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Health and Physical Development

Health and Physical Development - Older Preschoolers (45 to 60+ Months)

Your chubby-cheeked toddler is rapidly growing into a more coordinated preschooler. Continue to encourage healthy eating and sleeping habits, physical activity and appropriate technology use (laptops, touchscreen, etc.) to develop fine motor skills. Both indoors and outside, children need opportunities to move freely, to explore different types of play equipment, and to participate in planned and spontaneous movement activities.

About This Domain

The Health and Physical Development domain focuses on children’s physical growth and motor development, sound nutritional choices, self-care and health/safety practices. Healthy children who are able to move and play are ready to learn more effectively in all domains.


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Physical Health & Growth


HPD Goal-1: Children develop healthy eating habits.

Demonstrate willingness to try new healthy foods and make nutritious eating choices independently and with support.

Regulate food consumption based on their own feelings of hunger and fullness

Given a selection of familiar foods, identify which foods are nutritious and which are not.

Talk about variety and serving size of foods needed to be healthy, naming some foods and beverages that help to build healthy bodies.

HPD Goal-2: Children engage in active physical play indoors and outdoors.

Communicate ways exercise keeps us healthy and makes us feel good.

Participate in structured and unstructured motor activities that build strength, speed, flexibility, and coordination (red light, green light; chase; free play).

Transition independently from active to quiet activities most of the time.

Develop strength and stamina by increasing their amount of play and activity, using more muscles for longer periods of time.

HPD Goal-3: Children develop healthy sleeping habits.

Communicate ways sleep keeps us healthy and makes us feel good.

Independently start and participate in sleep routines most of the time, including listening to calming songs and/or stories.

Stay awake and alert except during voluntary nap time.


Suggestions for Enriching The Environment
  • For young children who need help eating and drinking, offer support, proper positioning, special equipment, and many chances to practice eating and drinking.
  • Offer cups and spoons. Encourage children to feed themselves when they are ready.
  • Give children a safe and comfortable place to sleep.
  • Ensure infants’ safety by always placing infants on their backs to sleep in cribs that meet current safety standards set by the Consumer Product Safety Commission.
  • Avoid putting blankets, bumper pads, and materials other than the child in cribs. Instead, place children in “sleep sacks” or warm pajamas.
  • Provide areas for children to rest that accommodate individual sleep needs and individual nap schedules to meet their needs.
  • Allow and encourage children to serve and clean up food. Provide materials for pretend play about shopping, cooking, serving, eating, and cleaning up, such as examples of nutritious foods in the dramatic play area, including plastic fruits and vegetables or empty food boxes.
Effective Strategies to Support Children's Development and Learning
  • Promote and support breastfeeding for young children. Provide storage for breast milk, private areas for nursing mothers, and education about the benefits of breastfeeding for both mother and infant. Feed iron-fortified formula to infants who are not breastfed.
  • When an infant shows early signs of hunger (e.g., beginning to stir when sleeping), begin preparing food or milk so it is ready when the child is ready to eat.
  • Hold and talk with infants during feeding and allow enough time for them to finish bottles or food.
  • Offer types, sizes, and textures of food that each infant or toddler can eat safely and successfully. Work with families, dietitians, and health care professionals to offer the breast milk, formula, foods, and other forms of nutrition appropriate for children with special nutritional needs.
  • Allow children to leave food uneaten. Do not force them to eat more than they want. They may be full.
  • Allow enough time for young children to explore foods with their fingers and to eat.
  • Provide a relaxed atmosphere for meals and snacks. Sit with children and join in eating healthy foods (fruits, vegetables, whole grains, dairy products, and protein).
  • Model appropriate mealtime behaviors. Talk about foods and how they help the body. (“Milk helps make your bones and teeth strong.”)
  • Prepare healthy snacks and meals with children. Expose children to a wide variety of nutritious foods, including foods from their own and other cultures and that show respect families’ cultural, religious, and other preferences.
  • Offer new foods to help them get used to new tastes and textures. According to, you may need to offer new foods 10-15 times.
  • Talk with children about which foods are healthy choices and which foods are not healthy.
  • Give children opportunities during snacks and meals to practice pouring, using utensils, and serving themselves food.
  • Reward positive behavior with attention, not with sweets or other food. Instead celebrate with praise, smiles, and excitement.
  • Some children are highly sensitive to light, noise, and the way they are touched. Provide spaces that offer less stimulation so they can feel calm and comfortable. Work with families and specialists to offer appropriate physical activity for these children.
  • Ask families to share the sleep routine used at home and use it in the children’s environment if appropriate (rock the child to sleep, let them hold a special toy). Learn and say the words families use to tell someone they are tired. Use these words and teach children to use them to tell you they are tired.
  • Help children learn to calm themselves and fall asleep. For infants, consider playing soft music, lowering the lights, and quieting the environment. For older children who choose their own sleep positions, rubbing their back may help them relax and fall asleep.
  • Model and discuss healthy eating habits and provide a variety of nutritious snacks and meals.
  • Develop a routine for eating regular meals and snacks.
  • Provide activities that encourage children to explore a variety of foods, textures, and use of utensils.
  • Invite and encourage children to participate in physical activity and free play every day. Schedule several periods of active physical play each day, with each period lasting thirty to sixty minutes for preschool age children. Include time for child-directed play and adult-directed activities, and participate with children in the activities.
  • Share information about programs or activities in the community that encourage physical activity for all families, including children with special needs. Programs and activities might include parks, greenways, playgrounds, swimming pools, lakes, and gyms.
  • Take children outside often and regularly in all seasons. Dress them appropriately for the weather (raincoats, sweaters, boots, mittens, coats, and hats, using sunscreen as needed). Show children you enjoy being outdoors and encourage them to explore the outdoor environment.
  • Read books with children about healthy practices. Discuss the concepts of rest, exercise, and good eating related to good health.
  • Encourage and support children’s needs for rest and relaxation by scheduling both active and quiet times during the day.
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Motor Development


