Well Child Care at 4 Years

4 yr milestones


Your child should always be a part of the family at mealtime. This should be a pleasant time for the family to be together and share stories and experiences. Give small portions of food to your child. If he is still hungry, let him have seconds. Selecting foods from all food groups (meat, dairy, grains, fruits, and vegetables) is a good way to provide a balanced diet. Choose and eat healthy snacks such as cheese, fruit, or yogurt. Televisions should never be on during mealtime.


At this age children usually become more cooperative in their play with other children. They are curious and imaginative.

Allow privacy while your child is changing clothes or using the bathroom. When your child starts wanting privacy on his own, let him know that you think this is good.

Behavior Control

Breaking rules occasionally occurs at this age. Making children stand in a corner by themselves for 4 minutes is usually an effective way to correct the undesirable behavior. This technique is called time-out. If you have questions about behavior, ask your doctor.

Reading and Electronic Media

It is important to set rules about television watching. Limit total TV time to no more than 1 hour per day. Children should not be allowed to watch shows with violence or sexual behaviors. Watch TV with your child and discuss the shows. Find other activities you can do with your child. Reading, hobbies, and physical activities are good alternatives to TV.

Dental Care

  • Brushing teeth regularly after meals and before bedtime is important. Think of a way to make it fun.
  • Make an appointment for your child to see the dentist.
  • If your child sucks his thumb, ask your doctor or dentist for advice on how to help him stop.

Safety Tips

Keep your child away from knives, power tools, or mowers.

Fires and Burns

  • Practice a fire escape plan.
  • Check smoke detectors and replace the batteries as needed.
  • Keep a fire extinguisher in or near the kitchen.
  • Teach your child to never play with matches or lighters.
  • Teach your child emergency phone numbers and to leave the house if fire breaks out.
  • Turn your water heater down to 120°F (50°C).

Car Safety

  • Never leave your child alone in a car.
  • Everyone in a car must always wear seat belts or be in an appropriate booster seat or car seat.

Pedestrian and Bicycle Safety

  • Teach your child to never ride a tricycle or bicycle in the street.
  • All family members should use a bicycle helmet, even when riding a tricycle.
  • It is much too early to expect a child to look both ways before crossing the street. Supervise all street crossing.


  • Teach your child to never take medicines without supervision and not to eat unknown substances.
  • Put the poison center number on all phones.
  • Do not put anything that could be poisonous into drink bottles, glasses, or jars.


  • Teach your child the first and last names of family members.
  • Teach your child to never go anywhere with a stranger.
  • Teach your child that no adult should tell a child to keep secrets from parents, no adult should show interest in private parts, and no adult should ask a child for help with private parts.


  • Children who live in a house where someone smokes have more respiratory infections. Their symptoms are also more severe and last longer than those of children who live in a smoke-free home.
  • If you smoke, set a quit date and stop. Set a good example for your child. If you cannot quit, do NOT smoke in the house or near children.
  • Teach your child that even though smoking is unhealthy, he should be civil and polite when he is around people who smoke.


Your child will probably receive shots such as:

  • DTaP (diphtheria, acellular pertussis/whooping cough, tetanus) shot
  • measles, mumps, rubella (MMR)
  • chickenpox (varicella)
  • polio vaccine.

An annual influenza shot is recommended for children up until 18 years of age. After a shot your child may run a fever and become irritable for about 1 day. Your child may also have some soreness, redness, and swelling where a shot was given.

For fever, give your child an appropriate dose of acetaminophen. For swelling or soreness, put a wet, warm washcloth on the area of the shot as often and as long as needed for comfort.

Call your child’s healthcare provider immediately if:

  • Your child has a fever over 105°F (40.5°C).
  • Your child has a severe allergic reaction beginning within 2 hours of the shot (for example, hives, wheezing or noisy breathing, swelling of the mouth or throat).
  • Your child has any other unusual reaction.

Next Visit

A once-a-year check-up is recommended. Be sure to check your child’s shot records before starting school to make sure he or she has all the required vaccinations.

Written by Robert Brayden, MD, Professor of Pediatrics, University of Colorado School of Medicine.
Pediatric Advisor 2012.2 published by RelayHealth.
Last modified: 2011-09-21
Last reviewed: 2011-09-20
This content is reviewed periodically and is subject to change as new health information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.

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