An Affiliate of Wake Internal Medicine Consultants, Inc.

Four Years Well Child Visit

Your four-year-old continues to use his imagination and develop social skills. Many of his milestones mirror the three-year-old child. In terms of sleeping, be firm with a nighttime routine and be sensitive to any night fears. Do not let him get in the habit of sleeping with you if he has fears. Tuck him back in bed and stress his safety and allow him to fall asleep on his own. The diet of a four-year-old should mirror your own…three balanced meals and one or two nutritious snacks per day.


  • Shows improved balance.
  • Hops on one foot without losing balance.
  • Throws a ball overhand with coordination.
  • Can cut out a picture using scissors.
  • May not be able to tie shoelaces.
  • May still wet the bed (normal).
  • Runs, jumps and climbs with ease.
  • Dresses and undresses himself.
  • Walks up and down stairs alternating feet without assistance.
  • Cognitive and Social: The typical four-year-old :
  • Has a vocabulary of more than 1,000 words.
  • Easily puts together sentences of four or five words.
  • Can use the past tense.
  • Can count to four.
  • Will constantly question things.
  • May have language that is a bit unrecognizable.
  • May begin using vulgar words.
  • Learns and sings simple songs.
  • Tries to be very independent.
  • May show increased aggressive behavior.
  • Talks about personal family matters to others.
  • Commonly has imaginary playmates.
  • Has an increased understanding of time.
  • Is able to tell the difference between two objects based on things like size and weight.
  • Lacks moral concepts of right and wrong.
  • Rebels if too much is expected of him or her.
  • Throws fewer and fewer tantrums.
  • Shows affections for family and friends.


  • Encourage and provide space for physical activity.
  • Show the child how to participate in and follow the rules of sporting activities.
  • Encourage play and sharing with other children.
  • Encourage creative play.
  • Teach children to do small chores, such as setting the table.
  • Read together.
  • Limit television watching to two hours a day of quality programs.
  • Expose the child to different stimuli by visiting local areas of interest.


  • Teach your child his name, parent’s names, address and phone numbers including area codes. Also teach emergency numbers i.e., 911.
  • Make sure your child is in a forward-facing car seat with harness straps until he reaches 65-80 pounds and can move to a booster seat.
  • Strap your child into his high chair.
  • If using handed down equipment, make sure it has not been recalled
  • Keep toys with parts smaller than 1¼ inch in diameter out of reach.
  • Begin teaching stranger awareness.
  • Teach pedestrian and playground safety.
  • Always use sunscreen.
  • Teach your child wariness of other people’s pets. Do not allow him to just walk up and reach for a dog or cat that is unfamiliar.
  • Always use a helmet when riding a bike.

At your next visit, it will be time for the “finger prick” that will check hemoglobin and cholesterol levels. Many children find this more stressful than shots so prepare your child well in advance. It’s hard to believe your child will be gearing up for kindergarten soon but enjoy the magical development taking place and remember to be firm and consistent with your rules. Call us with any questions you may have.

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Wake Gastroenterol
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North Raleigh

10880 Durant Rd, Suite 100

Raleigh, NC 27614

Phone: 919-781-7500

Mon-Fri: 8am-5pm

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