4 Year Well-Child Visit

Your four year old is officially a “preschooler.” He or she can express emotions and opinions readily, but may not always have much control over these expressions. “Why?” is still a frequent question, and curiosity is ever present. What can you expect at this visit with the Pediatrician?

Vitals – Heart rate and respiratory rate will be counted, temperature and blood pressure are taken.

Growth measurements – Height, weight, and BMI (Body Mass Index) continue to be measured and plotted on growth curves for age and gender.  The BMI is s a person’s weight in kilograms (kg) divided by the square of height in meters. Higher BMI can be an indicator of high body fatness. BMI can be used to screen for weight categories that may lead to health problems but it is not diagnostic of the health of an individual by itself. It is another marker we use to help determine the health of your child. 

Vision and Hearing – Most offices will check your child’s vision and/or hearing at this visit. Any abnormalities noted, including poor eyesight, hearing loss, etc, will result in a referral to a vision or hearing specialist for further, more detailed evaluations. 

Development –

• Social: They use the bathroom, brush teeth, dress and undress by themselves. They engage in imaginative play.  
• Speech & Language: They can answer “what would you do if…” questions, and use 4-word sentences. Words they speak are understood by strangers. They tell stories from books. They follow rules and like to play games. 
• Gross (large) motor: They can skip on 1 foot and climb stairs by alternating their feet.
• Fine motor: They grasp a pencil with thumb and fingers and can draw a person with at least 3 body parts, and a simple cross shape. They can button and unbutton clothing. 

Questions from the Pediatrician – your child’s doctor will ask questions about nutrition and meals, sleeping, voiding (urination) and stooling (bowel movements), and development. You may begin to discuss pre-school and school readiness.

Nutrition – Continue to offer your child a variety of fruits, vegetables, proteins, dairy, fats, and carbohydrates. Promote family meal times with snacks in between. Allow your child to decide how much to eat at once.  Avoid fruit juices or other sweetened beverages, but always have water available to drink. 

Healthy Teeth – brushing your child’s teeth twice daily should be an important part of your daily routine. Clean teeth and avoidance of any drinks other than water before bedtime can help prevent cavities even in young children. Your child should be seen by the dentist every 6 months for check ups and cleanings. 

Exam – your child will have a head-to-toe exam at every well-child visit. 

Vaccinations – The CDC recommended vaccination schedule recommends booster vaccinations for DTaP (Diphtheria, Tetanus, and acellular Pertussis), Polio, MMR (Measles, Mumps, Rubella), and Varicella (Chicken Pox) at age 4-5y.  Your Pediatrician will discuss these in detail with you at your visit. Depending on the time of year, your child’s doctor may recommend the Influenza vaccine as well.  

Questions from you – you will likely have questions about proper developmental milestones, nutrition, sleep habits, and behavior. Bring your questions to the visit and never hesitate to ask your child’s Pediatrician about your concerns.

School readiness – Many 4 year olds are entering preschool programs or simply getting ready to start kindergarten soon while still at home. Parents can help facilitate this process by giving 4 year olds opportunities to interact and socialize with other children and structured learning environments, and getting involved in library reading programs. Children should be given the opportunity to express desires and communicate with others, both other children and adults. 

Safety information – part of every well-child visit is discussion of safety that is appropriate for age. For toddlers, this includes:

• car seat instructions – children should continue to be in their car seats, in the back seat. Never leave your child in the car alone. 
• water safety – young children should never be left alone in the water, even if it is only a few inches or only for a short amount of time. Drowning occurs quickly. 
• fall risks – young children are climbers. Make sure furniture such as bookshelves and dressers are attached securely to the wall when possible.  Monitor them closely at the playground.
• choking – young children will not always chew foods well so make sure foods are cut into tiny pieces. Avoid contact with small objects and plastic bags. 
• child proofing – make sure all cleaning supplies, medications, and chemicals are up high or locked away. Check your floors and lower cabinets/shelves for small objects. Use outlet covers and hide electrical cords. Place barriers around space heaters and fireplaces. 
• sun exposure – avoid direct exposure during the middle of the day as much as possible. Use hats and long sleeves. Use sunscreen with a high SPF. 
• firearms – remove all firearms from the home, if possible. Otherwise, ensure they are locked in a safe and stored unloaded. 

Next visit:  5 years

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