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Well Child Visit at 4 Years
A well child visit
is when your child sees a healthcare provider to prevent health problems. Well child visits are used to track your child's growth and development. It is also a time for you to ask questions and to get information on how to keep your child safe. Write down your questions so you remember to ask them. Your child should have regular well child visits from birth to 17 years.
Development milestones your child may reach by 4 years:
Each child develops at his or her own pace. Your child might have already reached the following milestones, or he or she may reach them later:
- Speak clearly and be understood easily
- Know his or her first and last name and gender, and talk about his or her interests
- Identify some colors and numbers, and draw a person who has at least 3 body parts
- Tell a story or tell someone about an event, and use the past tense
- Hop on one foot, and catch a bounced ball
- Enjoy playing with other children, and play board games
- Dress and undress himself or herself, and want privacy for getting dressed
- Control his or her bladder and bowels, with occasional accidents
Keep your child safe in the car:
- Always place your child in a booster car seat. Choose a seat that meets the Federal Motor Vehicle Safety Standard 213. Make sure the seat has a harness and clip. Also make sure that the harness and clips fit snugly against your child. There should be no more than a finger width of space between the strap and your child's chest. Ask your healthcare provider for more information on car safety seats.
- Always put your child's car seat in the back seat. Never put your child's car seat in the front. This will help prevent him or her from being injured in an accident.
Make your home safe for your child:
- Place guards over windows on the second floor or higher. This will prevent your child from falling out of the window. Keep furniture away from windows. Use cordless window shades, or get cords that do not have loops. You can also cut the loops. A child's head can fall through a looped cord, and the cord can become wrapped around his or her neck.
- Secure heavy or large items. This includes bookshelves, TVs, dressers, cabinets, and lamps. Make sure these items are held in place or nailed into the wall.
- Keep all medicines, car supplies, lawn supplies, and cleaning supplies out of your child's reach. Keep these items in a locked cabinet or closet. Call Poison Control (1-800-222-1222) if your child eats anything that could be harmful.
- Store and lock all guns and weapons. Make sure all guns are unloaded before you store them. Make sure your child cannot reach or find where weapons or bullets are kept. Never leave a loaded gun unattended.
Keep your child safe in the sun and near water:
- Always keep your child within reach near water. This includes any time you are near ponds, lakes, pools, the ocean, or the bathtub.
- Ask about swimming lessons for your child. At 4 years, your child may be ready for swimming lessons. He or she will need to be enrolled in lessons taught by a licensed instructor.
- Put sunscreen on your child. Ask your healthcare provider which sunscreen is safe for your child. Do not apply sunscreen to your child's eyes, mouth, or hands.
Other ways to keep your child safe:
- Follow directions on the medicine label when you give your child medicine. Ask your child's healthcare provider for directions if you do not know how to give the medicine. If your child misses a dose, do not double the next dose. Ask how to make up the missed dose.Do not give aspirin to children under 18 years of age. Your child could develop Reye syndrome if he takes aspirin. Reye syndrome can cause life-threatening brain and liver damage. Check your child's medicine labels for aspirin, salicylates, or oil of wintergreen.
- Talk to your child about personal safety without making him or her anxious. Teach him or her that no one has the right to touch his or her private parts. Also explain that others should not ask your child to touch their private parts. Let your child know that he or she should tell you even if he or she is told not to.
- Do not let your child play outdoors without supervision from an adult. Your child is not old enough to cross the street on his or her own. Do not let him or her play near the street. He or she could run or ride his or her bicycle into the street.
What you need to know about nutrition for your child:
- Give your child a variety of healthy foods. Healthy foods include fruits, vegetables, lean meats, and whole grains. Cut all foods into small pieces. Ask your healthcare provider how much of each type of food your child needs. The following are examples of healthy foods:
- Whole grains such as bread, hot or cold cereal, and cooked pasta or rice
- Protein from lean meats, chicken, fish, beans, or eggs
- Dairy such as whole milk, cheese, or yogurt
- Vegetables such as carrots, broccoli, or spinach
- Fruits such as strawberries, oranges, apples, or tomatoes
- Make sure your child gets enough calcium. Calcium is needed to build strong bones and teeth. Children need about 2 to 3 servings of dairy each day to get enough calcium. Good sources of calcium are low-fat dairy foods (milk, cheese, and yogurt). A serving of dairy is 8 ounces of milk or yogurt, or 1½ ounces of cheese. Other foods that contain calcium include tofu, kale, spinach, broccoli, almonds, and calcium-fortified orange juice. Ask your child's healthcare provider for more information about the serving sizes of these foods.
- Limit foods high in fat and sugar. These foods do not have the nutrients your child needs to be healthy. Food high in fat and sugar include snack foods (potato chips, candy, and other sweets), juice, fruit drinks, and soda. If your child eats these foods often, he or she may eat fewer healthy foods during meals. He or she may gain too much weight.
- Do not give your child foods that could cause him or her to choke. Examples include nuts, popcorn, and hard, raw vegetables. Cut round or hard foods into thin slices. Grapes and hotdogs are examples of round foods. Carrots are an example of hard foods.
