Your Child’s Checkup: 4 Years

What to Expect During This Visit

Your doctor and/or nurse will probably:

1. Check your child’s weight and height, calculate body mass index (BMI), and plot the measurements on the growth charts.

2. Check your child’s blood pressure, vision, and hearing using standard testing equipment.

3. Ask questions, address concerns, and offer advice about how your child is:

Eating. Schedule three meals and two nutritious snacks a day. If you have a picky eater, keep offering a variety of healthy foods for your child to choose from. Kids should be encouraged to give new foods a try, but don’t force them to eat them.

Peeing and pooping. By 4 years old, most kids are using the toilet. But many preschoolers who are potty trained during the day are not able to stay dry all night. It’s also common for busy preschoolers to have an occasional daytime accident. Look for signs of “holding it” and encourage regular potty breaks. Talk to your doctor if your child is not yet potty trained or was previously trained and is now having problems.

Sleeping. Preschoolers sleep about 11–12 hours a day. Many 4-year-olds have given up their afternoon nap, but be sure to schedule some quiet time during the day.

Developing. By 4 years, it’s common for many children to:

• be completely understood by strangers
• know their first and last name and gender
• relate events or tell a story
• follow three-step commands
• hop on one foot
• walk up stairs, alternating feet
• catch a bounced ball most of the time
• identify some colors and numbers
• enjoy playing with other children

4. Perform a physical exam with your child undressed while you are present. This will include listening to the heart and lungs, observing motor skills, and talking to your child to assess speech and language development.

5. Update immunizations. Immunizations can protect kids from serious childhood illnesses, so it’s important that your child receive them on time. Immunization schedules can vary from office to office, so talk to your doctor about what to expect.

6. Order tests. Your doctor may assess your child’s risk for anemia, high cholesterol, and tuberculosis and order tests, if needed.

Looking Ahead

Here are some things to keep in mind until your child’s next routine visit at 5 years:

Eating

1. Make time to eat together as a family most nights of the week.
2. Serve a variety of foods, including lean meats, fruits, vegetables, and whole grains.
3. Preschoolers should get 2 cups (480 ml) of low-fat milk (or equivalent low-fat dairy products) daily.
4. Limit foods and drinks high in sugar and fat.
5. Limit juice to no more than 6 ounces (180 ml) a day.

Routine Care

1. Let your child be active every day while under adult supervision.
2. Limit screen time (spent on TV shows, DVDs, smartphones, video games, tablets, and computers) to no more than 1 to 2 hours a day of quality children’s programming.
3. If your child doesn’t go to preschool, look for opportunities for playing and interacting with other kids.
4. To help prepare your child for kindergarten:
   • Keep consistent daily routines and times for meals, snacks, playing, reading, cleaning up, waking up, and going to bed.
   • Practice counting numbers and singing the ABCs, along with other songs and rhymes.
   • Read to your child every day.
   • Encourage drawing, coloring, and recognizing and writing letters.
   • Allow your child to take responsibility for self-care, including going to the bathroom, washing hands, brushing teeth, and getting dressed. Offer reminders and help when needed.
   • Teach your child his or her address and phone number.
5. Have your child brush teeth twice a day with a pea-sized amount of fluoride toothpaste. Schedule regular dental checkups as recommended by your child’s dentist.

Safety

1. Supervise your child around water and when playing near streets. Consider enrolling your child in a swimming class.
2. Make sure playground equipment is well maintained and age-appropriate. Surfaces should be soft to absorb falls (sand, rubber mats, or a deep layer of wood or rubber chips).
3. Apply sunscreen of SPF 30 or higher on your child’s skin at least 15 minutes before going outside to play and reapply about every 2 hours.
4. Limit your child’s exposure to secondhand smoke, which increases the risk of heart and lung disease.
5. Make sure your child always wears a helmet when riding a tricycle or bicycle.
6. When your child has reached the highest weight or height limit allowed by the car-seat manufacturer, switch to a belt-positioning booster seat until your child is 4 feet 9 inches (150 cm) tall, usually between 8 and 12 years of age.
7. Protect your child from gun injuries by not keeping a gun in the home. If you do have a gun, keep it unloaded and locked away. Ammunition should be locked up separately. Make sure kids cannot access the keys.

These checkup sheets are consistent with the American Academy of Pediatrics (AAP)/Bright Futures guidelines.