HPD Goal-4: Children engage in play and movement to develop the large muscle control and abilities needed to explore and move in their environment.

Demonstrate stability, flexibility, and balance while performing complex movements by standing on one foot, turning, stretching, bending, hopping, balancing on beams, jumping, and moving to music.

Demonstrate more coordination of upper and lower body when, throwing, catching, kicking, bouncing objects, swinging, and hitting objects with racquets or paddles.

Move quickly through the environment and be able to both change directions and stop (run fast, pedal fast).

Show awareness of own body in relation to other people and objects while moving through space. When asked, can move in front of, beside, or behind someone or something else.

Participate in play and movement activities and describe how physical activity contributes to their overall health (“Exercise helps make me strong!”).

HPD Goal-5: Children engage in play and experiences to develop muscle control and hand-eye coordination to manipulate objects and work with tools.

Engage in complex hand-eye coordination activities and play with a moderate degree of precision and control (fasten clothing, cut shapes, put together small pieces, string beads).

Display strength and control while using a variety of tools and materials including scissors, pencils, crayons, small toys, spray bottles, and hole punchers.

Draw and write figures with more detail (faces with features, letters, or letter-like forms).

Participate in self-help skills, such as buttoning, zipping, snapping and pouring.


Suggestions for Enriching The Environment
  • Provide children with large, safe areas to move and play in, both indoors and outdoors if possible.
  • Put small, safe objects on a tray or protected spot on the floor for children to grab and handle. For example, offer rattles and teething toys for infants. Provide blocks, crayons, and snap-together toys for older toddlers. For children with impaired vision, use toys with switches and varied textures. Increase contrasts to help them see materials (bright toy on black background; pictures outlined with heavy line).
  • Provide pillows, small mounds, balance beams, steppingstones, and other low barriers for children to climb on and crawl over. This develops balance, builds strength, and improves coordination.
  • Create an environment that includes materials and equipment that can be used by children with varying physical abilities. For children with disabilities, provide supports or special equipment that allows them to participate in physical activities and play (therapeutic walker, scooter board, supportive seating for swings or riding toys, bars for pulling up).
  • Create mazes and obstacle courses that are age appropriate. For example, invite children to move through tunnels, under chairs, around tree trunks, and over low hills.
  • Provide push and pull toys, riding toys (with and without pedals), balls, tools, slides, and other materials that give children chances to exercise large muscles and practice skills.
  • Offer children toys and materials to fill, stack, dump, and pour, such as small blocks, buckets, plastic cups, and water. Provide options for children with different abilities. For example, include play dough, puzzles with and without knobs, empty boxes, and containers with lids. Be sure to stock manipulative centers with containers into which objects can be placed.
  • Provide child-size tables and chairs so children can use them independently.
  • Change materials routinely to encourage discovery, engagement, and participation.
  • Set up the environment so children can choose activities that develop strength, endurance, coordination, and other gross motor skills. Include activities such as jumping, hopping, and throwing.
  • Provide safe tricycles and other safe wheeled vehicles for children to ride.
  • Play music with different beats and from different cultures. Encourage children to move to the rhythm of the music. March and dance to the music.
  • Set up the environment so children can choose activities that develop fine motor skills. Set up tables with puzzles, pegboards, large beads for stringing, and small blocks such as Duplo’s.
  • Add dress up clothes, dolls, and doll clothes to the dramatic play area where children can practice buttoning, zipping, and snapping.
  • Set up an art area where children have the opportunity to use crayons, washable markers, chalk, paintbrushes of various sizes, scissors, and other art materials.
  • Set up a writing area with various kinds of paper, pencils, markers, and other writing tools.
Effective Strategies to Support Children's Development and Learning
  • Play with infants on their tummies frequently throughout the day. Place interesting toys in front of them and use a rolled towel to support a baby’s chest and arms if needed. For babies who do not like being on their stomachs, try a few minutes of tummy time several times a day rather than for one long period.
  • Use diapering time to do baby exercises and to play (bicycling legs, arm lifts, kicking, reaching).
