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Well Child Care at 4 Years

Nutrition

Eating meals together as a family has many benefits. Mealtime is a great time to let your child tell you about his interests, concerns, and worries. Encourage your child to talk and to listen to others as they share stories and experiences. This helps keep your family feeling close and connected. Children who have meals with their families are less likely to smoke, drink, and abuse drugs, and more likely to do well in school.

You can model healthy eating by what you eat and how much you eat. Select foods from all food groups (protein foods, dairy, grains, fruits, and vegetables) for a healthy diet. Give small portions of food to your child. If he is still hungry, let him have seconds. Serve healthy snacks like cheese, fruit, and yogurt. Avoid junk foods and soda pop.

Development

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 asking for privacy, let him know that you think this is good.

Some children still wet the bed at night. If your child wets the bed regularly, ask your child’s healthcare provider about ways to help your child.

Read to your child every day. Make reading a part of the evening ritual. Set rules about TV watching. Limit total TV and video watching to no more than 1 to 2 hours a day. Don’t let your child watch shows with violence or sexual behaviors. If you allow TV, watch with your child and talk about the program. For the rest of the time, choose other activities, like reading, games, singing, and physical activity. Don’t put a TV in your child's bedroom. Having a TV, computer, or video game in your child's bedroom increases your child's risk for obesity, sleep disorders, and attention problems.

Behavior Control

Your child will still break some rules at this age. If your child breaks a rule, after a short, clear, and gentle explanation, immediately find a place for your child to sit alone. It’s very important for the "time-out" to happen right after the rule is broken. Time-outs should last 1 minute for each year of age.

Don’t send your child to his room for time-outs. A bedroom should not feel like a place of punishment.

Ask your child’s healthcare provider if you have questions about discipline or need help with behavior problems.

Dental Care

It’s important to take care of your child’s baby teeth because they help your child chew food and speak clearly. They also help save space for the permanent teeth that will come in later. You can help care for your child’s teeth by following these tips:

  • Avoid sugary foods to help prevent cavities.
  • Make sure that your child brushes his teeth after meals and flosses once a day. Check your child's teeth after he has brushed.
  • Talk with your healthcare provider or dentist if your child still sucks a finger or pacifier, or still uses a sippy cup. These habits can cause problems with permanent teeth.
  • Your child should see a dentist every 6 months or as often as the dentist recommends.

Safety Tips

Accidents are the number-one cause of serious injury and death in children. Keep your child away from knives, power tools, or mowers.

Falls

  • Never allow your child to climb on chairs, ladders, or cabinets.
  • Do not allow your child to play on stairways.
  • Make sure windows are closed or have screens that cannot be pushed out.

Car Safety

  • Make sure that your child is buckled into an approved car safety seat. Children under 13 should always ride in the back seat.
  • Never leave children alone in a parked car, even for a few minutes. Children are at risk for heat illness and injury when left alone. Always check to make sure your child is not still in the car when you leave your car.

Traffic and Bicycle Safety

  • Teach you child to never cross the street by himself. Cross the street with your child and explain why you are looking both ways before crossing.
  • Your child and all family members should always wear a bicycle helmet, even when riding a tricycle.
  • Teach your child to never ride a tricycle or bicycle in the street.

Water Safety

  • Watch children and never leave them alone around water, including wading pools, swimming pools, spas or hot tubs, ponds, lakes, streams, or any other open water. If a child is in the water, an adult should also be in the water close enough to reach and grab the child if needed. Children who have completed swimming programs are still not safe from drowning.
  • The American Academy of Pediatrics recommends swimming lessons for children over 4 years of age.

Poisoning

  • Teach your child to never take medicines without supervision and not to eat unknown substances.
  • Buy medicines in containers with safety caps.
  • Do not store poisons in drink bottles, glasses, or jars or anywhere children can reach them.
  • Put the poison center number on all phones.

Strangers

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

Fires and Burns

  • Teach your child to never play with matches or lighters.
  • Turn your water heater down to 120°F (49°C) or lower.
  • Install smoke detectors. Check your smoke detectors as often as recommended by the manufacturer or at least once a month to make sure they work. For all detectors that use batteries, replace batteries at least once a year or when they are low.
  • Teach your child emergency phone numbers and to leave the house if there is a fire.
  • Keep a fire extinguisher in or near the kitchen.

Smoking

  • Children who live in a house where someone smokes have more respiratory infections, like colds, flu, and throat 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. Ask your healthcare provider for help in quitting. If you cannot quit, do NOT smoke in the house, car, or near children. It helps keep your child healthy and sets a good example.

Immunizations

Immunizations protect your child against several serious, life-threatening diseases. Your child will probably receive shots such as:

  • Diphtheria, tetanus, and pertussis (DTaP) shot
  • Measles, mumps, rubella (MMR) shot
  • Chickenpox (varicella) shot
  • Polio shot
  • Flu vaccine

Your child may have a fever and be irritable for a few days after getting shots. Your child may also have some soreness, redness, and swelling where the shots were given. Ask your healthcare provider what symptoms or problems you should watch for and what to do if your child has them.

Be sure to check your child's shot records before starting school to make sure he or she has all of the required vaccinations. Be sure to bring your child's shot record to all visits with your provider.

Next Visit

A routine checkup every year is recommended.

Written by Robert Brayden, MD, Clinical Professor of Pediatrics, University of Colorado School of Medicine.
Pediatric Advisor 2015.2 published by RelayHealth.
Last modified: 2013-10-03
Last reviewed: 2013-10-03
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.
Copyright ©1986-2015 McKesson Corporation and/or one of its subsidiaries. All rights reserved.
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