Well-Child Checkup: 4 Years

Even if your child is healthy, keep taking them for yearly checkups. This helps protect your child's health with scheduled vaccines and health screenings. Your child's doctor can make sure your child's growth and development is progressing well. A check-up is a great time to ask any questions about your child's emotional and physical development. Bring a list of your questions to the appointment. The doctor can address all of your concerns.

This sheet describes some of what you can expect.

The doctor will ask questions and observe your child's behavior to get an idea of their development. By this visit, most children:

• Will comfort others who are hurt or sad, like hugging a crying friend.
• Like to be a "helper."
• Can talk about at least one thing that happened during their day.
• Can tell what comes next in a well-known story.
• Can name a few colors of items.
• Say sentences of four or more words.
• Hold crayons or pencils between fingers and thumb (not a fist).
• Can draw a person with three or more body parts.
• Can catch a large ball most of the time.
• Can unbutton some buttons.

The doctor 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. Or you may want to talk about helping your child prepare for kindergarten. The doctor 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? Do they join 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 kids? What are they 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 do they react when you leave? Some anxiety is normal. This should get better over time as your child becomes more independent.

Healthy eating and activity are two 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. This could be 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 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 junk foods should only be eaten 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. Your child might still be hungry after a meal. You can offer more vegetables or fruit. It's okay to put limits on how much your child eats.
• Encourage at least 3 hours of 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 doctor 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 doctor about 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.
• Encourage good sleep habits. For preschool-age children, ages 3 to 5, 13 hours of sleep are recommended in a 24-hour period. Create a quiet, calm bedtime routine.

Advice to keep your child safe includes:

• When your child is riding a bike, have them wear a helmet with the strap fastened. While your child is 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 doctor if there are state laws about car seat use that you need to follow.
• When 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 age 13 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. Never leave your child unattended near any body of water.
• If you have a swimming pool, check that it's 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 without adult supervision. This is important even if they know how to swim.
• Teach your child to stay away from strange dogs, cats, and other animals. 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 30 minutes before going outdoors. Use sunscreen with an SPF of 15 to 50. Put it on your child's skin that isn't covered by clothing.
• If it's necessary to keep a gun in your home, store it unloaded and locked. Keep ammunition stored and locked in a separate location.
• 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. And teach them that no one should ask to see or touch their private parts. And no one should ask for help with an adult's or other child's private parts. If a doctor has to examine these parts of the body, be present.
• Teach your child it is okay 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.

At this visit your child may get vaccines, such as:

• Diphtheria, tetanus, and pertussis.
• Flu (influenza) every year.
• Measles, mumps, and rubella.
• Polio.
• Chickenpox (varicella).
• COVID-19.

Ask your child's doctor which vaccines are advised at this visit.

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 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 rewards 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, explain why the action is not okay. 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 five nice things to your child every day. Then do it!