4-Year-Old Well Child Check

The four-year-old is more of everything. Expansive and extreme, wild and wonderful, energetic, ridiculous and silly.

She likes new things, is a nonconformist, a free thinker, and a very fast study. This year you may ask yourself in wonder, "What in the world did I do to have a child like this?" The answer is, there's nothing much you could or can do; your child is just being four!


Four-year-olds can strut around and brag about how great they are during the day, and then wake up at night from a bad dream and suck their thumbs. Be careful that they don't fool you, they seem to be older than they really are. For all their exhibitionist behavior and aggressiveness, the four-year-old can understand and respond very well to limits. Although they act more independent, they are aware of criticism and thrive on praise and support.


A four-year-old is apt to open a conversation with his name, age, and address. After that, he can talk up a storm, using as many as 2000 words by the end of the year, and using them well. Ask him the difference between a penny, a nickel, and a dime, and he may know that plus the alphabet and his numbers.

He's fun to talk to, because his sentences may be as long as six words, and he's beginning to use plurals correctly, but his word endings aren't quite right yet. He's absolutely fascinated with the world around him, and his "how," "why," "when," questions are the way he's trying to make sense of it all.

Body Control

Four-year-olds have a lot of energy, and they move fast. They can climb like monkeys, and hang upside down. They can swing all by themselves, do somersaults, hop, skip, and jump. Because their balance is better, they are good at riding tricycles. They can play ball and do gymnastics, and get carried away with their newly developed body control that they often take too many chances. Your four-year-old will develop better hand control too, and may be able to button, lace her shoes, and string smaller beads. She can use tools, paint with a brush, and use scissors. She may be trying to print her name, but fine motor tasks are at the beginning stages, so praise her efforts, but don't expect perfect control. When she eats, it's with a fork and spoon, and afterwards she can (and should) brush her teeth.


  • Hops and stands on one foot up to five seconds
  • Goes upstairs and downstairs without support
  • Kicks ball forward
Hand And Finger Skills
  • Copies square shapes
  • Draws a person with two to four body parts
  • Uses scissors
  • Speaks in sentences of five to six words
  • Speaks clearly enough for strangers to understand
  • Increasingly inventive in fantasy play
  • Dresses and undresses
  • More independent
  • Often cannot distinguish between fantasy and reality
  • Can express anger verbally rather than physically (most of the time)
  • Still throws occasional tantrums over minor frustrations

Growth And Nutrition

Daily nutritional guide for the 4 to 6 year old

Grains - 6-11 servings/day

  • Bread, ½ slice
  • Cereal, rice, pasta cooked, 1/3 cup
  • Cereal, dry ½ cup
  • Crackers, 3 to 4

Vegetables -2-3 servings/day

  • Vegetables, cooked or canned ¼ cup
  • Salad, ½ cup

Fruits -2-3 servings/day

  • Fruit, cooked or canned, ¼ cup
  • Fruit, fresh, ½ piece
  • Juice, 1/3 cup

Dairy-2-3 servings/day

  • Milk (does not have to be whole) ½ cup
  • Cheese, 1 ounce
  • Yogurt, ½ cup

Meats and Proteins -2 servings/day

  • Meat, fish, poultry, tofu, 1 ounce (2 1 inch cubes)
  • Beans, dried, cooked, 1/3 cup
  • Egg, 1

Calcium 1000 mg/day

Keep snacks healthy, encourage drinking water and keep juice to a minimum.

Common Issues And Concerns


This year or next year, your child's conscience will emerge. The conscience acts as a stand-in for the parent, an internal voice that will tell him what is "right" and "wrong" in terms of behavior. To effectively discipline your child, you need to be firm, and explain to the child what he did wrong. Make your punishment "fit the crime," be concise, and be "immediate." Two key elements to good discipline are consistency and balance. Be sure you disapprove of the same thing tomorrow that you punished for today. Also, when you catch your child doing something well or right, praise him so he doesn't get only negative messages.


It is important to read to you child. Children not only love to be read to, but the story and fairy tales assist kids in working through their own fantasies, conflicts, and experimentation with roles. If children are read to at home, they will do better in school, have more complex vocabularies, and ask more complex questions. A good screening tool to assess your child's pre-reading skills can be found at Get Ready to Read!


Even though your child is older now, it's important to realize that until age seven, television and movies are risky business. Because your child still can't differentiate between reality and fantasy, certain scenes, even in classic family entertainment movies, can terrify her and cause nightmares. Studies have shown that although children can learn from imitating television, they do not learn to think or solve problems. It's been proven that children who watch hours of television every day lag behind their peers in development. Remember, children can't set their own limits.

Common Health Concerns


Stomachaches are very common in four-year-olds and five-year-olds, especially in girls. If your child complains of recurrent stomachaches, see if you can find a pattern to them. Do they happen in the morning before she goes to preschool, for example, and not on Saturday or Sunday when she's home? If so, they may be her way to express anxiety.

If your child has a stomachache, quiet her and feel her abdomen for tenderness. If she has sharp pains in one area, pain which gets worse as time goes on, no bowel movements, vomiting, or a hard "rocklike" stomach, call our office immediately.


A child first complains of headaches at about the age of four; early morning and late in the afternoon are common times. Sometimes mild headaches are a form of resistance to pressures on the child or low blood sugar, and will respond to rest or a glass of juice. As a parent, it would be a good idea to note on your calendar when headaches occur so you can see if there is a common cause. If headaches become worse over time or occur more often, and if other symptoms surface like eye problems, stomach problems, or weakness, call our office.


Because your four-year-old is a risk-taker, accidents can happen easily. Accidents are most common when the child is tired and hungry, when he's in a new environment, or when new people are caring for him. If you are pregnant, ill, having trouble with your spouse, rushed, or too busy, an accident could happen. Be sure you know the stage of development your child is in, so you can anticipate new risks.

At four, your child should have a good set of safety guidelines; rules for riding a tricycle, crossing the street, playing on the playground, and swimming. Accidents will happen, and to deal with the unexpected, you should know some first aid. 

For further information on safety, you may also visit Healthychildren.org.

Next Well Child Visit

The next routine physical examination is at five years of life.