Office Location | Home

Check Ups

4 Year Check Up

DIET/NUTRITION: Your child should be drinking 16-24 oz of skim or 2% milk each day or taking in 2-3 servings of other dairy products.  Dairy products are an important source of calcium, which is needed to build strong bones.  If your child does not like plain milk, other options include flavored milk (chocolate or strawberry), orange juice with added calcium, yogurt, and cheese.  Continue to offer your child a variety of foods from different food groups, including fruits and vegetables, every day.  Don’t be alarmed if your child refuses a certain food more than once.  Many children will eventually try something that they have refused as many as 10 times in the past.   Young children often only will have 1 good meal a day and will eat smaller amounts throughout the rest of the day.   Try not to fall into the trap of only offering typical “kid” foods, such as hot dogs, peanut butter, and macaroni and cheese.  While there is nothing wrong with your child occasionally eating these foods, children learn to eat what is familiar to them and what they see others eat, and they need variety for a healthy diet.  Filling up on juice or drinking more than 24 ounces of milk each day also can cause kids not to eat well.  Limiting your child’s juice intake to no more than 1 cup each day can improve the appetite and prevent cavities, and learning to drink water at this age is helpful.  If your child refuses to eat anything at mealtime, sometimes you may have to allow him to get down and leave his plate for later.  Let him know that when he gets hungry he may try again to eat his meal, but try to avoid giving him sweets or snacks if he fusses again later, or he may learn that all he has to do to get his way is wait and wear you down.  More than anything, mealtime should not always be unpleasant, so try to establish simple rules, sit down together as a family and relax.  If your child is growing well and eating food from different food groups his diet is probably adequate.

DEVELOPMENTMost four year oldscan hop and skip, alternate feet when going down stairs, dress themselves, copy a square, and catch a ball.  They can remember a song or poem and are very curious, asking lots of questions all the time.  Their speech should be essentially understandable to strangers, although some children will continue to have difficulty with particular sounds.  Four year olds should be able to play well with a group of children.  Many children at this age know their ABCs and have begun to learn their numbers.  Reading remains a very important tool to help children build the foundation for their own reading skills later.

BEHAVIOR/DISCIPLINE: Provide clear and easy to understand rules for you child, and make consequences consistent for bad behavior.  Praise for good behavior often works better than punishment for bad behavior, but make sure you carry out whatever penalty you have discussed for broken rules, so your child learns that bad behavior will not be tolerated and takes your rules seriously.  Using time-outs at this age still can be effective with the general rule being one minute of time-out for each year of age.  Withholding privileges also can be effective punishment for breaking rules, such as removing a toy from play for a short time or not allowing television time or play outside.

DENTAL CARE: By age 4 children should be visiting the dentist every 6 months and brushing their teeth at least before bedtime and preferably also in the mornings.  Most children should be able to use regular toothpaste if they are able to spit when they brush to avoid swallowing too much fluoride.

SAFETY:  Children should remain in carseats in the backseat until they are 4 years and 40 pounds, and then they should ride in booster seats until age 8 or until regular seat belts fit them properly.  (As of July 1, 2005 Indiana law will require children to ride in booster seats until age 8.)  If children are placed in the car with regular seat belts before they are big enough, they are at risk for neck and abdominal injuries in the event of a crash.  Teach good behavior from an early age by requiring your child to wear a helmet if he rides a tricycle or bicycle.  Make sure that smoke detectors in your home work properly, and form a fire escape plan in your home.  Use sunscreen and insect repellent in the summer as needed to avoid sunburn and insect bites.  Never let a child out of your sight near any water.  Teach your child the dangers of talking to or accepting items or rides from strangers.