  • Give young children brightly colored and interesting toys to reach for or move toward (balls, mobiles, soft toys). Encourage them to bring their hands together as they play with objects.
  • Play games from different cultures that include hand motions with words, such as “Pat-a-cake,” “Todos Los Pescados,” and “Itsy Bitsy Spider.”
  • Offer materials and activities to encourage large sweeping motions and the ability to hold objects. For example, children might draw or paint with crayons, finger paints, or objects like rubber stamps and small-wheeled vehicles. Use wide brushes or markers; adapt handles for children with limited hand control.
  • Run, jump, skip, hop, and throw balls with children, both indoors and outside. Encourage them to move their bodies indoors and outdoors with movement games, music, and dancing from different cultures (“I’m a Little Teapot,” “Little Sally Walker,” “De Colores,” “All Fish Swimming in the Water”).
  • Create activities to encourage children from different abilities to play and learn together. For example, play a game of catch with a foam ball with children sitting down on the floor or ground. Include children who cannot walk with other children in the group.
  • Plan activities that use a variety of materials to support fine motor skill development, with adaptations as needed, respecting culture and differing ability levels (paper, pencils, crayons, safety scissors, play dough, manipulatives, blocks, etc.).
  • Provide daily opportunities for children to use handheld tools and objects.
  • Provide a variety of materials, such as beads and snap cubes, for children to put together and pull apart.
  • Provide many opportunities for and actively participate in children’s outdoor play.
  • Encourage children to take part in active play every day, such as climbing, running, hopping, rhythmic movement, dance, and movement to music and games.
  • Supervise and participate in daily outdoor play. Provide adequate space and age-appropriate equipment and materials, with adaptations as needed.
  • Plan daily physical activities that are vigorous as well as developmentally and individually appropriate.
  • Create activities that encourage children with different abilities to play and learn together. For example, play a game of catch with a foam ball with children sitting down on the floor or ground. Include children who cannot walk with other children in the group.
  • Take walks with children, varying pace and distance.
  • Provide opportunities for non-competitive games and daily movement activities to allow children to practice motor skills repeatedly over a period of time.
  • Encourage children to walk on balance beams, sidewalk cracks, and chalk lines on the ground both forward and backwards.
  • Ask children to try standing on one foot for 5 seconds.
  • Encourage children to stretch, bend, twist, and turn while keeping their feet in place.
  • Give children opportunities to practice each skill in a variety of ways, such as throwing and kicking balls, beanbags, and other objects of different shapes, weights, and sizes.
  • Provide opportunities for children to practice hitting balls with paddles, plastic bats, or racquets. Begin by having a stationary target, such as a large ball on the ground, gradually working up to a moving target.
  • Provide opportunities for children to practice crossing the midline, including patting shoulders with opposite hands, crossing feet, reaching hand over head and touching opposite ear, and clapping games with partners.
  • Encourage children to try new types of movement, such as skipping. Give them verbal cues, including “lift your knees,” “hop and land on one foot,” and “hop and land on the other foot.”
  • Encourage children to dress, button, snap, and zipper themselves.
  • Provide activities that help children increase strength, such as putting old safety scissors and rolling pins at the playdough table.
  • Do finger plays with children such as “Where is Thumbkin” and “Five Little Ducks.”
  • Work with children on effective ways to hold a pencil and scissors and provide many opportunities for meaningful and enjoyable writing and art experiences.
  • Integrate physical activities throughout the curriculum, including the arts, literacy, math, and science.
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Self-Care, Safety and Well Being


HPD Goal-6: Children develop personal hygiene and selfcare skills.

Dress and undress themselves independently.

Independently practice personal care and self-help skills, including washing hands, brushing teeth, toileting, flushing, throwing tissues away.

Help with meal and snack preparation.

Describe the value of good health practices to their well-being (wash hands to get rid of germs, drink milk to build strong bones).

HPD Goal-7: Children use safe behaviors and personal safety practices with support from adults.

Identify, avoid, and alert other children to potentially dangerous behaviors, such as keeping a safe distance from swings.

Consistently recognize and avoid people, objects, substances, activities, and environments that might cause harm.

