4 Year Well-Child Visit

• Feeding: Continue to offer 3 meals and 1-2 nutritious snacks each day. Your child should be eating what the rest of the family eats. You should decide what you’re going to serve, and your child should decide how much she wants to eat. Involve your child in meal planning and preparation. It’s important to share mealtimes as a family.
• Elimination: Most children are completely potty trained at this age, though some continue to have nighttime wetting. Continue to reinforce the importance of good hand washing.
• Sleep: Many children this age are afraid of the dark. Their active imaginations make nightmares common. Read bedtime stories and use a night-light to comfort them and help them feel safe.

Development:

• Motor Skills: At age 4, your child can dress herself (including doing buttons) with minimal supervision, but may occasionally have trouble with front and back. She can brush her own teeth, and can go up and down the stairs without holding the railing. She jumps and climbs well, throws a ball overhand, and uses scissors to cut out pictures.
• Communication/Socialization: Language at this age is easily understood, and your child is able to understand more complex thoughts such as “early in the morning or next year.” She will ask many questions, use complex sentences, and use past tense correctly. She is able to use the following sounds correctly: k, b, d, g, r, and will likely learn to use s, sh, and ch, during this year. The last sounds to be mastered are t, v, l, th, z, zh, and j; these sounds are typically perfected between ages 6 and 7.

Parenting: Discipline with love by using firm, consistent rules. Use only nonviolent discipline. The negativism that was prominent during ages 18 months to 3 years is replaced by a spirit of cooperation. Most 4 year olds want to please their parents by doing what their parents say. Generously praise your child for good behavior. Limit TV watching to less than 2 hours per day of good quality children’s entertainment.

Safety: Children this age have difficulty differentiating between reality and fantasy. They are beginning to know what actions might be dangerous, but close observation at all times is essential to keep your child safe.

• Continue to use a car safety seat. If you have a passenger side airbag, your child needs to remain in the back seat until age 12 years.
• Never leave your child alone in the car, home, tub, or yard.
• Teach safety around animals.
• Any guns in the home should be locked up with ammunition kept separately.
• Keep matches, lighters and cigarettes in a high, latched cabinet. Never allow smoking in your home or car.
• Keep the poison control phone number by your phone (1-800-222-1222).
• Talk with your child about strangers and explain “good touch vs. bad touch.”
• Make sure that your child knows her name, her parents’ names, home phone number including area code, and the emergency number (911).
• Use life jackets and helmets. Be a good example for all children.

Play: Reading remains one of the most important activities that you can share with your child. Children this age enjoy playing with their peers. They can play simple board games and do puzzles. They also enjoy art and craft activities as well as devising new games with new rules. Outdoor activities remain important, as do singing, dancing, and simple riddles.

Next visit is at 5 years of age. This is an exciting but difficult exam, as your child will have a “finger poke” to check hemoglobin and cholesterol as well as a number of immunizations. You may want to prepare your child a day in advance and bring along a favorite comfort object like a blanket. Tell them that you will be there to hold and comfort them but the injections are important to prevent them from getting ill. Some parents offer an incentive to completing the injections, “when we’re all done, we’ll go out for lunch or to the park,” for instance.