Well-Child Checkup: 4 Years
Even if your child is healthy, keep
taking them for yearly checkups. This helps make sure that your child’s health is
with scheduled vaccines and health screenings. Your child's healthcare provider can
sure your child’s growth and development is progressing well. A check-up is a great
have any questions answered about your child’s emotional and physical development.
list of your questions to the appointment so you can address all of your concerns.
This sheet describes some of what you
Development and milestones
The healthcare provider will ask
questions and observe your child’s behavior to get an idea of their development. By
visit, most children are doing these:
Comforts others who are hurt
or sad, like hugging a crying friend
- Likes to be a "helper"
Talks about at least 1 thing
that happened during their day
Tells what comes next in a
Names a few colors of
Says sentences of 4 or more
Holds crayon or pencil
between fingers and thumb (not a fist)
Draws a person with 3 or more
Catches a large ball most of
Unbuttons some buttons
School and social issues
The healthcare provider will ask
how your child is getting along with other kids. Talk about your child’s experience
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? Do they follow the routine and
take part in group activities? What do teachers or caregivers say about your
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
Play. How does your child like to play? For example, do
they play “make believe”? Does your child interact with others during
Independence. How is your child adjusting to school?
How do they 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
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
Encourage at least 3s hours physical activity through active
play each 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 no more than 1 hour each day. This
includes TVs, phones, tablets, video games, computers, and other devices. When
your child is using a screen, content should be of a children’s program with an
adult present. Don’t put any screens in your child’s bedroom. Children learn by
talking, playing, and interacting with others.
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
Have regular dental visits. Take your child to the
dentist at least twice a year for teeth cleaning and a checkup.
Advice to keep your child safe
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
their 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's 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 they know 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 at least 15 or up to 50 to your child's skin that aren't
covered by clothing.
- If it's necessary to keep a gun in your home, store it unloaded
- Use correct names for all body parts, and teach your child the
correct names of all body parts. Teach your child that no one should ask them to keep
secrets from their parents or caregivers, to see or touch their private parts, or
help with an adults or other child's private parts. If a healthcare professional has
to examine these parts of the body, be present.
- Teach your child it is OK to say "no" to touches that make them
uncomfortable. For example, if your child does not want to hug a family member or
friend, respect their decision to say “no” to this contact.
Based on recommendations from the
CDC, at this visit your child may get the following vaccines:
Diphtheria, tetanus, and
Flu (influenza) every
Measles, mumps, and
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
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
Pledge to say 5 nice things
to your child every day. Then do it!