Four Year Visit

4 Year Old Child

Four year olds are still very active and curious.  Typically, this is the beginning of the constant “why” questions.  Their behavior is usually more reasonable and cooperative than at the age of 3.  Separating from parents comes more easy.  In a year, growth is typically about 3 inches and 4 ½ pounds.


By four, children can balance on one foot, make a standing broad jump, state full name, copy a “+” sign, and draw a person in 3 or more parts.  Their vocabulary has broadened significantly, and there are rarely speech articulation problems.  The correct use of prepositions and pronouns is also seen.  Children are speaking in long narratives and are completely intelligible to strangers.  Four year olds can generally dress themselves except for tying shoelaces.

Telling “lies” and experimenting with bad language is commonly seen now as children test what they experience away from home.  Anticipate your child’s normal curiosity about their body and the difference between boys and girls.  Reading books continues to be an exciting and wonderful way to help children learn about the world.  Read, read, read!  It is the biggest educational boost you can give your child!

The AAP recommends vitamin D supplementation for all infants, children, and adolescents.    After reviewing the literature, it certainly looks like many children may benefit from vitamin D, although not everyone necessarily needs it.   Some children are more at risk for vitamin D deficiency than others.  Risk factors for vitamin D deficiency include dark skin (African-americans, Indians, Hispanics), time spent indoors and not out in the sunlight (particularly in the winter months), low amount of milk consumption (less than 16 oz a day), and obesity.  The recommended dose is 400 IU (international units) once daily.  This can be bought over the counter in either liquid, chewable, or pill form.  Another option would be a multivitamin (i.e. Flintstones Gummies Complete ).   Read the label carefully when dosing this to your child.  Too much vitamin D can be harmful.


Children at this age are usually able to form friendships with a few friends.  They are more able to take turns and share.  They love pretend play and especially like trying to act out roles (mommy, daddy, policeman, etc.).  They enjoy sorting, building, climbing, doing art projects, and may also enjoy helping with household chores.  They love story telling and puppetry.  Their world is filled with fantasy and magic.  At this age, most children benefit from nursery school or play group experience, which can be an informal arrangement set up by a few parents.


Four year olds have achieved bowel and bladder control, although they may not be dry at night.  Many are still picky eaters.  Keep trying to make mealtime calm and enjoyable despite erratic eating habits.  Most have given up naps, but will benefit from some quiet time in the afternoon.

Nightmares are common.  Dreams are very realistic.  Try to use night-lights, reassure your child, and encourage the ability to overcome the scary object.  Reading books about the feared object (spiders, snakes etc.) can be very helpful. Don’t ridicule fears and try not to accustom them to nightly parental visits.

Thumb sucking may continue.  Try to divert attention by distraction.  Refrain from scolding.

Try keeping TV viewing to a minimum-no more than 1 hour a day-as this has a powerful influence over children.  Be selective about what they see-especially programs with a high content of violence.  Watch with them to see for yourself.  Cartoons can be very violent.


  • Discuss stranger safety.
  • Reinforce the use of bike helmets when riding bikes, tricycles, or scooters.
  • Transition into a booster seat is acceptable now if your child is 40 pounds or taller than 40 inches.


All children this age should have begun to see a dentist by now and should be brushing teeth with supervision twice a day.


The following are indicators of kindergarten readiness:

  • express themselves clearly
  • see themselves as competent and capable
  • have a curious open attitude to new experiences
  • enjoy being with children of their own age
  • can leave home and establish a good relationship with an adult
  • are able to walk, run, climb and crawl
  • take care of their own self-care needs

This is a delightful age.   Enjoy the time you spend with your four year old who is becoming quite a person!