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Raising Happy, Healthy Preschoolers

My youngest child is just five-years-old. She's precious, constantly talking and asking questions. She's incredibly tender-hearted but also a fierce leader, happily reminding everyone of the rules. She knows everyone's favorite color and makes sure we are always kind to one another. Ruby loves nature, especially rocks. Her pockets are always holding a few and on our walks, a large rock in the neighborhood can not be skipped. She climbs to the top and then jumps off like a true warrior. Baby dolls though, that's her jam. She is the best mother anyone ever did see. Our home is littered with babies tucked to sleep under the our rugs and within drawers in the television cabinet, they are at the kitchen table and every day as we walk into preschool, she has one peeking out of her backpack. Ruby Caroline assures our lives full of joy.


She also keeps us on our toes. At this age, we are constantly aware of new behaviors and helping her manage her new feelings, always second-guessing ourselves along the way. Her challenge of the rules and always asking why, causes us to pause and verify as well if this point is valid or if has simply been adopted out of habit. We are mindful of what we are eating, assuring she has well-balanced meals. Ruby challenges societal rules in that sometimes she wants to wear wild patterns on her shirt, stripes on her pants, and bright pink rain boots. Why not, right? Her perception of the world is so unbiased, she often surprises me to rethink my own beliefs, and certainly my own behaviors and habits. You see yourself reflected in your preschooler.


Parenting a little one at this age really does require that we create enough space in our lives that their constant questioning doesn't exhaust us. Certainly there are days the little ones can peck at us like a flock of chickens, but if we are overly exhausted with commitments and neglecting our own care, their needs may seem like a threat to us at times and cause us to be especially irritable. Don't miss out on their amazingly inquisitive nature, always asking them to hush or go play, because you aren't drawing healthy boundaries for yourself.


Your little one will need plenty of sleep too, nutritious food and plenty of physical activity to thrive. Many five-year-olds are attending preschool, while many others aren't quite ready for a structure environment.


Eat the Rainbow


Although it is discouraging, it is completely the norm for your preschooler to ask for cookies at every meal; however, what they really need is a variety of nutritious options served over the course of three meals and potentially even two smaller snacks. Offer vegetables, fruits, meats, and low fat dairy products and also, limit their high sugar and high-fat foods, as well as those with dyes.


When meeting children in the clinic, I ask them what foods they eat from the rainbow and encourage them to be mindful of this while choosing their foods. Finger foods are great for kids this age, carrot sticks, celery, fruit, and cheese balls. Be cautious of raisins though, a staple when I was a kid, but now one of the most contaminated foods available.


Health & Safety


This is the perfect time to start teaching your little ones about self-care. Talk about what to do if you hear a smoke alarm or what to do if you get separated in a store. Teach them about being safe around strange dogs, not to get out of the car in a parking lot without an adult present, and how to look both ways before crossing the street.


After three-years-of-age, children begin wellness checks annually and admittedly, I wish these were even more often because I feel there is so much to cover in these sessions that even our longer, 90-minute consultations don't adequately tackle. Many parents feel taking their healthy children to the doctor when they are healthy is unnecessary, particular when families are large or they are under insured or they feel they will be pressured into clinical care they do not desire, but while there are a number of screenings and points of important clinical evaluation that make these visits invaluable, I find the discussions we have with children in our office, which mature with familiarity, are very eye-opening to parents.


One important lesson I think that is learned at the doctor's office is consent. When I was in my clinical program and was being reviewed by my clinical director, she observed me work with a young boy, whom I had cared for many times. After addressing his mental health needs, which were deeply sensitive and this young boy trusted me and shared very openly, we began the physical assessment aspect of the visit. He jumps up on the exam table and I asked him if I could lift his shirt and listen to his heart and belly. He agreed.


After the visit, when my director was offering me critique, she shared a great deal of praise (not knowing I had already been a practicing clinician for more than a decade, but specialized in women's health rather than the entire family) but then stated that she felt it was inappropriate for me to ask the child's permission to remove his clothing for the exam. I was really surprised and asked her to clarify and she asked, "What if he refused?" Well, then I would have respected his decision and worked to build trust so in a future visit, he would feel safe.


Maybe this is the mindset of a privileged primary care practitioner, as I do have the liberty of asking parents to schedule a follow-up visit. We don't have to meet insurance coding requirements that often mean rushing through visits to gather data not entirely pertinent to the needs of the consult. We can free-style, for lack of a better term, and really meet the child where they are at, building rapport and really educating them.


What gives me utter chills is the age old saying, "Don't ever show anyone your privacy except your parents and your doctor." Well, we know this advice to also be unsafe. What I hope to cultivate is an empowerment in children, even as young as five-years that allows them to trust themselves to say no, to truly speak up for themselves, and to understand their bodies needs, as well as my role in that care, so they trust me when these more sensitive exams are, in fact, necessary (but they often are not).


