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Well-Child Checkup: 4 Years

Woman putting helmet on preschooler boy on bike.
Bicycle safety equipment, such as a helmet, helps keep your child safe.

Even if your child is healthy, keep taking him or her for yearly checkups. This helps to make sure that your child’s health is protected with scheduled vaccines and health screenings. Your child's healthcare provider can make sure your child’s growth and development is progressing well. A check-up is a great time to have any questions answered about your child’s emotional and physical development. Bring a list of your questions to the appointment so you can address all of your concerns.

This sheet describes some of what you can expect.

Development and milestones

The healthcare provider will ask questions and observe your child’s behavior to get an idea of their development. By this visit, your child is likely doing some of the following:

  • Enjoys being with and helping other children

  • Talks about what he or she likes (for example, toys, games, people)

  • Tells a story or sings a song

  • Knows most colors and shapes

  • Says first and last name

  • Uses scissors

  • Draws a person with 2 to 4 body parts

  • Catches a ball that is bounced to them, most of the time

  • Stands briefly on one foot

School and social issues

The healthcare provider will ask how your child is getting along with other kids. Talk about your child’s experience in group settings such as preschool. If your child isn’t in preschool, you could talk instead about behavior at daycare or during play dates. You may also want to discuss preschool choices and how to help your child get ready for kindergarten. The healthcare provider may ask about:

  • Behavior and taking part in group settings. How does your child act at school or other group settings? Does he or she follow the routine and take part in group activities? What do teachers or caregivers say about your child’s behavior?

  • Behavior at home. How does your child act at home? Is behavior at home better or worse than at school? Be aware that it’s common for kids to be better behaved at school than at home.

  • Friendships. Has your child made friends with other children? What are the kids like? How does your child get along with these friends?

  • Play. How does your child like to play? For example, do they play “make believe”? Does your child interact with others during playtime?

  • Independence. How is your child adjusting to school? How does he or she react when you leave? Some anxiety is normal. This should get better over time, as your child becomes more independent.

Nutrition and exercise tips

Healthy eating and activity are 2 important keys to a healthy future. It’s not too early to start teaching your child healthy habits that will last a lifetime. Here are some things you can do:

  • Limit juice and sports drinks. These drinks—even pure fruit juice—have too much sugar. This leads to unhealthy weight gain and tooth decay. Water and low-fat or nonfat milk are best to drink. Limit juice to a small glass of 100% juice each day, such as during a meal.

  • Don’t serve soda. It’s healthiest not to let your child have soda. If you do allow soda, save it for very special occasions.

  • Offer healthy foods. Keep a variety of healthy foods on hand for snacks. These can include fresh fruits and vegetables, lean meats, and whole grains. Foods such as french fries, candy, and snack foods should only be served rarely.

  • Serve child-sized portions. Children don’t need as much food as adults. Serve your child portions that make sense for their age. Let your child stop eating when they are full. If your child is still hungry after a meal, offer more vegetables or fruit. It's OK to put limits on how much your child eats.

  • Encourage at least 30 to 60 minutes of active play per day. Moving around helps keep your child healthy. Bring your child to the park, ride bikes, or play active games like tag or ball.

  • Limit screen time to 1 hour each day. This includes TV watching, computer use, and video games.

  • Ask the healthcare provider about your child’s weight. At this age, your child should gain about 4 to 5 pounds each year. If they are gaining more than that, talk with the provider about healthy eating habits and activity guidelines.

  • Have regular dental visits. Take your child to the dentist at least twice a year for teeth cleaning and a checkup.

Safety tips

Advice to keep your child safe includes: 

  • When riding a bike, have your child wear a helmet with the strap fastened. While roller-skating or using a scooter or skateboard, it’s safest to wear wrist guards, elbow pads, knee pads, and a helmet.

  • Keep using a car seat until your child outgrows it. This is when your child's height or weight is more than the forward-facing limit for their car seat. Check your car seat owner’s manual for the specific height or weight. Ask the healthcare provider if there are state laws regarding car seat use that you need to know about.

  • Once your child outgrows the car seat, switch to a high-back booster seat. This allows the seat belt to fit correctly. A booster seat should be used until your child is 4 feet 9 inches tall and between 8 and 12 years of age. All children younger than 13 years old should sit in the back seat.

  • Teach your child not to talk to or go anywhere with a stranger.

  • Start to teach your child his or her phone number, address, and parents’ first names. These are important to know in an emergency.

  • Teach your child to swim. Many communities offer low-cost swimming lessons.

  • If you have a swimming pool, check that it is entirely fenced on all sides. Close and lock gates or doors leading to the pool. Don't let your child play in or around the pool alone, even if he or she knows how to swim.

  • Teach your child to stay away from strange dogs and cats. Never leave your child alone around animals.

  • Remember sun safety. Wear protective clothing. Try to stay out of the sun between 10 a.m. and 4 p.m. That's when the sun's rays are strongest. Apply sunscreen with an SPF of 15 or greater to your child's skin that aren't covered by clothing.

Vaccines

Based on recommendations from the CDC, at this visit your child may get the following vaccines:

  • Diphtheria, tetanus, and pertussis

  • Flu (influenza) every year

  • Measles, mumps, and rubella

  • Polio

  • Chickenpox (varicella)

Give your child positive reinforcement

It’s easy to tell a child what they’re doing wrong. It’s often harder to remember to praise a child for what they do right. Rewarding good behavior (positive reinforcement) helps your child gain confidence and a healthy self-esteem. Here are some tips:

  • Give your child praise and attention for behaving well. When appropriate, let the whole family know that the child has done well.

  • Reward good behavior with hugs, kisses, and small gifts such as stickers. When being good has rewards, kids will keep doing those behaviors to get the rewards. Don't use sweets or candy as rewards. Using these treats as positive reinforcement can lead to unhealthy eating habits and an emotional attachment to food.

  • When your child doesn’t act the way you want, don’t label them as bad or naughty. Instead, describe why the action is not acceptable. For example, say “It’s not nice to hit” instead of “You’re a bad girl.” When your child chooses the right behavior over the wrong one, such as walking away instead of hitting, remember to praise the good choice!

  • Pledge to say 5 nice things to your child every day. Then do it!

Online Medical Reviewer: Heather Trevino
Online Medical Reviewer: Liora C Adler MD
Online Medical Reviewer: Marianne Fraser MSN RN
Date Last Reviewed: 8/1/2020
© 2000-2020 The StayWell Company, LLC. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional's instructions.