Pediatricians, like parents, are not supposed to admit favorites. However, if I’m completely honest, 4 years is my favorite age. Four year-olds are perfectly articulate, have wonderful imaginations, want to learn, say the funniest things, generally desire to please, and still accept what you say as fact.


  • Car: Use a Convertible Car Seat (the big, 5 point harness style seat) in the back seat of the vehicle.
    • Important Note: As of 11/2018, the American Academy of Pediatrics (AAP) recommends children stay in the most restrictive seat possible until they reach the highest weight or height allowed by their seat.
    • This means most 4 year-olds should stay in the 5 point harness seat this entire year (replacing the previously recommended 4 year and 40 lb. recommendation to move to a booster seat). If you have a very large child that no longer fits in the 5 point harness seat, transition to a backed booster seat that utilizes the seat belt for restraint.
  • Teach stranger safety. Identify who your child can consider a safe adult should he or she get lost.
  • Teach playground/street safety.
  • Smoking: Make sure your home and cars are smoke-free zones. Also, check smoke alarms to ensure that they work properly, and change batteries annually.
  • Water: Do not allow children to swim unattended. Use sunscreen.
  • Wear a helmet on all things a kid can ride (e.g., bicycles, tricycles, scooters, ATVs, as passengers on adult bicycles).
  • Guns: Guns must be unloaded and locked in a safe. (Disturbing Fact: More children are killed from guns every year than are intruders.)
  • Keep matches, cleaners, chemicals, and toxic household products out of reach. (TIP: Add poison control’s number to your phone’s contact list: 1-800-222-1222.)


  • Provide 3 meals and 2 nutritious snacks a day.
  • Limit the number of fats and sweets your child gets in a day. In addition, your child does not need juice, it is essentially fruit sugar. If you choose to give juice to your child, do so in limited quantities (e.g., 4 oz a day). There is no place for soft drinks/soda in a child’s diet.
  • You choose the menu. I am a firm believer in good nutrition at an early age to build good lifetime eating habits. Consider the fact that you are fueling your child’s growing brain. It is my opinion that we as a society are propagating this notion of “kid food” (e.g., mac n’ cheese, hot dogs, French fries, chicken nuggets). These “kid foods” have very little nutritional value. Instead, offer meats with good protein, fruits and vegetables with good vitamins, etc.
  • Dairy products should be low in fat; this includes all milk. (If your pediatrician is concerned about your child failing to thrive, he or she may direct you otherwise.) All members in a family over the age of 2 should be drinking low fat milk.
  • Eat meals together as a family, and turn OFF the television. Not only does eating together as a family develop good nutritional habits, it also has multiple lasting effects on the social support of a family.
  • Model good eating habits.
  • Keep in mind that it is very difficult to eat healthy when eating out (especially at fast food restaurants).

Oral Health

  • Continue to brush twice a day, and floss teeth once a day.
  • Schedule an appointment to see a dentist every 6 months.
  • Fluoride supplementation depends on the level of fluoride in the drinking water in the city where you live. (Your pediatrician or dentist can prescribe fluoride, if needed.)


  • Sings songs
  • Draws a person with at least 3 body parts (e.g., head, arms, legs, body)
  • Knows the difference between make-believe and reality
  • Knows first and last name
  • Jumps/hops on one foot
  • Rides a tricycle or bicycle with training wheels
  • Speaking in 4-5 word sentences, 100% understandable to a stranger
  • Understands how things work at home (e.g., money, food, appliances)


  • Media Exposure: Limit total media time (e.g., TV, movies, video games) to no more than 2 hours a day, ideally less than 1 hour. Watch programs together so you know what information your child is receiving.
  • Sexual Education: Expect normal curiosity. Use correct terms. Answer questions frankly. Teach that certain body parts are private.
  • Social Interactions: Praise good behavior. Encourage your child to talk about feelings and experiences. Provide structured learning (e.g., preschool).
  • Learning Experiences: Read together. Visit libraries, parks, museums. This is the age to get your child really excited about learning.