​Age: 4 Years

July 06, 2020

Four is one of the best ages in terms of kids. 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.

SAFETY

  1. Car: Use a Convertible Car Seat in the back seat of the vehicle

    1. 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.

    2. 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.

  2. Playgrounds: Teach playground/street safety.

  3. Strangers: Teach stranger safety. Identify who your child can consider a safe adult should he or she get lost.

  4. Hazards: Keep matches/lighters/chemicals/medications/cleaners/toxic household products out of reach or locked. (TIP: Add poison control’s number to your cell phone now 1-800-222-1222).

    1. Lock guns with ammunition separate and in a gun safe. (Disturbing fact: More children are killed from guns every year than intruders)

  5. Water:

    1. Do not leave children in the bathtub unattended.

    2. Do not allow children to swim unattended.

    3. Consider swim lessons.

  6. Smoking: Do not smoke in the home or in your car. Check smoke alarms to ensure they work properly and change batteries annually.

  7. Helmets: Wear a helmet on all things a kid can ride (e.g., bicycles, tricycles, scooters, ATVs, etc.).

  8. Sun: Use sunscreen when outside

NUTRITION

  1. Provide 3 meals and 2-3 nutritious snacks a day.

  2. Limit the number of fats and sweets your child gets in a day. In addition, you child does not need juice, it is essentially fruit sugar. If you choose to give it 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.

  3. You choose the menu. Offering good nutrition at an early age builds good lifetime eating habits. Consider the fact that you’re fueling your child’s growing brain. As a society, we are propagating this notion of “kid food” (e.g., mac n’ cheese, hot dogs, French fries, chicken nuggets). These have very little nutritional value. Offer a variety of foods rich in fruits and vegetables. Also try to include foods rich in protein.

  4. Dairy products should be low fat. This includes all milk (unless your child is failing to thrive and you are directed to do otherwise by your pediatrician). All members over the age of 2 in a family should be drinking low fat milk. Maximum amount is 24 oz/day. If your child isn’t a big milk drinker, just ensure your child is getting enough calcium and vitamin D from other sources (e.g., almond milk, dark leafy greens, milk products, supplements, etc.)

  5. Eat meals as a family (around a table with no media). Not only does eating together as a family develop good nutritional habits, it has multiple lasting effects on the social support of a family.

  6. Model good eating habits.

  7. Keep in mind it is very difficult to eat healthy when eating out (especially at fast food restaurants).

  8. Give a multivitamin daily only if your child is not eating a balanced diet.

SLEEP

Total sleep at night is usually 10-13 hours. Most 4 year-olds no longer need a nap during the day. Every child’s need for sleep is a little different. If your child is acting sleepy and grumpy by 4 or 5 in the afternoon, he or she may not be quite ready to eliminate the nap. If the child takes a nap, but then won’t go to sleep at night; it’s time to stop the nap. Most children are sleeping independently in a “big kid bed” at this age.

MILESTONES

  1. Sings songs

  2. Draws a person with at least 3 body parts (e.g., head, arms, legs, body)

  3. Knows the difference between make-believe and reality

  4. Knows first and last name

  5. Jumps/hops on one foot

  6. Rides a tricycle or bicycle with training wheels

  7. Speaking in 4-5 word sentences, 1,000+ words, 100% understandable

  8. Understands how things work at home (e.g., money, food, appliances)

  9. Walks up and down stairs alternating feet without support

ORAL HEALTH

  1. Continue to brush and floss teeth twice a day.

  2. Schedule an appointment to see a dentist every 6 months.

  3. Fluoride supplementation depends on the level of fluoride in the drinking water in the city where you live (your pediatrician or dentist can prescribe it if needed).

  4. Children often need help still to adequately brush teeth.

OTHER

  1. Media Exposure: Limit total media time (e.g., TV, movies, video games) to no more than 1 hour a day of high quality material. Watch programs together so you know what information your child is receiving.

  2. Sexual Education: Expect normal curiosity. Use correct terms. Answer questions frankly. Teach that certain body parts are private.

  3. Social Interactions: Praise good behavior. Encourage your child to talk about feelings and experiences. Provide structured learning (e.g., preschool). Children should play well with others at this age.

  4. Learning Experiences: Read together. Visit libraries, parks, museums. This is the age to get your child really excited about learning.

  5. School: Now is the time to consider your plans for school next year (neighborhood public school, charter, or private). If you are considering a charter school, lotteries happen December-February prior to an August start.

ILLNESS

Treat fever and minor illnesses at home as long as your child looks and acts ok. Bring your child to the doctor if: symptoms are severe or prolonged (e.g., fever beyond 5 days, bad cough, etc.), your child has signs of dehydration, your child reports specific symptoms (e.g., sore throat, hurt arm, etc.), your child has difficult or labored breathing, your child is lethargic, or you are concerned.

YOUR NEXT VISIT

Your child’s next well child check is at 5 years of age. The 5 year visit is the classic “kindgarten” visit. If you did not give vaccines today, your child will receive: DtaP (diphtheria, tetanus, and pertussis), IPV (inactivated polio), MMR (measles, mumps, and rubella), and varicella (chickenpox). Your child will also get a hemoglobin check (to ensure he or she is not anemic), if it wasn’t done today. Additionally, depending on the time of year, your child may also need a flu shot.

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