Your Child's Checkup: 4 Yearsenparentshttps://kidshealth.org/EN/images/headers/P-YCC-4Years-enHD.jpgFind out what this doctor's visit will involve and what your child might be doing by the fourth year.Your Child's Checkup: 4 Years, checkup, checkups, check up, check ups, check-up, check-ups, well-child visit, well-child visits, well visit, well visit, doctor's visit, doctor's visits, doctors visits, going to the doctor, development, physical exam, physical examination, routine exam, routine visit, routine examination, examination, examinations, your child's growth, milestone, milestones, what should my child be doing, preschooler, preschoolers, pre-schooler, pre-schoolers, going to preschool, starting preschool, 4-year-old, 4 year old, 4 years, 4 years old, 4, four-year-old, four year old, four years, four years old, turning 4, turning four, just turned four, kindergarten, kindergartener, kindergarden, kindergardener, kindergardner, kindergardin, getting ready for kindergarten, kindergarten prep, holding it, accidents, pees his pants, pees her pants, poops his pants, poops her pants, wets the bed, bedwetter, bedwetting, bed wetter, bed wetting, wetting the bed, peeing the bed, tell a story, hop on one foot, hop, hops, hopping, walk up stairs, walk down stairs, know colors, identify colors, throw a ball overhand, throw a ball, booster, booster seat, booster seats, reading, writing, drawing, abcs, alphabet, numbers, counting, coloring, CD1Primary Care08/16/200601/29/201901/29/2019Mary L. Gavin, MD07/14/2017d5836279-3ae0-4302-b63b-5be44c5c368ahttps://kidshealth.org/ws/RadyChildrens/en/parents/checkup-4yrs.html/<h3>What to Expect During This Visit</h3> <p>Your doctor and/or nurse will probably:</p> <p><strong>1.</strong> Check your child's <strong>weight and height,</strong> calculate <strong><a href="https://kidshealth.org/ws/RadyChildrens/en/parents/bmi-charts.html/">body mass index (BMI)</a></strong>, and plot the measurements on the <a href="https://kidshealth.org/ws/RadyChildrens/en/parents/growth-charts.html/">growth charts</a>.</p> <p><strong>2.</strong> Check your child's <strong>blood pressure, <a href="https://kidshealth.org/ws/RadyChildrens/en/parents/vision.html/">vision</a>, and <a href="https://kidshealth.org/ws/RadyChildrens/en/parents/hear.html/">hearing</a></strong> using standard testing equipment.</p> <p><strong>3. Ask questions, address concerns, and offer advice</strong> about how your child is:</p> <p><strong><a href="https://kidshealth.org/ws/RadyChildrens/en/parents/feed-preschooler.html/">Eating</a>.</strong> Schedule three meals and two nutritious <a href="https://kidshealth.org/ws/RadyChildrens/en/parents/preschool-snacks.html/">snacks</a> 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&nbsp;to give new foods a try, but don't force them to eat them.</p> <p><strong>Peeing and pooping.</strong> By 4 years old, most kids are using the toilet. But many preschoolers who are <a href="https://kidshealth.org/ws/RadyChildrens/en/parents/toilet-teaching.html/">potty trained</a> 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.</p> <p><strong>Sleeping.</strong> <a href="https://kidshealth.org/ws/RadyChildrens/en/parents/sleep-preschool.html/">Preschoolers sleep</a> about 10&ndash;13 hours a day. Many 4-year-olds have given up their afternoon nap, but be sure to schedule some quiet time during the day.</p> <p><strong>Developing.</strong> By 4 years, it's common for many kids to:</p> <ul> <li>be completely understood by strangers</li> <li>know their first and last name and gender</li> <li>relate events or tell a story</li> <li>hop on one foot</li> <li>walk up stairs, alternating feet</li> <li>identify some colors and numbers</li> <li>enjoy playing with other children</li> </ul> <p><strong>4. Do a physical exam</strong> 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 <a href="https://kidshealth.org/ws/RadyChildrens/en/parents/comm-4-to-5.html/">speech and language</a> development.</p> <p><strong>5. Update immunizations.</strong> <a href="https://kidshealth.org/ws/RadyChildrens/en/parents/vaccine.html/">Immunizations</a> can protect kids from serious childhood illnesses, so it's important that your child get them on time. <a href="https://kidshealth.org/ws/RadyChildrens/en/parents/immunization-chart.html/">Immunization schedules</a> can vary from office to office, so talk to your doctor about what to expect.</p> <p><strong>6. Order tests.</strong> Your doctor may assess your child's risk for <a href="https://kidshealth.org/ws/RadyChildrens/en/parents/anemia.html/">anemia</a>, <a class="kh_anchor">lead</a>, high <a href="https://kidshealth.org/ws/RadyChildrens/en/parents/cholesterol.html/">cholesterol</a>, and <a href="https://kidshealth.org/ws/RadyChildrens/en/parents/tuberculosis.html/">tuberculosis</a> and order tests, if needed.