View trusted insights from KidsHealth.org, the No. 1 most-viewed health site for children, created by the experts at Nemours. We've also provided information from the most-respected nonprofit organizations.
From Nemours' KidsHealth
- A to Z Symptom: Nausea
- Frequently Asked Questions About Immunizations
- Medical Care and Your 8- to 12-Month-Old
- Immunization Schedule
- Bathroom, Laundry, and Garage: Household Safety Checklist
- Medical Care and Your 4- to 5-Year-Old
- Medical Care and Your 2- to 3-Year-Old
- Medical Care and Your 6- to 12-Year-Old
- Medical Care and Your Newborn
- Kitchen: Household Safety Checklist
- Backyard and Pool: Household Safety Checklist
- Electrical, Heating & Cooling: Household Safety Checklist
- A to Z: Cystitis
- A to Z: Hand, Foot, and Mouth Disease
- A to Z: Hydrocele
- Tick Removal: A Step-by-Step Guide
- A to Z: Gastroenteritis
- A to Z: Foreign Body, Nose
- A to Z: Epididymitis
- A to Z: Lumbago
- A to Z: Rash, Diaper
- A to Z: Otalgia (Ear Pain)
- Finding a Doctor for Your New Baby
- What Can I Do to Ease My Child's Fear of Shots?
- Talking to Your Child's Doctor
- What's a Nurse Practitioner?
- Your Newborn's Growth
- Growth Charts
- Bedrooms: Household Safety Checklist
- Walls & Floors, Doors & Windows, Furniture, Stairways: Household Safety Checklist
- Sports Physicals
- A to Z Symptom: Fever
- A to Z Symptom: Rash
- A to Z Symptom: Sore Throat
- A to Z: Rhinitis, Allergic
- A to Z: Sarcoidosis
- A to Z: Scarlet Fever
- A to Z Symptom: Vomiting
- Newborn Screening Tests
- Looking at Your Newborn: What's Normal
- A to Z: Constipation
- A to Z Symptom: Diarrhea
- A to Z Symptom: Cough
- A to Z Symptom: Fainting
- Failure to Thrive
- Preparing Your Child for Visits to the Doctor
- A to Z: Tinea Cruris (Jock Itch)
- A to Z: Tinea Corporis (Ringworm)
- Medical Care and Your 13- to 18-Year-Old
- Medical Care and Your 4- to 7-Month-Old
- Medical Care and Your 1- to 3-Month-Old
- Medical Care and Your 1- to 2-Year-Old
- Your Child's Immunizations
- Fever and Taking Your Child's Temperature
- Influenza (Flu)
- Lyme Disease
- Your Child's Checkup: 2 Years (24 Months)
- Your Child's Checkup: 3 Years
- Your Child's Checkup: 15 Months
- Your Child's Checkup: 5 Years
- Your Child's Checkup: 2.5 Years (30 Months)
- Your Child's Checkup: 1.5 Years (18 Months)
- Your Child's Checkup: 1 Year (12 Months)
- Your Child's Checkup: 9 Months
- Your Child's Checkup: 6 Months
- Your Child's Checkup: 2 Months
- Your Child's Checkup: 1 Month
- Your Child's Checkup: Newborn
- Your Child's Checkup: 3 to 5 Days
- Your Child's Checkup: 4 Months
- Your Child's Checkup: 9 Years
- Your Child's Checkup: 8 Years
- Your Child's Checkup: 6 Years
- Your Child's Checkup: 10 Years
- Your Child's Checkup: 11 Years
- Your Child's Checkup: 4 Years
- Your Child's Checkup: 12 Years
- Your Child's Checkup: 7 Years
- Your Child's Checkup: 14 Years
- Your Child's Checkup: 13 Years
- Your Child's Checkup: 18 Years
- Your Child's Checkup: 17 Years
- Your Child's Checkup: 16 Years
- Your Child's Checkup: 15 Years
Trusted External Resources
- Delaware’s Department of Services for Children, Youth, and Their Families (DSCYF)
- 2012 Child & Adolescent Immunization Schedules (from the Centers for Disease Control & Prevention; to help foster parents know which vaccines are recommended and when)
- Child Welfare League of America (CWLA)
- Healthy Foster Care America (from the American Academy of Pediatrics)
- Delaware’s Department of Services for Children, Youth, and Their Families (DSCYF)
Your Child's Checkup: 4 Years
What to Expect During This Visit
Your doctor and/or nurse will probably:
3. Ask questions, address concerns, and offer advice about how your child is:
Eating. Schedule three meals and two nutritious snacks a day. If you have a picky eater, keep offering a variety of healthy foods for your child to choose from. Kids should be encouraged to give new foods a try, but don't force them to eat them.
