Four Year Well Check




  • Dresses with little (buttons and laces) help.
  • Brush teeth with little help
  • Walks along a low wall or curb.
  • Rides a tricycle.
  • Hops and jumps on one foot.
  • Names 4 colors.
  • Builds a tower of 10 blocks.
  • Throws a ball overhand.
  • Copies a cross or a circle.
  • Speaks understandable in 4-5 word sentences and can tell a story about day’s activities.
  • Manages daytime toilet needs. May be dry at night.
  • Plays cooperatively with others for 15-30 minutes.


  • Offer a wide variety of foods, including healthy snacks. Leave cut up fruits or vegetables low in the refrigerator for snacks. Limit high-fat foods and concentrated sweets such as candy, chips, soft drinks, or juice. I can prepare my own cereal if bowls and spoons are kept low and if milk is kept in a small pitcher.
  • Talk about healthy choices at the grocery store as you choose your foods. Let me make choices from several acceptable alternatives for snacks and drinks.
  • Sit down to family meals when you can. This is a good time to build family closeness, talk about the day, and catch up on feelings and activities. Try to keep meals positive.
  • I can set and clear the table with supervision. I like to help. Include me in preparing the meal when possible.

Dental concerns

  • Brush my teeth twice daily using a pea-sized amount of toothpaste with fluoride on a soft toothbrush. Parents still need to supervise brushing and may need to brush once a day to make sure I brush the back teeth as well. Flossing still requires adult help, too.
  • Dental visits are needed every 6 months.
  • Regular or frequent thumb or finger sucking should be discussed with my doctor.

Family concerns

  • Show affection for other members of the family. Encourage good relationships between my sisters and brothers. Acknowledge conflict, but do not allow hitting, biting, or other violent behavior.
  • Handle anger constructively in the family. Model good behavior.
  • Try to spend 15 minutes of individual time with me, listening and doing something I enjoy.Parents need adult time without children. Trade baby-sitting with a trusted relative or
  • friend. This may make parenting less stressful and more fun.
  • Remember to enjoy and treasure the fun things I say and do. It’s easy to become caught up in the daily hassles.
  • Read to me at least 20 minutes a day. Keep reading even after I can read for myself. Let me see you read as well.
  • Limit TV to an average of 1 hour per day. Watch quality shows. Talk with me about what you see and how it makes you think and feel.


  • I usually need 10 hours of sleep a night and a nap in the afternoon, though I may be growing out of that nap.
  • Establish a bedtime routine such as bath, brush teeth, story, hugs and kisses, and bedtime. I am comforted by routines. Limit night TV or vigorous play just before bedtime.
  • I should be able to stay in my bed at night.


  • Establish and enforce exact, firm, consistent rules for safe behavior.
  • Never let me stay alone in a car.
  • Keep poisons, matches, and alcohol out of reach and out of sight. Keep the poison control number near your phone (1-800-POISON-1).
  • Test smoke alarms and change batteries twice a year.
  • It is best if guns are kept out of homes with children. If this is not possible, all guns should be stored unloaded and locked, with ammunition kept separately.
  • Keep your house and car smoke free.
  • Teach first and last name, address, and phone number.
  • Chose caregivers carefully. Discuss with them your attitudes about discipline and behavior. Do not allow spanking or hitting for discipline. Make unscheduled and unannounced visits to my daycare.
  • Always use a booster seat (until I am 80 pounds or the car seat straps fit appropriately).
  • Have me wear a bicycle helmet when I’m riding a tricycle or bike.
  • Teach neighborhood, playground, and street safety skills. Always supervise play near streets and driveways.
  • Never leave me alone in or around swimming or wading pools or in the bathtub.
  • Teach me to swim, but don’t expect me to be "drown-proof." I will still need supervision.

Behavior, discipline, and promoting social competence

  • Be positive. Praise me for cooperation and accomplishments. Catch me behaving well and acknowledge it. Positive discipline teaches me to discipline myself. Spend time with me doing something we both enjoy.
  • Encourage me to talk about my experiences with friends, daycare, and family relationships.
  • Read with me and discuss feelings and reactions with the characters.
  • Establish and enforce consistent, clear, firm rules for safety.
  • Try to ignore negative behaviors that do not hurt others (such as whining).
  • Set developmentally appropriate limits. When setting limits, try to distract me from undesirable behavior. Use gentle restraint or remove an object from me until I can control myself.
  • Talk about body parts and sense of naughtiness, but recognize that "sex talk" is private about should be discussed at home.
  • Teach me to manage anger and resolve problems without yelling or violence. Be a good role model.
  • Encourage assertiveness without excessive aggression.
  • Provide some type of structured learning environment for me. Try day care, Head start, preschool, Sunday school, or a playgroup.
  • Parenting classes and support groups are available for free or at low cost. These boost skills and confidence.
  • I can now appreciate some natural consequences – for example, no dinner means that I am hungry at bedtime, throwing toys means broken toys that will get thrown away.


  • All immunizations should be complete for school attendance with this well child visit. I may need booster or new vaccines as the teen years approach.

By five years old I will

  • Dress without help.
  • Know is or her own address and phone number.
  • Count on fingers.
If your child is seriously ill, please call us directly at (512) 458-5323

If your child is seriously ill, please call us directly at (512) 458-5323