With support, show how to respond safely in emergency situations, such as fire or tornado, and in the presence of strangers or dangerous objects. Recognize basic safety symbols, such as poison symbols.

Know how and when to alert adults to dangerous situations or in an emergency, including in public places, such as a store, identifying people who may be able to help them.


Suggestions for Enriching the Environment
  • Provide a safe environment indoors and outdoors so children can explore without hurting themselves or others. Help families learn about how to provide safe environments at home.
  • Provide a safe, healthy, supportive environment with appropriate supervision.
  • Understand and respond appropriately to signs of child abuse and neglect.
  • Maintain environments that support children’s ability to carry out self-care and hygiene routines independently (step-stool, child-size sink, toilet, coat rack, toothbrushes, etc.).
  • Give children plenty of time and space to complete routine self-care tasks, such as hand washing, brushing teeth, toileting, dressing to go outside, and eating.
  • Provide opportunities for children to take on pretend roles of health care and safety occupations (doctor, nurse, firefighter, police officer) to help children understand and feel more comfortable with these professionals.
  • Use routine care as opportunities for one-on-one interactions; talk about the routine and feelings; sing a song; move legs and arms of young infants.
  • Hold, cuddle, make eye contact, and talk with young children to build trust.
  • Provide children many opportunities to use the toilet when they show they are ready. Support all attempts to use the toilet. Coordinate the timing and process of toilet learning with the family.
  • Stay near infants and toddlers at all times and watch to keep them safe.
  • Do not try to make infants or toddlers do things they are afraid to do. Help them learn to trust their feelings about what is safe and what is not safe.
  • Continue to supervise older toddlers closely. They are beginning to develop self-control, but it is easy for them to get excited and forget what is dangerous.
  • Model safe practices for children. (Don’t stand on chairs or sit on shelves.) Explain why and how unsafe actions can hurt them and others.
  • Repeat safety messages every time they are needed. Understand that you may have to repeat them many times. (“Please put your feet on the ground. Chairs are for sitting.”)
Effective Strategies to Support Children's Development and Learning
  • Respond quickly and consistently when children tell you they need something. Learn to read their cues, cries, and gestures. Ask family members how and when children may communicate certain needs.
  • Establish regular routines for diapering, toileting, hand washing, eating, sleeping, and dressing children. Do things the same way every time as much as possible.
  • Give specific praise for remembering safety messages and safe behaviors. (“Thank you for waiting for me.” “That’s good. You’re sitting in your chair.”)
  • Use play to reinforce safety messages and practice responding to dangerous situations. (“Let’s pretend the fire alarm went off. What should we do?”)
  • Establish routines of hand-washing at appropriate times (e.g., before and after meals, after outdoor play, etc.) and provide guidance for children to learn how to wash their hands appropriately. Provide hand-washing stations that children can reach safely on their own.
  • Encourage children to practice cleansing their mouths and brushing their teeth. Model tooth brushing for older toddlers and preschoolers. Provide stations for tooth brushing that children can reach safely on their own.
  • Encourage children to take an active part in dressing themselves. Suggest a step the child can complete. (“Put your foot in your pant leg.” “Pull up your pants.” “Pull your arm out of your sleeve.”)
  • Allow plenty of time for children to try and participate in self-care tasks.
  • Ask families and healthcare professionals if a child has special self-care needs. Help children understand and participate in these special self-care tasks. Use picture cards to guide them through the steps of self-care routines like hand washing.
  • Provide adaptive equipment for children as needed.
  • Learn about the abilities and customs of children and their families. Set up routines so children can do them
  • Teach and model hygienic practices (e.g. sneezing or coughing into your elbow or sleeve).
  • Use interesting and entertaining ways to practice personal care and self-help skills (e.g., add baby doll outfits and clothing with fasteners to the dramatic play center, provide props that encourage children to practice hygienic practices such as washing their hands).
  • Encourage children to show independence in self-care practices. Provide time, support, and equipment as needed.
  • Offer children play food and kitchen utensils from many cultures, especially the cultures of families in your group. Offer toys and props to practice self-care behaviors (healthy play food, dress-up clothes that are easy to put on, tubs to wash baby dolls).
  • Read books about visits with the doctor and the dentist. Offer play props so children can pretend to visit them.
  • Teach children about the benefits of good personal health practices. Make sure to take into account individual family beliefs and customs.
  • Teach safety rules and model safe practices (e.g., bus safety, indoor and outdoor play safety, staying with the group, safe use of materials, and knowing personal identification information).
  • Teach and model appropriate responses to potentially dangerous situations, including fire, violent weather, and strangers or other individuals who may cause harm.
  • Repeat safety messages every time they are needed. Understand that you may have to repeat them many times. (“It isn’t safe to run outside without an adult.”)