</p> <h3>Looking Ahead</h3> <p>Here are some things to keep in mind until your child's next checkup at <a href="https://kidshealth.org/ws/RadyChildrens/en/parents/checkup-5yrs.html/">5 years</a>:</p> <h4>Eating</h4> <ol class="kh_longline_list"> <li>Make time to <strong><a class="kh_anchor">eat together</a></strong> as a family most nights of the week.</li> <li>Serve a <strong>variety of healthy foods</strong>, including lean meats, fish, fruits, vegetables, and whole grains.</li> <li>Preschoolers should get 2.5 cups (600 ml) of <strong><a href="https://kidshealth.org/ws/RadyChildrens/en/parents/calcium.html/">low-fat milk</a></strong> (or equivalent low-fat dairy products) daily. You can also give a <strong>fortified milk substitute</strong> like soy or almond milk.</li> <li><strong><a class="kh_anchor">Limit juice</a></strong> to no more than 4&ndash;6 ounces (120&ndash;180 ml) a day.</li> </ol> <h4>Routine Care</h4> <ol class="kh_longline_list"> <li>Let your child be <strong>active</strong> every day while under adult supervision. Be active as a family.</li> <li>Limit <strong><a href="https://kidshealth.org/ws/RadyChildrens/en/parents/tv-habits.html/">screen time</a></strong> (TV shows, DVDs, smartphones, video games, tablets, and computers) to no more than 1 hour a day of quality children's programming. Keep TVs and devices out of your child's bedroom.</li> <li>If your child doesn't go to <strong>preschool</strong>, look for opportunities for playing and interacting with other kids.</li> <li>To help prepare your child for <strong>kindergarten</strong>: <ul> <li>Keep <strong>consistent daily routines</strong> and times for meals, snacks, playing, reading, cleaning up, waking up, and going to bed.</li> <li>Practice <strong>counting numbers</strong> and singing the <strong>ABCs</strong>, along with other songs and rhymes.</li> <li><strong><a href="https://kidshealth.org/ws/RadyChildrens/en/parents/reading-preschool.html/">Read</a></strong> to your child every day.</li> <li>Encourage drawing, coloring, and recognizing and writing letters.</li> <li>Allow your child to take some responsibility for <strong>self-care</strong>, including going to the bathroom, <a href="https://kidshealth.org/ws/RadyChildrens/en/parents/hand-washing.html/">washing hands</a>, brushing teeth, and getting dressed. Offer reminders and help when needed.</li> <li>Teach your child your home address and phone number.</li> </ul> </li> <li>Have your child <strong><a href="https://kidshealth.org/ws/RadyChildrens/en/parents/healthy.html/">brush teeth</a></strong> twice a day with a pea-sized amount of fluoride toothpaste. Schedule regular <strong>dental checkups</strong> as recommended by your child's dentist.</li> </ol> <h4>Safety</h4> <ol class="kh_longline_list"> <li>Supervise your child outdoors, especially when playing <strong><a href="https://kidshealth.org/ws/RadyChildrens/en/parents/water-safety.html/">around water</a></strong> and near streets. Consider enrolling your child in a swimming class.</li> <li>Make sure <strong><a href="https://kidshealth.org/ws/RadyChildrens/en/parents/playground.html/">playground</a></strong> 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).</li> <li><strong>Apply <a href="https://kidshealth.org/ws/RadyChildrens/en/parents/sun-safety.html/">sunscreen</a></strong> of SPF 30 or higher at least 15 minutes before your child goes outside to play and reapply about every 2 hours.</li> <li>Protect your child from&nbsp;<strong><a href="https://kidshealth.org/ws/RadyChildrens/en/parents/secondhand-smoke.html/">secondhand smoke</a></strong>, which increases the risk of heart and lung disease. Secondhand vapor from <a href="https://kidshealth.org/ws/RadyChildrens/en/parents/e-cigarettes.html/">e-cigarettes</a> is also harmful.</li> <li>Make sure your child always wears a <strong>helmet</strong> when <a href="https://kidshealth.org/ws/RadyChildrens/en/parents/bike-safety.html/">riding a tricycle or bicycle</a>.</li> <li>If your child is still in a <strong>rear-facing car seat</strong>, check the maximum weight and height limits recommended by the manufacturer. Turn the car seat around when your child is the right size. Kids should stay harnessed in the car seat until they reach the highest weight or height limit allowed by the seat's manufacturer. When your child has outgrown this seat, switch to a <strong>belt-positioning <a href="https://kidshealth.org/ws/RadyChildrens/en/parents/auto-prek-bigkid.html/">booster seat</a></strong> until your child is 4 feet 9 inches (150 cm) tall, usually between 8 and 12 years of age.