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4 Years of Age

What to Expect at the 4-Year Well Visit:

  • Measles / mumps / rubella / varicella (MMRV) vaccine
  • DTaP / polio vaccine

See the full immunization schedule ›

Safety:

  • Falls are the most common type of injury.
  • Surfaces under play equipment should be soft enough to absorb a fall (safety mats, wood chips, sand) and be maintained to a depth of 9 inches.
  • Lock all doors to any dangerous areas. Use gates on stairways and window guards.
  • It is best to keep all guns out of the home. If you choose to keep a gun, it should be kept unloaded and in a locked place. Ask if the homes where your child visits have guns and how they are stored.
  • Make sure your water heater temperature is set to a maximum of 120° F.
  • Keep the Poison Control Number in your phone or readily available: 1-800-222-1222
  • Keep chemicals, medicines, and other poisons out of reach.
  • Refer to this handout for car seat information.
  • Use a sunscreen with an SPF of 30 or higher, reapplying every 2 hours, and avoid peak sun intensity of 10 am to 3 pm.
  • AAP recommends insect repellents should be less than 30% DEET and used for infants 2 months old and older. Wash off skin with soap and water when done. Wash clothes before wearing again. Do not use combination DEET and sunscreen products. Apply permethrin for ticks to clothes, not to skin.

Development:

  • Speech is understandable to strangers.
  • Knows some basic rules of grammar, such as using “he” and “she.”
  • Can say first and last name.
  • Starts to copy some letters.
  • Hops, stands on one foot.
  • Uses scissors.
  • Would rather play with other children than alone.
  • Cooperates with other children.
  • Can tell a story or sing a song.

Diet:

  • Continue to make family mealtimes a priority.
  • Don’t expect children to “clean their plate” but offer appropriate portion sizes using smaller plates, bowels and cups. At this age they should be learning when they are full.
  • No television during mealtimes.
  • The best drinks are water and low fat milk. Your child does not need any juice, soda, or sports drinks
  • Teach table manners. Explain and model appropriate table manners for your child like not talking with your mouth full, using a napkin, asking politely for food to be passed. With supervision your child can start learning how to use a knife.
  • Have your child set the table or help in some other way with meal preparation.

Watch Out For:

  • Please notify your provider if your child is not understandable to others, has trouble scribbling, shows no interest in interactive games, or resists dressing, sleeping or using the toilet.