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Ages & Stages

Your Checkup Checklist: 4 Years Old

​​​​​​​​​A 4-year-old engages the world with endless curiosity. Then, they may tell you a story all about it or ask a zillion questions. This is the age of why, what, when and how?

At 4 years old, your child feels "grown up." They typically can get dressed and undressed and go to the bathroom (though they still may not have control at night). They are curious about their bodies and start to want some privacy.

Most kids this age can identify emotions, even nuanced feelings like anxiety and joy, in themselves and others. They comfort others who look sad and like to be helpers. They may respond well to praise and clearly stated rules. But they're also eager to explore boundaries. How far can they walk away from a caregiver before being chased? How many toys can they get away with taking from a sibling?

Your 4-year-old needs to use up energy by running, climbing, swinging and jumping. But they also need time to rest, play quietly and use their imaginations. Make-believe and dress-up are important for this age. Media and technology have strong appeal and should be used wisely.

What to expect at the 4-year well-child visit

Your 4-year-old will probably participate more in this check-up visit than in the past. The pediatrician will ask them more questions directly. This helps gain your child's cooperation and shows that they've reached some milestones. They may ask if your child brushes their teeth, or what they like to draw or about a favorite story. The doctor will also focus on helping you provide your child a safe, secure ​environment. In addition, they may talk with you about school readinesshealthy nutrition and habits, screen time and injury prevention.

Here's what else to expect at this visit:

✅ Immunizations

Between the ages of four and six, your child will need several booster shots. They will receive the fifth dose of the DTaP (diphtheria, tetanus, and acellular pertussis), fourth dose of the polio, second dose of the MMR (measles, mumps, and rubella)​ and second dose of the varicella (chickenpox) vaccines.

Your pediatrician will recommend the influenza (flu) vaccine during flu season, and talk about the latest COVID-19 guidelines. You can use these tips​ to make getting a shot less stressful. See "Vaccines Your Child Needs by Age 6."

✅ Health Screenings

A full physical exam will be performed along with hearing, vision and oral health screenings. The vision screening likely will involve an eye chart. The pediatrician also will assess fine and gross motor skills, and observe your child's speech for any difficulties. If a patient is at risk for things like lead exposure or other conditions, your child will be screened for those.

As in last year's visit, pediatricians may take time to address possible needs like having adequate food and being around safe people.​If needed, your doctor can provide community resources offering housing, food and social support.

Questions your pediatrician may ask

  • Has your child received any specialty or emergency care since the last visit? Or, has your child or anyone in the family developed a new health condition?

  • Violence has become common in people's lives; do you feel safe in your home?

  • Can your child go to the bathroom by themselves? Are there any issues around pooping?

  • What are your child's likes and dislikes?

  • Are you concerned about anyone in your home smoking, drinking or using drugs?

✅Developmental Screenings

Your child's play, speech, learning, and movement all are expressions of their growing developmental skills. Most 4-year-olds pretend to be someone or something else, like a teacher or a dog, during play. They can repeat parts of a story or song, and tell you what comes next if they've heard it often. They can answer questions that explain something, like: What is a coat for?

As language skills continue to develop, speech challenges like repetitions of whole words, false starts and stuttering are normal. Never hurry a child to respond because it can increase stuttering. Most ​outgrow these patterns, but if a child stutters for more than six months, they should be taken for an evaluation.

Children this age can have big feelings, which make them sensitive. They can be easily encouraged or hurt by what others say and do. You can teach your child coping skills by modeling behaviors like apologizing and being respectful of others. Know that nightmares and night terrors are common at this age.

To explore developmental milestonesuse our motor skills tool. Be sure to share any concerns with your pediatrician. They can offer next steps like a possible referral for further evaluations or an early intervention program.

Questions your pediatrician may ask

  • Does your child understand concepts like "same" and "different?" Can they follow 2- to 3-step instructions?

  • What do you do when your child is upset?

  • Can your child get dressed and undressed?

  • Can they serve themselves food and water?

  • How is preschool? What does your child like to do there?

  • Does your child draw a person with three body parts? Can they ​hold a crayon or pencil ​using fingers and thumb, rather than a fist?

  • Does your family have a media use plan?

Questions you may have

❓ Did you know
It's easy to offer too much information when answering one of a 4-year-old's many questions. Keep answers short, simple and factual.

✅Feeding & Healthy Nutrition

Like last year, 4-year-olds often have a reduced appetite. That's because they have a slower growth rate at this age. If your child refuses food, they likely aren't hungry. In fact, encouraging a child to eat often means extra unneeded calories. Provide healthy options, especially fruits and vegetables, in appropriate amounts at regular times through the day. Then, let your child decide how much to eat. Minimize foods and drinks high in added sugars​ and saturated fat and low in nutrients. Also, don't prepare substitute foods to entice them to eat because that encourages picky eating.

Questions your pediatrician may ask

  • What did you have for dinner last night?

  • What snacks do you offer your child?

  • What does your child drink each day? How much water and milk?

Questions you may have


The 4-year-old child feels more independent but still needs supervision. They are not ready to cross the street alone, must be watched during outside play, and watched around water. Parents should constantly evaluate the safety of their child's environment. Children should continue to use car seats, using a 5-point harness as long as possible. Most 4-year-olds aren't yet big enough for a booster seat.

Questions your pediatrician may ask

  • Is your community safe for outdoor play?

  • Do you have a plan for how often your child can use media?

  • Who watches your child when you cannot?

  • Is there a firearm in your home or the homes of others where your child might play?

  • How are you practicing pool and water safety?

Questions you may have

✅ Communication Tips

Your pediatrician's top priority is to attend to your concerns. They may refer you to care elsewhere if it is after hours or if a specialist is needed. Pediatricians also can refer you to resources available in your community.

More information

Last Updated
American Academy of Pediatrics (Copyright @ 2023)
The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.
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