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4 Years


Your child is old enough to receive “kindergarten” vaccines – boosters for DTaP, polio, MMR, and varicella.
We recommend annual flu shots in the fall/winter months as well.


Four year olds usually have a good appetite, though it may be less than usual some days, and that’s okay. Your child should usually eat neatly and without much help, but s/he may dawdle. Create a pleasant atmosphere at mealtimes by turning off the TV and having table conversation that includes your child. Be sure to provide a well-rounded diet including the four food groups: meat & protein (4 servings), milk & dairy (2 servings), fruits & veggies (4 or more servings), and bread & cereal (4 servings).


Teeth: Dental care is very important. You will need to continue assisting your child with brushing his/her teeth until s/he is in first grade or so. Limit juice, sweets, and candies. Establish regular care with a dentist if your child has not yet been to one.

Sleep: We still recommend a quiet time in the afternoon. Your child may rest, play quietly, or read. Spend some quality time with your child just before bedtime. Talk about the day or read a book. If your child awakens during the night, offer reassurance, but discourage your child from getting into bed with you.

Elimination:  Your child should be improving on toilet habits, though accidents may still happen. Bedwetting is still common at this age. For kids who have been dry at night, bedwetting may also recur during stressful times.


Children ages 3-6 are curious about differences between boys and girls. Be matter-of-fact and tell your child the proper names. (e.g. “Girls have a vagina and grow up to be mommies. Boys have a penis and grow up to be daddies.”)  Your child may pretend to be the opposite gender, and this is normal. By 7 to 8 years of age, children are generally happy and comfortable with their gender.



  • Your child should be restrained (5 point harness or booster seat, depending on your child’s size) at all times when in a moving vehicle.

  • Drowning is preventable – always watch your child around water!

  • If you own a gun, be sure it is ALWAYS unloaded and locked up with the safety on.

  • Review the plan of escape for the entire family in case of a fire. Test smoke detectors monthly.

  • Continue to teach street safety and stranger safety.

  • Children are curious! Keep matches, knives, and other dangerous items out of their reach.

  • Use SUNSCREEN daily and reapply frequently whenever your child is spending a lot of time outdoors.

  • Insist on the use of helmets when riding bicycles.  Be a good example!

  • Keep the poison control number near the phone.  1-800-222-1222




Being active is a healthy behavior to teach your child now by engaging in physical activity as a family.


  • skips

  • balances on 1 foot for several seconds

  • hops on one foot

  • builds a tower of 8 blocks

  • copies a cross and draws a person with three or more parts

  • pours, cuts and mashes his or her own food

  • dresses self including zippers and most buttons


Provide opportunities to interact with other children so your child will be prepared to start school.

  • beginning to feel independent but fearful of failure (may make excuses for bad behavior)

  • exaggerates and likes to play pretend

  • plays well with one person and likes small groups

  • less self-centered, considers the feelings of others

  • understands recent past and near future


Read interactively with your child daily, point out letters, and make a game out of rhyming words.

  • carries on a conversation with long sentences and many sentences linked together

  • asks many questions

  • names friends and family members

  • gives first and last name

  • sings a song or recites a nursery rhyme from memory

  • is clearly understandable


Next appointment is at 5 years of age, but please come back sooner if you have any concerns about your child’s health or development!!


Giving your children chores to complete can give them a sense of accomplishment, foster feelings of belonging, and encourage responsibility.  There are several chores that are appropriate for a 4 year old child:

  • Feed pets

  • Wipe up spills

  • Put away toys

  • Make the bed

  • Straighten bedroom

  • Water houseplants

  • Sort and clean silverware

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