Well Child Care, 4 Years Old

PHYSICAL DEVELOPMENT

Your 4-year-old should be able to hop on 1 foot, skip, alternate feet while walking down stairs, ride a tricycle, and dress with little assistance using zippers and buttons. Your 4-year-old should also be able to:

  • Brush their teeth.

  • Eat with a fork and spoon.

  • Throw a ball overhand and catch a ball.

  • Build a tower of 10 blocks.  

EMOTIONAL DEVELOPMENT

  • Your 4-year-old may: 

  • Have an imaginary friend.

  • Believe that dreams are real.

  • Be aggressive during group play.

Set and enforce behavioral limits and reinforce desired behaviors. Consider structured learning programs for your child like preschool or Head Start. Make sure to also read to your child. 

SOCIAL DEVELOPMENT

  • Your child should be able to play interactive games with others, share, and take turns. Provide play dates and other opportunities for your child to play with other children.

  • Your child will likely engage in pretend play.

  • Your child may ignore rules in a social game setting, unless they provide an advantage to the child.

  • Your child may be curious about, or touch their genitalia. Expect questions about the body and use correct terms when discussing the body.

MENTAL DEVELOPMENT

Your 4-year-old should know colors and recite a rhyme or sing a song. Your 4-year-old should also:

  • Have a fairly extensive vocabulary.

  • Speak clearly enough so others can understand.

  • Be able to draw a cross.

  • Be able to draw a picture of a person with at least 3 parts.

  • Be able to state their first and last names.

IMMUNIZATIONS

Before starting school, your child should have:

  • The fifth DTaP (diphtheria, tetanus, and pertussis-whooping cough) injection.

  • The fourth dose of the inactivated polio virus (IPV) .

  • The second MMR-V (measles, mumps, rubella, and varicella or "chickenpox") injection.

  • Annual influenza or "flu" vaccination is recommended during flu season.

Medicine may be given before the doctor visit, in the clinic, or as soon as you return home to help reduce the possibility of fever and discomfort with the DTaP injection. Only give over-the-counter or prescription medicines for pain, discomfort, or fever as directed by the child's caregiver.

TESTING

Hearing and vision should be tested. The child may be screened for anemia, lead poisoning, high cholesterol, and tuberculosis, depending upon risk factors. Discuss these tests and screenings with your child's doctor.

NUTRITION

  • Decreased appetite and food jags are common at this age. A food jag is a period of time when the child tends to focus on a limited number of foods and wants to eat the same thing over and over.

  • Avoid high fat, high salt, and high sugar choices.

  • Encourage low-fat milk and dairy products.

  • Limit juice to 4 to 6 ounces (120 mL to 180 mL) per day of a vitamin C containing juice.

  • Encourage conversation at mealtime to create a more social experience without focusing on a certain quantity of food to be consumed.

  • Avoid watching TV while eating.

ELIMINATION

The majority of 4-year-olds are able to be potty trained, but nighttime wetting may occasionally occur and is still considered normal.

SLEEP

  • Your child should sleep in their own bed.

  • Nightmares and night terrors are common. You should discuss these with your caregiver.

  • Reading before bedtime provides both a social bonding experience as well as a way to calm your child before bedtime. Create a regular bedtime routine.

  • Sleep disturbances may be related to family stress and should be discussed with your physician if they become frequent.

  • Encourage tooth brushing before bed and in the morning.

PARENTING TIPS

  • Try to balance the child's need for independence and the enforcement of social rules.

  • Your child should be given some chores to do around the house.

  • Allow your child to make choices and try to minimize telling the child "no" to everything.

  • There are many opinions about discipline. Choices should be humane, limited, and fair. You should discuss your options with your caregiver. You should try to correct or discipline your child in private. Provide clear boundaries and limits. Consequences of bad behavior should be discussed before hand.

  • Positive behaviors should be praised.

  • Minimize television time. Such passive activities take away from the child's opportunities to develop in conversation and social interaction.

SAFETY

  • Provide a tobacco-free and drug-free environment for your child.

  • Always put a helmet on your child when they are riding a bicycle or tricycle.

  • Use gates at the top of stairs to help prevent falls.

  • Continue to use a forward facing car seat until your child reaches the maximum weight or height for the seat.  After that, use a booster seat. Booster seats are needed until your child is 4 feet 9 inches (145 cm) tall and  between 8 and 12 years old.

  • Equip your home with smoke detectors.

  • Discuss fire escape plans with your child.

  • Keep medicines and poisons capped and out of reach.

  • If firearms are kept in the home, both guns and ammunition should be locked up separately.

  • Be careful with hot liquids ensuring that handles on the stove are turned inward rather than out over the edge of the stove to prevent your child from pulling on them. Keep knives away and out of reach of children.

  • Street and water safety should be discussed with your child. Use close adult supervision at all times when your child is playing near a street or body of water.

  • Tell your child not to go with a stranger or accept gifts or candy from a stranger. Encourage your child to tell you if someone touches them in an inappropriate way or place.

  • Tell your child that no adult should tell them to keep a secret from you and no adult should see or handle their private parts.

  • Warn your child about walking up on unfamiliar dogs, especially when dogs are eating.

  • Have your child wear sunscreen which protects against UV-A and UV-B rays and has an SPF of 15 or higher when out in the sun. Failure to use sunscreen can lead to more serious skin trouble later in life.

  • Show your child how to call your local emergency services (911 in U.S.) in case of an emergency.

  • Know the number to poison control in your area and keep it by the phone.

  • Consider how you can provide consent for emergency treatment if you are unavailable. You may want to discuss options with your caregiver.

WHAT'S NEXT?

Your next visit should be when your child is 5 years old.

This is a common time for parents to consider having additional children. Your child should be made aware of any plans concerning a new brother or sister. Special attention and care should be given to the 4-year-old child around the time of the new baby's arrival with special time devoted just to the child. Visitors should also be encouraged to focus some attention of the 4-year-old when visiting the new baby. Time should be spent defining what the 4-year-old's space is and what the newborn's space is before bringing home a new baby.