
    • Shows hand dominance
  • Language
    • Tells a story
    • Say 3 word sentences with most (75%+) of language being understood
    • Ask lots of questions
  • Cognitive/Social
    • Follow 3 part commands
    • Share toys
    • Play imaginative play
    • Start to understand time
    • Start to name some colors, letters
    • Want to help and can perform some basic tasks
    • Cannot understand the difference between reality and fantasy and will fear imaginary things like monsters
    • Temper tantrums are still common

Notice there are many 3s here:

  • 3 words with 3/4 of the language understandable
  • 3 wheel driving – tricycle
  • 3 part commands

Learning Point
This is the first in a short case series of key developmental milestones in younger childhood and how understanding these “magic numbers” can help a clinician understand when a child may be exhibiting atypical development around these ages.

For 5 year olds, a review can be found here.
For 7 year olds, a review can be found here.

Three is a “magic number” because 3YOs have ALL the basics of everything an adult can do even if it isn’t mastered or perfected. Before 3YO, the skills are in components and not as well integrated (i.e. scribbles for drawing, or 1 word sentences, etc.) or they just don’t have the skill yet (i.e. toileting).

Physically, they are half the height of an adult; weight is more variable. They have all 20 teeth (primary).
They sleep about half of the day.

They can feed themselves and are adept at basic spoon or fork use.

They can write. They can make a circle and lines which are the basics of writing.

They understand math. They can count to 3 and understand the concept of 1 or 2 items versus “many” or “more.”

They can have a conversation. They can say 3-4 word sentences, and follow a story or conversation and most of their language is understandable.

They can respond accurately to social greetings such as “What is your name?” or “How old are you?”

They can drive. They can “drive” a bike and understand basic safety skills for keeping themselves and others safe in/on a vehicle.

They can dress themselves. They made not get it right or need some help but they can put on clothes and use the fasteners.

They have basic toileting skills. Some children may be completely toilet trained and others are in the process of learning all of these skills.

They want to be social. They can share, take turns and work with others. These are basics for a job, education, recreation (e.g. games, sports, interests) and family/community interactions.

They can wait and take turns. While they can’t wait a long time, they can do it. Taking turns is often implicit in waiting, as a child may need to wait until a parent can attend to their needs.

They can really focus on a task for a longer period of time.

Questions for Further Discussion
1. Why do you like or dislike 3 year olds?
2. What would be some warning signs that maybe a 3YO is developing atypically?
3. What are resources in your area to help a typically or atypically developing 3YO?

Related Cases

To Learn More
To view pediatric review articles on this topic from the past year check PubMed.

Evidence-based medicine information on this topic can be found at SearchingPediatrics.com and the Cochrane Database of Systematic Reviews.

Information prescriptions for patients can be found at MedlinePlus for this topic: Toddler Development and Child Development

To view current news articles on this topic check Google News.

To view images related to this topic check Google Images.

To view videos related to this topic check YouTube Videos.

Developmental milestones record – 3 years: MedlinePlus Medical Encyclopedia. Accessed October 2, 2023. https://medlineplus.gov/ency/article/002014.htm

Developmental Milestones: 3 to 4 Year Olds. HealthyChildren.org. Accessed October 2, 2023. https://www.healthychildren.org/English/ages-stages/preschool/Pages/Developmental-Milestones-3-to-4-Year-Olds.aspx

Author
Donna M. D’Alessandro, MD
Professor of Pediatrics, University of Iowa

Published