Four Year Visit


  • Can dress self, climbs well.
  • Draws basic person, familiar with scissors.
  • Knows colors, knows some letters, counts.
  • Able to communicate with adults other than parents.


  • Cut, paste, and paint. Card games, imaginative play and board games.
  • Give child simple chores around the house (which you do not have to redo).
  • Start riding 2 wheel bike with training wheels.
  • Work in garden, cook together.
  • Keep screen time (TV,video,computer) to less than 1 hour a day. Have TV free days to prevent the TV habit.
  • Read, Read, Read!


  • Teach water safety, consider swim lesions, wear life jackets on dock or boat.
  • Helmets properly fitted when on bikes, skates and scooters.
  • Continue stranger training. Teach your child not to accept food, rides or help from people without checking with you. Continue teaching phone numbers, parent's names. Identify "helping" and safe strangers in community. Let your child know that only people who are helping keep them clean and healthy should be touching their bottom.
  • Teach your child about your home fire plan, meeting location and how to get out.
  • If there are guns in home, lock them and store ammunition separately under separate lock. Talk to your children about gun safety.
  • When your child is over 4 years or 40 lbs., you may switch to belt positioning booster seat. See for more information about booster seats.
  • Burn prevention: Caution around fireplace, wood stoves, grills and campfires. Careful with hot liquids, boiling water on stovetop.
  • Poisonings are common events. Lock up medicines, cleaners, detergents, & antifreeze. Syrup of Ipecac is no longer recommended for home treatment of poisoning by the American Academy of Pediatrics, although some experts continue to recommend its use in certain situations. In case of ingestion of poisons, call the Poison Control Center (1-800-222-1222) immediately prior to giving Ipecac.


  • Model behavior and control temper; be consistent. Use logical consequences for behaviors. Reward/praise positive behavior. Have conversations about why, when and how.
  • Find time for you and your spouse to spend time together without children. Consider starting a "date night" policy.


  • Educate about eating a balanced diet and reasons for it.
  • Eat together as a family, with no TV. One meal for everyone when possible.
  • Encourage milk and water. Limit juice and sweetened drinks.
  • Do not reward /comfort with food. Go to the playground or library instead of going for a cookie or ice cream!
  • Vitamins are not necessary unless you need fluoride supplementation. If you are concerned that he/she doesn't eat a balanced diet a multivitamin is okay

Dental Hygiene

Continue taking your child to the dentist every 6 months. Ask for fluoride supplements if your child drinks non-fluorinated water.

Tests Today & Immunizations

Vision and hearing screenings. For more information please visit Immunization Schedule under "Keeping Kids Healthy" tab.

Next Visit

Please make an appointment when your child is 5 years old.


  • Positive Discipline for Preschoolers by Jane Nelsen
  • How to Talk so Kids Will Listen and Listen so Kids Will Talk by Adele Faber and E. Mazlish
  • Raising an Emotionally Intelligent Child by John Gottman, PhD