4 Year Well Visit: Information for Parents & Caregivers

• Take time for yourself and to be with your partner.

• Stay connected to friends, your personal interests, and work.

• Have regular playtimes and mealtimes together as a family.

• Give your child hugs. Show your child how much you love them.

• Show your child how to handle anger well, have time alone, talk respectfully, and participate in activities.

• Stop hitting, biting, and fighting right away.

• Don’t smoke or use e-cigarettes. Keep your home and car smoke-free.

• Don’t use alcohol or drugs.

• If you are worried about your living or food situation, talk with us. Community agencies and programs such as WIC and SNAP can also provide information and assistance.

• Young children love to imitate their parents/caretakers.

• Children at this age play well and cooperate with other children

• They become more creative with “make believe” play.

• They can usually pick out clothes to wear and dress themselves completely, and can hop on one foot several times.  

• They can play board or card games, copy a circle and may start to copy capital letters.

• Most children at this age tell stories and are fully understandable to people who don’t know them well.

• Caregivers can promote their child's language development by providing a language-rich environment such as talking aloud to your child as you are going through the day.

• Give your child plenty of time to finish sentences.

• Consider enrolling your child in a preschool, Head Start, or community program.

• CDC’s Milestone Tracker is a useful app (iOS and Android and on the web) to read about stages of your child’s development, for ages 2 months to 5 years.  

• FREE behavioral and developmental assessments are available.

• San Diego County residents through the First 5 Programs (888) 534-7785 or First5sandiego.org.

• Southern Riverside residents through the Healthy Steps Programs (858) 966-8300 or  Healthysteps.org.

• Riverside and San Bernardino Counties are also served by Inland Regional Center (909) 890-4763 or https://www.inlandrc.org/.

• Praise your child’s good behavior with your attention, or “catch them being good”.    

• Be patient and give encouragement.

• Don’t spank, hit, slap, threaten, insult, humiliate or shame to correct your child’s behavior.

• Fear, pain or distress make learning harder for your child and do not help children feel loved, safe and respected in their family.

• The most powerful tool for effective discipline is attention to reinforce good behavior.

• Teach good behavior.

• At four years of age, children have a better understanding of family rules.

• They can be expected to follow simple, age-appropriate rules about 80% of the time.

• Encourage internalization of family rules by asking about them.  

  • If your child asks for more computer time when his time is already done, ask him

    • “How much time do you get each day?”

    • “How much time have you had today?”

    • “When can you have more time?”  

• If your child expresses frustration or disagreement about the rule, acknowledge their feelings and offer empathy while staying committed to the rule.

  • I know you love your computer time, and it is hard… You’ll have more time tomorrow”.

• Model calm behavior for your child.

• Decide on some acceptable ways of expressing feelings in your family.

• Healthy ways to express your feelings can include walking around the room a few times or taking a deep breath.

• Create a “calming space” where anyone in the family can go to take a break and cope with big feelings.  

• Make the consequences as logical as possible.  

  • For example, if your child uses a toy in a way that is not allowed, the toy is removed for a period of time.

Mealtimes should be a pleasant time for the family.

• Eat together as a family.

• Your child should be feeding themselves completely on their own now.  

• Have your child help plan, prepare, set up and serve food.

• Have designated areas of eating.

• Don’t eat in the car, in front of the TV or while using electronic devices.

• Let your child decide how much to eat. If they eat less at a meal, they will make it up at another meal.Model healthy eating

• Think “5210” Every Day!

  • 5 or more servings of fruits & vegetables

  • 2 hours or less recreational screen time

  • 1 hour or more of physical activity

  • 0 sugary drinks. Give more water & low-fat milk

Important Vitamins and Nutrients

• Calcium: Builds strong bones. Calcium is commonly found in dairy products, sardines, broccoli, kale, and enriched orange juice.

• Vitamin D: Helps keep bones strong and supports many bodily functions. Most children’s multivitamins will contain the recommended 600 IU per day.  Vitamin D is found in milk, yogurt, cheese, salmon, tuna, mushrooms, egg yolk, and fortified cereals.

• Iron: Helps keep blood and growth and development healthy. Iron is found in eggs, chicken, leafy greens, red meat, beans, and fortified grains like breads and cereals.

Food Assistance

• 2-1-1 is an organization that helps families connect with food assistance programs such as CalFresh, local and regional food banks, emergency food services, Women Infant Children (WIC) program and more. Contact them at 211sandiego.org/resources/food-assistance/ OR dial 2-1-1 from any phone.

• Some families may qualify for assistance in purchasing food for children up to age 5. For more information on the WIC program please ask your doctor or contact WIC directly

• WIC San Diego http://sandiegowic.org/ 1-800-500-6411

• WIC Riverside https://www.ruhealth.org/wic 1-800-472-2321

• Read daily to your child.

• Model healthy activities by reading to them and allowing them to participate in reading activities.  

• Use books to talk together. Ask your child questions about the story or pictures.

• Let them “tell” the story.

• Limit daily screen time to less than 2 hours total.

• Turn off screens at least 1 hour before bedtime to help with better sleep.

• Limit or reduce media exposure (including playing with electronic toys).

• Give high-quality programming and always avoid violent content.

• Good alternatives to TV are reading, hobbies and physical activities.

• Do not have electronic media in your child’s bedroom- this includes a TV, DVD player, video game, computer, and cell phone.

• Give your child plenty of time to finish sentences.

• Read books together each day and ask your child questions about the stories.

• Take your child to the library and let him choose books.

• Listen to and treat your child with respect.

• Insist that others treat your child with respect.

• Model saying you’re sorry and help your child to do so if he hurts someone’s feelings.

