Your Child's 4-Year Checkup

Checkups are a way to make sure your child is growing well and help you find out if there are any health problems. After the visit, make an appointment for your child's 5-year checkup.

• Help your child learn healthy eating habits:

  • Eat together as a family as often as possible.

  • Offer healthy food choices and include fruits and vegetables at every meal.

  • Let your child eat when hungry and stop when full. Do not force your child to eat.

  • Limit foods and drinks that are high in sugar (such as cookies and soda), salt, and fat (such as fried food).

  • If your child drinks juice, do not give more than 4–6 ounces (120–180 ml) (the amount in one juice box) of 100% fruit juice a day.

  • Give your child about 2½ dairy servings a day. This can include low-fat or nonfat milk, fortified soy milk, and low-fat cheese and yogurt. Non-dairy sources of calcium include fortified juice, cereal, and bread; dark leafy greens; and tofu (calcium-set).

• Help your child get about 10–13 hours of sleep in a 24-hour period. If your child is no longer napping, allow for some quiet time during the day.

• Help your child sleep well:

  • Set regular sleep and wake times.

  • Create a relaxing bedtime routine. It should take about 20–30 minutes and can include a light snack, a warm bath, a favorite toy, and story time.

  • Use a night-light if your child is afraid of the dark.

  • Avoid scary stories, shows, or screen time, especially before bed.

• Children this age learn best by talking and playing with others and touching things in their world. Video chatting is OK, but if your child has other screen time: 

  • Choose educational programming and apps.

  • View/play together when possible.

  • Limit screen time to less than 1 hour a day.

  • Do not allow a TV, computer, tablet, or smartphone in your child's bedroom.

• Help your child get ready to start school:

  • Follow a regular schedule for meals, playing, reading, cleaning up, and sleeping.

  • Teach your child how to share, take turns, speak respectfully, and be kind when playing with other children.

  • Teach your child to use the toilet and wash hands without your help.

  • Teach your child their name, address, and phone number.

  • Help your child learn to sit quietly in a group and understand when it is OK to talk and ask questions.

• Read, sing songs, and play counting games together. Spend time coloring and drawing. Help your child write letters and numbers.

• Answer questions about the body using simple language that is easy to understand. Use correct names for body parts when your child becomes curious about the differences between girls and boys.

• Set clear rules. Give reasonable consequences for not cooperating. Do not hit or spank your child. Talk to your health care provider if you need help with your child's behavior.

• When your child gets upset, help them to:

  • Think of ways to calm down (such as taking deep breaths).

  • Name the problem. ("You feel angry because you can't have the toy.")

  • Find a solution. ("Maybe setting a timer to take turns could work.")

• Most 4-year-olds are using the toilet regularly during the day, but may not be dry at night. Talk to your health care provider if your child is not toilet trained during the day.

• Stay active as a family by visiting parks and playgrounds, taking walks, and playing games (such as tag or catch). Regular activity helps build strong bones, eases stress, and helps prevent kids from becoming overweight.

Keep your child safe:

• Continue to use a forward-facing car seat with a harness in the back seat until your child reaches the highest weight or height limit allowed by the car-seat manufacturer.

• Teach your child about how to be safe with adults. Tell your child to tell you right away if anyone:

  • wants to see or touch your child's private parts or asks for help with private parts

  • asks for a secret to be kept from parents

  • makes them feel uncomfortable or unsafe

• To prevent drowning, watch your child constantly near water. Sign your child up for a swim class, if possible.

• Have your child wear a helmet when riding a bike or scooter or when in a child carrier on an adult bike.

• A gun in the home increases the risk of accidents and injuries. If you do have a gun, keep it unloaded and locked up. Lock up bullets separately from the gun. Ask if there are guns in homes where your child visits and if they are stored safely.

• Do not let anyone smoke around your child.

Prepare for emergencies:

• Take a class on first aid and CPR. Be sure you know what to do if your child is choking.

• Put smoke and carbon monoxide alarms near all sleeping areas and on every level of your home. Test batteries monthly and change at least once a year.

• Make a fire escape plan and practice twice a year with everyone who lives at home. Include:

  • two ways to get out of every room

  • a safe place to meet outside the house

• Take care of your child's teeth:

  • Take your child to the dentist every 6 months or as recommended by the dentist.

  • Follow your health care provider's or dentist's recommendations about getting a fluoride coating (called a varnish) on your child's teeth.

  • Teach your child to brush their teeth (with your help) twice a day. Use a soft toothbrush and a pea-sized amount of fluoride toothpaste. Brush for 2 minutes and encourage your child to spit after brushing.

  • As soon as two teeth touch, help your child floss between them every day.

  • If your child is thirsty between meals or at night, give water only. Do not let your child sip juice or milk throughout the day or in bed because this can cause tooth decay.

• In the sun, protect your child's skin with a water-resistant sunscreen with an SPF of at least 30, and re-apply every 2 hours or more often if swimming or sweating. It's best to keep your child in the shade, especially between 10 a.m. and 2 p.m.

• Follow your health care provider's instructions on immunizations (shots) and testing.

• Your health care provider can tell you about help that is available in the community or through a social worker. Talk to your health care provider if you're worried that:

  • You don't have enough food for your child.

  • You don't have a safe place to live.

  • You don't have health insurance.

  • You have a problem with drugs or alcohol.

• Call your child's health care provider if you have concerns about your child's health, growth, or development.