At this age though, our role as your child's clinician is to educate them on self-care practices, evaluating their norm for height, weight, and blood pressure and guiding them in ways that help them optimize their health. Time flies as the parent and issues can go on much longer than we would imagine, or go entirely unnoticed, as much as we want to believe we are the all-and-everything for our children. We will talk about daily habits, such as sleep schedules, their diet, dental health (best discussed when they are super young), use of technology and blue lights, physical movement, and counseling on guarding their mental and emotional health. We may also do a vision test, hearing screening, and discuss options for child immunizations.


We will also discuss safety practices for the five-year-old such as wearing a bicycle helmet, using a booster seat in the car, and considering swim lessons. What temperature is your water heater? Many parents don't think of this, but as their little ones become more independent, this is when clinicians see more children burned because their faucet water was hotter than safe for the child (120 degrees F). Poison Control Center (1-800-222-1222).


Your Preschooler's World


My five-year-old absolutely loves going to preschool. She loves her friends, her teacher, and it provides her opportunity to really step into the "big kid" role (the youngest of six). While she has learned her alphabet, how to spell her name, most of her address, the months of the year and the days of the week, more than anything, she has really come to understand many nuances of friendship. She is learning how to protect herself, and speak up for others.


The consistent routine is especially comforting for her. Know that during this time, any major changes such as the birth of a sibling or a family move, can be quite stressful for them. Their behavior is likely to regress a bit, some little ones will begin to stutter, and even touch themselves in a more private way, but not always a more private environment. Rest assured, this will soon pass.


Do you see empathy in your child? Do they console a child who has fallen on the playground? Do they enjoy playing in the group or are they more likely to play along the sidelines? Are they sharing and taking turns, a real challenge at this age as they are still learning impulse control? Are they lashing out? Evaluate boundaries and if their needs are met and routine consistent, but also be patient with them, and gentle in your teaching.


Preschoolers live in a world of make-believe, but don't assume that they know the difference between real and pretend. My son, now twenty-three (he just text me to let me know that he's 24 years!), was always telling us of his hero tales. He would allegedly fly to Walmart as we all slept and get all the things people needed and deliver them to their homes. There is nothing he wasn't strong enough to accomplish, or that his super power vision couldn't identify. We did name him Noah, so of course, he had complete faith he and God were real tight. At five, children use what they know to be true to deduce whether new information is fact or fantasy; they aren't always right. (To be clear, he was right. My son is a superhero.)


Sharing lots of nonfiction books and realistic media helps them build their knowledge base. Visit the zoo, the library, the beach, and hike in nature often. Visit cultural events different than your own. Gain experiences rather than add to their toy boxes. Unicorns and dragons are great though, so no need to avoid these entirely, but assure you are exposing your preschooler to plenty of factual information. By age five or six, they will have a fairly strong grasp on what is real and what is pretend.


The preschool age is a time to cherish. Lots of growth happens at this time in their lives, in many ways - physical, emotional, and social. Ruby just asked us the other day if she could be an artist when she grows up and it surprised me that she even knew what this was or was thinking of her future.


Challenges can be significant at this age as well. Some children regress in their sleeping, develop new anxieties, or really struggle to control and process their emotions, which requires a great deal of intentional anticipatory guidance and discipline. We can help you here, understand what is normal and how to navigate the tougher days.


Cautionary Tale


The societal norm is to over utilize primary care so that nearly half of every 1000 children are prescribed an antibiotic annually and one-third of those are completely inappropriate. My clients are typically well-versed in this fact which is part of their resistance for avoiding the doctor unless they believe they are truly in need. Because they live fairly healthy lives and don't pop in the urgent care for every ailment, they can go years without being seen and ultimately, lack a relationship with a doctor. Adults, particularly men, do this as well.


The difficulty this creates is first, because I was midwife to so many little ones, parents will call me when they do have concern about an acute issue. They trust me and they want my opinion, but no longer is this child in my care when regular visits haven't been maintained, so I am not able to give advice and certainly can't write letters to school or prescribe medications. What is most concerning though, is when families are in need for representation after having been reported to Child Protective Services. Several times now, this has happened in my practice, and the care was so long ago that case reporters can conclude medical neglect by one parent or both. When you make decisions for your family about healthcare that are outside the norm, you really do need to establish a consistent pattern of care so you can argue that you aren't negligent, but in fact educated yourselves and opt not to follow all recommendations after coming to an educated decision. As your child's clinician I can also do this, as your advocate. COVID as well, brought many calls of concern for children who had never established themselves in my care, so I was unable to guide parents through these scenarios. Our fees are incredibly low. Make wellness care a priority. Teach your child their health is important by modeling this investment yourself.

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