• Praise your child for being kind to others.

• Help your child express his feelings.

• Give your child the chance to play with others often.

• Visit your child’s preschool or childcare program. Get involved.

• Ask your child to tell you about his day, friends, and activities.

• Children younger than 6 years need 3 hours of activity every day.

• Supervise all outdoor play, especially near streets and driveways.

• Help your child build lifelong habits for staying active, enjoying recreation, and learning healthy ways to compete.

• Support trying different activities instead of focusing on just one sport.

• Create opportunities for daily play.

• Praise your child for being active.

• Sleep is important to your child’s overall health.

• 4-year-olds need between 10-13 hrs of sleep (including naps) in a 24 hr period

• Set up a quiet routine before bedtime and be consistent.

• If your child wakes up a lot at night or calls for you frequently, briefly reassure them and put them back in their bed.

• You can also get additional information regarding sleep from the Pediatric Sleep Council at www.babysleep.com.

• Brush your child’s teeth twice per day with a soft bristled toothbrush and a small amount of fluoridated toothpaste.

• Schedule regular visits with your child’s dentist.

• Limit how much sweet and sugary foods and drinks your child gets.

• The American Academy of Pediatrics recommends applying fluoride varnish to kids' teeth every 3-6 months, starting when they get their first tooth until they are 5 years old. Fluoride Varnish Information.

• To find eligible Medi-Cal dental clinics near you: Call 1-800-322-6384 or visit http://www.denti-cal.ca.gov/

Strangers

• Teach your child the first and last names of family members.

• Teach your child never to go anywhere with a stranger.

• Use correct terms for all body parts as your child becomes interested in how boys and girls differ.

• Teach your child that no adult should tell a child to keep secrets from parents.

• No adult should show interest in private parts.

• No adult should ask a child for help with private parts.

• If you feel unsafe in your home or have been hurt by someone, let us know. Hotlines and community agencies can also provide confidential help.

Choking

• Foods that may cause choking should be avoided until 5 years old. These include nuts, peanuts, popcorn, pretzels, chips, large chunks of meat, hard candy, gum, whole grapes, raisins, hot dogs, raw vegetables, and spoonfuls of peanut butter.

• Cut food into small pieces and make sure anything you give your child is soft, easy to swallow and cut into small pieces.

• Learn first aid.

Community

• Teach your child about how to be safe in the community.

• Never leave your child alone in the car, house, or yard.

• Teach your child to ask if it is OK to pet a dog or another animal before touching it.

Car Safety

• Continue to use a car safety seat.

• Everyone should buckle up with both lap and shoulder belt on every trip.

• Children should remain in a forward-facing car safety seat up to that seats weight and length limits.  

• Children should use a belt-positioning booster seat typically until 8 years old and 4 feet 9 inches (144.8 cm) tall.

• Never put your child in the front seat if your car has an airbag.

• All children should ride in the back seat until age 13 years.

Fires and Burn

• Check your smoke detector to make sure it is working.

• Keep a fire extinguisher in or near the kitchen.

• Practice a fire escape plan.

• Keep all electrical appliances out of the bathroom or out of reach, especially hair straightening and curling irons.

• Turn your water heater down to 120°F (50°C).

Falls

• Make sure windows are closed or have screens that cannot be pushed out.

• Do not allow your child to climb on ladders, chairs, or cabinets.

• Lock doors to dangerous areas like the basement or garage.

• Make sure drawers, all furniture, televisions and lamps are anchored to the wall when possible and can't fall over.

Pedestrian and Tricycle safety

• Hold your child's hand when you are near traffic.

• All family members should use a bicycle helmet, even when riding a tricycle.

Water Safety and Sun Protection

• Watch your child constantly when they are around the bathtub, jacuzzi, pool or any other body of water outside the house.

• Protect your child from the sun with clothing, a hat, other covering, and sunscreen of 15 SPF or higher.  

Poisonings

• Keep all medicines, vitamins, cleaning fluids, and other chemicals locked away.

• Pay special attention to laundry pods and dishwasher pods- these are brightly colored and very dangerous if ingested.

• Never present medications/vitamins as “candy” to young children.

• Keep the poison center number on all phones 1-800-222-1222 or 9-1-1.

• Even small amounts of lead can hurt your child's health and brain development.

• Take away toys and jewelry that could have lead.

• Look up recalls on a website called Consumer Product Safety Commission.

Firearm Safety

• Remove guns from the home.

• If you do have a gun, store it unloaded and in a locked cabinet.

• Store ammunition in a separate location.

• Immunizations protect your child against serious, life-threatening diseases.

• The routinely recommended vaccines at this well visit are:

  • DTaP (Diphtheria, Tetanus, acellular Pertussis)

  • IPV (Inactivated Polio Vaccine)

  • MMR (Measles Mumps Rubella)

  • Varicella (Chickenpox)

• It is safe for your child to be given all recommended vaccines according to the schedule published by the American Academy of Pediatrics.

• Vaccines are safe and effective, and proven to save lives.

• If you have concerns about vaccines, please talk to your child’s primary healthcare provider for accurate information.

• Learn more about recommended immunizations from the American Academy of Pediatrics.

• Common side effects from vaccines

  • Fever - can be treated with acetaminophen or ibuprofen.

  • Soreness - can be treated with ibuprofen or cool compress.

  • Swelling at injection site - can be treated with cool compress.

• For more details, visit the Immunizations section on Health Hub.

We will talk about:

• Taking care of your child, your family, and yourself

• Creating family routines

• Dealing with anger and feelings

• Preparing for school

• Keeping your child’s teeth healthy, eating healthy foods, and staying active

• Keeping your child safe at home, outside, and in the car