Peeing and pooping. By 4 years old, most kids are using the toilet. But many preschoolers who are potty trained during the day are not able to stay dry all night. It's also common for busy preschoolers to have an occasional daytime accident. Look for signs of "holding it" and encourage regular potty breaks. Talk to your doctor if your child is not yet potty trained or was previously trained and is now having problems.
Sleeping. Preschoolers sleep about 10–13 hours a day. Many 4-year-olds have given up their afternoon nap, but be sure to schedule some quiet time during the day.
Developing. By 4 years, it's common for many kids to:
- be completely understood by strangers
- know their first and last name and gender
- relate events or tell a story
- hop on one foot
- walk up stairs, alternating feet
- identify some colors and numbers
- enjoy playing with other children
4. Do a physical exam with your child undressed while you are present. This will include listening to the heart and lungs, observing motor skills, and talking to your child to assess speech and language development.
5. Update immunizations. Immunizations can protect kids from serious childhood illnesses, so it's important that your child get them on time. Immunization schedules can vary from office to office, so talk to your doctor about what to expect.
Here are some things to keep in mind until your child's next checkup at 5 years:
- Make time to eat together as a family most nights of the week.
- Serve a variety of healthy foods, including lean meats, fish, fruits, vegetables, and whole grains.
- Preschoolers should get 2.5 cups (600 ml) of low-fat milk (or equivalent low-fat dairy products) daily. You can also give a fortified milk substitute like soy or almond milk.
- Limit juice to no more than 4–6 ounces (120–180 ml) a day.
- Let your child be active every day while under adult supervision. Be active as a family.
- Limit screen time (TV shows, DVDs, smartphones, video games, tablets, and computers) to no more than 1 hour a day of quality children's programming. Keep TVs and devices out of your child's bedroom.
- If your child doesn't go to preschool, look for opportunities for playing and interacting with other kids.
- To help prepare your child for kindergarten:
- Keep consistent daily routines and times for meals, snacks, playing, reading, cleaning up, waking up, and going to bed.
- Practice counting numbers and singing the ABCs, along with other songs and rhymes.
- Read to your child every day.
- Encourage drawing, coloring, and recognizing and writing letters.
- Allow your child to take some responsibility for self-care, including going to the bathroom, washing hands, brushing teeth, and getting dressed. Offer reminders and help when needed.
- Teach your child your home address and phone number.
- Have your child brush teeth twice a day with a pea-sized amount of fluoride toothpaste. Schedule regular dental checkups as recommended by your child's dentist.
- Supervise your child outdoors, especially when playing around water and near streets. Consider enrolling your child in a swimming class.
- Make sure playground equipment is well maintained and age-appropriate. Surfaces should be soft to absorb falls (sand, rubber mats, or a deep layer of wood or rubber chips).
- Apply sunscreen of SPF 30 or higher at least 15 minutes before your child goes outside to play and reapply about every 2 hours.
- Protect your child from secondhand smoke, which increases the risk of heart and lung disease. Secondhand vapor from e-cigarettes is also harmful.
- Make sure your child always wears a helmet when riding a tricycle or bicycle.
- 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. When your child has outgrown this seat, switch to a belt-positioning booster seat until your child is 4 feet 9 inches (150 cm) tall, usually between 8 and 12 years of age.
- Protect your child from gun injuries by not keeping a gun in the home. If you do have a gun, keep it unloaded and locked away. Ammunition should be locked up separately. Make sure kids cannot access the keys.
- Discuss appropriate touch. Teach your child that some body parts are private and no one should see or touch them. Tell your child to come to you if anyone ever asks to look at or touch his or her private parts, if he or she is ever asked to look at or touch someone else's private parts, or is asked to keep a secret.
- Talk to your doctor if you're concerned about your living situation. Do you have the things that you need to take care of your child? Do you have enough food, a safe place to live, and health insurance? Your doctor can tell you about community resources or refer you to a social worker.
These checkup sheets are consistent with the American Academy of Pediatrics (AAP)/Bright Futures guidelines.
Reviewed by: Mary L. Gavin, MD
Date reviewed: July 26, 2017