Well Child Visit Handout - 4 Years

FOUR YEARS
 
Date of Visit:  ___________
Weight:           ___________
Height:            ___________
 
 
NORMAL DEVELOPMENT:         Your child may have the following characteristics…
 PHYSICAL:  
•  Runs, climbs, and jumps well.
•  Skips and hops on one foot.
•  Dresses and undresses.
•  Buttons and zips.
•  Cuts with blunt scissors.
•  Builds a tower of 10 blocks.
•   Throws ball overhand.
 
 SOCIAL & EMOTIONAL:
•  Difficulty seeing another’s viewpoint.
•  Special love for parent of opposite sex.
•  Sexually curious.
•  Uses fantasy and dramatic play.
•  Assertive and domineering.
•  Exaggerates and pretends.
•  Developing strong sense of family and home.
•  Sometimes defies parents.
•  Fear of ghosts and monsters—nightmares may start.
•  May have an imaginary friend.
•  Mimics what is seen and heard—watch your language.
 
 LANGUAGE:
•  Uses longer sentences.
•  Questioning is at its peak.
•  Name-calling may begin.
•  Likes to tell stories.
•  Uses silly words.
•  Vivid imagination.
 
DIET:
•  Erratic appetite, dawdling, refusing certain foods, and distinct food preferences are typical.  “Food jags” are common—requesting one food for days.
•  Children like to help prepare and serve food.  Allowing them to do this within their capabilities may improve eating habits.  Avoid a battle of the wills at mealtime, but do encourage table manners.  Offer nutritious snacks, such as fresh fruits and vegetables,  cheese, graham crackers, peanut butter, or unsweetened fruit juices.  A good daily diet contains food from the basic four food groups.     
 
HYGIENE:
•  Regular dental care and dental visits are important.  Teeth should be brushed twice daily with fluoride toothpaste—once by a parent and once by the child.  Limit sweets between meals and try not to use candy or sweets as a reward.
•  Many children at this age still wet the bed at night.  It should become less and less frequent.
 
DISCIPLINE
•  Praise for desirable behavior.   
•  Consistency in punishing behavior is essential.
•  Continue “time out” as necessary, instead of spanking.
•  Children at this age have vivid imaginations.  When they make up stories, they are probably not lying—it is hard for them to separate real from pretend.
 
SAFETY:
•  May sure your child is properly restrained in a car seat (if less than 40 lbs, 40 inches) or a booster seat with a lap/shoulder belt.  Place the child safety seat in the backseat.
•  Keep car doors locked when traveling.
•  Never leave your child alone in the car or house.  Know where your child is at all times.
•  Teach street safety about crossing the street and traffic signals.
•  Your child is too young to be crossing alone, but this is a good time to teach the basics.
•  Caution children about unsafe hiding places, i.e. refrigerators, car trunks, and clothes dryers.
•  Install smoke alarms on every floor and change batteries twice a year.
•  Supervise all swimming because swimming lessons do not make your child “water safe.”
 
TOYS:
•  Books, music, crayons, paints, clay, sand toys, cars, trucks, stuffed animals, and riding toys.
 •  Picture books are important now as your child “reads” pictures to prepare for reading words later.
•  Read with your child and discuss what is going on in the pictures.  Highly illustrated books are good choices so your child can study the pictures as you read.  Try to read aloud to your child each night!  (Recommendation:  Jim Trelease’s Read Aloud Handout!).
 
HEALTH MAINTENANCE:
•  IMMUNIZATIONS:  DTaP, IPV, MMR, and PPD placement if not already given (see vaccine information sheets).
•  ACETAMINOPHEN DOSAGE:  Acetaminophen (i.e., Tylenol, Tempra) can be given for fever every 4 hours (See Tylenol Dosing Handout).  Tylenol is dosed according to your child’s weight.
 
ANTICIPATORY GUIDANCE:  (Information credited to Brazelton’s Touchpoints)
•  Mastery:  This year is sometimes called the “the golden year.”  Four-year-olds greet the world with open arms.  They want to master the world but are still pulled by dependence on their parents.  They pay increasing attention to their peers and forming strong friendships.  They ask many “Why?” questions to find out about their world.  Parents find themselves in new roles because they are no longer simply providing for their children.  
•  Transgressions:  Wishes become lies.  They likely say things that are untrue because they wish it to be true.  These are examples of their magical thinking.  Parents may feel angered or frightened by these behaviors but must realize this is a normal part of being four.
•  Parental rejection:  Four-year-olds may reject one parent as they try to understand each parent individually.  This can be very difficult for the excluded parent unless they understand that this is predicable and enables the child to fully understand one parent at a time.
•  Discipline:  At this age, discipline involves teaching.  Every “NO” needs a “Yes” or an explanation of why.  Continue to set limits for your child and explain the reasons behind your limit setting.