</li> <li>Protect your child from <strong><a href="https://kidshealth.org/ws/RadyChildrens/en/parents/gun-safety.html/">gun injuries</a></strong> 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.</li> <li><strong>Discuss appropriate touch.</strong> Teach your child that some body parts are private and no one should see or touch them. Tell your child to come to you if anyone ever asks to look at or touch his or her private parts, if he or she is ever asked to look at or touch someone else's private parts, or is asked to keep a secret.</li> <li>Talk to your doctor if you're concerned about your <strong>living situation</strong>. Do you have the things that you need to take care of your child? Do you have enough food, a safe place to live, and <a href="https://kidshealth.org/ws/RadyChildrens/en/parents/buy-health-insurance.html/">health insurance</a>? Your doctor can tell you about community resources or refer you to a social worker.</li> </ol> <p><em>These checkup sheets are consistent with the American Academy of Pediatrics (AAP)/Bright Futures guidelines.</em></p>La revisión de su hijo cuando tenga 4 añosQué esperar durante esta visita.https://kidshealth.org/ws/RadyChildrens/es/parents/heckup-4yrs-esp.html/58d14279-dd8f-41bb-86a8-1cb85e2c06c6
Communication and Your 4- to 5-Year-OldCommunicating with our kids is one of the most pleasurable and rewarding parts of parenting. Learn how to connect with your 4- to 5-year-old.https://kidshealth.org/ws/RadyChildrens/en/parents/comm-4-to-5.html/5a5c23d9-ea63-4f44-892a-83b9f4a953a9
Fitness and Your 3- to 5-Year-OldTake advantage of your child's natural tendency to be active. Staying fit can help improve kids' self-esteem and decrease the risk of serious illnesses later in life.https://kidshealth.org/ws/RadyChildrens/en/parents/fitness-4-5.html/c3f96baa-8d0b-4d36-9c8a-bc78bb8c7e29
Growth and Your 4- to 5-Year-OldKids who are 4 to 5 years old continue to learn in a very physical way, but are more focused than when they were younger.https://kidshealth.org/ws/RadyChildrens/en/parents/growth-4-to-5.html/d37c04a2-41e6-438c-b62c-106b37c19cc5
Helping Your Child Adjust to PreschoolThe more comfortable you are with placing your child in preschool and the more familiar the setting is for your child, the fewer problems you - and your child - will encounter.https://kidshealth.org/ws/RadyChildrens/en/parents/adjust-to-preschool.html/7ba2b44e-946a-400f-8f2b-29175260f2e9
How Vaccines Help (Video)Vaccines help keep kids healthy, but many parents still have questions about them. Get answers here. https://kidshealth.org/ws/RadyChildrens/en/parents/vaccine-video.html/381d8b32-8c56-41c1-b6b5-247544dcac7e
Medical Care and Your 4- to 5-Year-OldRegular well-child exams are an important part of keeping kids healthy and up to date on immunizations against serious diseases. Find out what to expect at the doctor's office.https://kidshealth.org/ws/RadyChildrens/en/parents/medical-care-4-5.html/d4650ac4-8d08-418c-a203-c1971344715b
Raising a Fit PreschoolerPreschoolers have a lot of energy, and the physical skills and coordination to ride a tricycle or chase a butterfly.https://kidshealth.org/ws/RadyChildrens/en/parents/fit-preschooler.html/1d6c46e6-fa63-4a68-b7d4-536cf20b7144
Safe Exploring for PreschoolersKids ages 3-5 have tons of energy and are eager to walk, run, dance, and play. It's a great age for exploration too.https://kidshealth.org/ws/RadyChildrens/en/parents/preschool-explore.html/fe7d9003-85b5-475b-9af2-07a252dc2344
Strategies for Feeding a PreschoolerDuring the preschool years, kids are more willing to cooperate. So it's a great time to teach them about healthy food choices in new and exciting ways.https://kidshealth.org/ws/RadyChildrens/en/parents/feed-preschooler.html/eb5c52b6-bab5-4672-80c3-a2a226ed4073
Talking to Your Child's DoctorBuilding a relationship with your child's doctor requires communication and reasonable expectations.https://kidshealth.org/ws/RadyChildrens/en/parents/talk-doctor.html/27ae947a-1ed1-435e-ab95-61c84d7fde8d
Talking to Your Child's Preschool TeacherEnrolling your little one in preschool can be a time filled with many questions. Find out how to establish an open, clear channel of communication with your child's preschool teacher.https://kidshealth.org/ws/RadyChildrens/en/parents/talk-to-preschool-teacher.html/127a5a8a-a269-4fa5-b042-8897c5f3c23e
Your Child's CheckupsThese age-specific guides can help you be prepared for and keep track of your well-child visits.https://kidshealth.org/ws/RadyChildrens/en/parents/checkups.html/b9a0df04-49c9-43df-afb8-b8631c99c601
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