- Give your child 3 meals and 2 to 3 snacks per day. Cut all food into small pieces. Examples of healthy snacks include applesauce, bananas, crackers, and cheese.
- Have your child eat with other family members. This gives your child the opportunity to watch and learn how others eat.
- Let your child decide how much to eat. Give your child small portions. Let your child have another serving if he or she asks for one. Your child will be very hungry on some days and want to eat more. For example, your child may want to eat more on days when he or she is more active. Your child may also eat more if he or she is going through a growth spurt. There may be days when he or she eats less than usual.
Keep your child's teeth healthy:
- Your child needs to brush his or her teeth with fluoride toothpaste 2 times each day. He or she also needs to floss 1 time each day. Have your child brush his or her teeth for at least 2 minutes. At 4 years, your child should be able to brush his or her teeth without help. Apply a small amount of toothpaste the size of a pea on the toothbrush. Make sure your child spits all of the toothpaste out. Your child does not need to rinse his or her mouth with water. The small amount of toothpaste that stays in his or her mouth can help prevent cavities.
- Take your child to the dentist regularly. A dentist can make sure your child's teeth and gums are developing properly. Your child may be given a fluoride treatment to prevent cavities. Ask your child's dentist how often he or she needs to visit.
Create routines for your child:
- Have your child take at least 1 nap each day. Plan the nap early enough in the day so your child is still tired at bedtime.
- Create a bedtime routine. This may include 1 hour of calm and quiet activities before bed. You can read to your child or listen to music. Have your child brush his or her teeth during his or her bedtime routine.
- Plan for family time. Start family traditions such as going for a walk, listening to music, or playing games. Do not watch TV during family time. Have your child play with other family members during family time.
Other ways to support your child:
- Do not punish your child with hitting, spanking, or yelling. Never shake your child. Tell your child "no." Give your child short and simple rules. Do not allow your child to hit, kick, or bite another person. Put your child in time-out in a safe place. You can distract your child with a new activity when he or she behaves badly. Make sure everyone who cares for your child disciplines him or her the same way.
- Read to your child. This will comfort your child and help his or her brain develop. Point to pictures as you read. This will help your child make connections between pictures and words. Have other family members or caregivers read to your child. At 4 years, your child may be able to read parts of some books to you. He or she may also enjoy reading quietly on his or her own.
- Help your child get ready to go to school. Your child's healthcare provider may help you create meal, play, and bedtime schedules. Your child will need to be able to follow a schedule before he or she can start school. You may also need to make sure your child can go to the bathroom on his or her own and wash his or her own hands.
- Talk with your child. Have him or her tell you about his or her day. Ask him or her what he or she did during the day, or if he or she played with a friend. Ask what he or she enjoyed most about the day. Have him or her tell you something he or she learned.
- Help your child learn outside of school. Take him or her to places that will help him or her learn and discover. For example, a children's museum will allow him or her to touch and play with objects as he or she learns. Your child may be ready to have his or her own library card. Let him or her choose his or her own books to check out from the library. Teach him or her to take care of the books and to return them when he or she is done.
- Talk to your child's healthcare provider about bedwetting. Bedwetting may happen up to the age of 4 years in girls and 5 years in boys. Talk to your child's healthcare provider if you have any concerns about this.
- Engage with your child if he or she watches TV. Do not let your child watch TV alone, if possible. You or another adult should watch with your child. Talk with your child about what he or she is watching. When TV time is done, try to apply what you and your child saw. For example, if your child saw someone talking about colors, have your child find objects that are those colors. TV time should never replace active playtime. Turn the TV off when your child plays. Do not let your child watch TV during meals or within 1 hour of bedtime.
- Limit your child's screen time. Screen time is the amount of television, computer, smart phone, and video game time your child has each day. It is important to limit screen time. This helps your child get enough sleep, physical activity, and social interaction each day. Your child's pediatrician can help you create a screen time plan. The daily limit is usually 1 hour for children 2 to 5 years. The daily limit is usually 2 hours for children 6 years or older. You can also set limits on the kinds of devices your child can use, and where he or she can use them. Keep the plan where your child and anyone who takes care of him or her can see it. Create a plan for each child in your family. You can also go to https://www.healthychildren.org/English/media/Pages/default.aspx#planview for more help creating a plan.
- Get a bicycle helmet for your child. Make sure your child always wears a helmet, even when he or she goes on short bicycle rides. He or she should also wear a helmet if he or she rides in a passenger seat on an adult bicycle. Make sure the helmet fits correctly. Do not buy a larger helmet for your child to grow into. Get one that fits him or her now. Ask your child's healthcare provider for more information on bicycle helmets.
What you need to know about your child's next well child visit:
Your child's healthcare provider will tell you when to bring him or her in again. The next well child visit is usually at 5 to 6 years. Contact your child's healthcare provider if you have questions or concerns about your child's health or care before the next visit. All children aged 3 to 5 years should have at least one vision screening. Your child may need vaccines at the next well child visit. Your provider will tell you which vaccines your child needs and when your child should get them.
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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.
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