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Guide for the Care of Children Online Manual

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Well checkup: 4 years

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Development

  • Your child will become more independent and begin to focus on adults and children outside of the family.
  • Your child should be able to:
    • ride a tricycle
    • use safety scissors
    • show awareness of gender identity
    • help get dressed and undressed
    • play with other children
    • retell part of a story
    • count from one to 10
    • identify different colors
    • hop
    • help with simple household chores
    • sing
  • Read to your child for at least 15 minutes every day. Read a lot of different stories, poetry and rhyming books. Ask your child what she thinks will happen in the book. Help your child use correct words and phrases.
  • Teach your child the meanings of new words. Your child is growing in language use.
  • Your child may be eager to write and may show an interest in learning to read. Teach your child how to print her name and play games with the alphabet.
  • Help your child follow directions by using short, clear sentences.
  • Limit your child to one to two hours or less of quality screen time each day. Screen time includes television, video game and computer use. Do not keep a TV in your child's bedroom. Watch TV with your child and supervise Internet use.
  • Encourage writing and drawing. Help your child learn letters and numbers.
  • Let your child play with other children to promote sharing and cooperation.

Feeding tips

  • Avoid junk foods and unhealthful snacks and soft drinks.
  • Encourage good eating habits. Lead by example! Offer a variety of foods. Ask your child to at least try a new food.
  • Offer your child healthful snacks. Avoid foods high in sugar or fat. Cut up raw vegetables, fruits, cheese and other foods that could cause choking hazards.
  • Let your child help plan and make simple meals. He can set and clean up the table, pour cereal or make sandwiches. Always supervise any kitchen activity.
  • Make mealtime a pleasant time.
  • Restrict pop to rare occasions.
  • Limit 100 percent fruit juice to four to six ounces a day.
  • Your child needs at least 800 milligrams of calcium and 400 IU of vitamin D each day
  • Milk is an excellent source of calcium and vitamin D.

Sleep

  • Your child needs between 10 to 12 hours of sleep each night.

Physical activity

  • Your child needs at least 60 minutes of active playtime most days of the week.
  • Physical activity helps build strong bones and muscles, lowers your child's risk of certain diseases (such as diabetes), increases flexibility, and increases self-esteem.
  • Choose activities your child enjoys, such as dancing, running, walking, swimming or skating.
  • Be sure to watch your child during any activity. Or better yet, join in!
  • You can find more information on health and wellness for children and teens at healthpoweredkids.org.

Safety

  • Use an approved car seat or booster seat for the height and weight of your child every time she rides in a vehicle.
  • Your child should transition to a belt-positioning booster seat when her height and weight is above the forward facing car seat limit. Check the safety label of the car seat. Be sure all other adults and children are buckled as well.
  • Be a good role model for your child. Do not talk or text on your cell phone while driving.
  • Practice street safety. Tell your child why it is important to stay out of traffic.
  • Have your child ride a tricycle on the sidewalk, away from the street. Make sure she wears a helmet each time while riding.
  • Check outdoor playground equipment for loose parts and sharp edges. Supervise your child while at playgrounds. Do not let your child play outside alone.
  • Teach your child water safety. Enroll him in swimming lessons, if appropriate. Make sure she is always supervised and wears a life jacket when around a lake or river.
  • Keep all guns out of your child's reach. Keep guns and ammunition in different parts of the house.
  • Keep all medicines, cleaning supplies and poisons out of your child's reach.
  • Call the poison control center (1-800-222-1222) or your health care provider for directions in case your child swallows poison. Have these numbers handy by your telephone or program them into your phone.
  • Teach your child animal safety.
  • Teach your child what to do if a stranger comes up to him. Warn your child never to go with a stranger or accept anything from a stranger. Teach your child to say "no" if he is uncomfortable. Also, talk about "good touch" and "bad touch."
  • Teach your child her name, address and phone number. Teach her how to dial 911.

Dental care

  • Teach your child how to brush her teeth. Use a soft- bristled toothbrush. You do not need to use toothpaste. Have your child brush her teeth every day, preferably before bedtime.
  • Make regular dental appointments for cleanings and checkups. (Your child may need fluoride supplements if you have well water.)

Eye exam

  • The American Public Health Association recommends that your child get an eye exam at 4 years.
  • Talk with your child's health care provider about your child having a complete eye exam at age 4 or before starting kindergarten.

Lab work

  • Your child may need to have her lead levels checked. This is a blood test to look for high levels of lead in the blood. Lead is a metal that can get into a child's body from many things. Evidence shows that lead can be harmful to a child if the level is too high.

Discipline

  • Set goals and limits for your child. Make sure the goal is realistic and something your child can easily see. Teach your child that helping can be fun!
  • Give your child time outs for discipline (one minute for each year old).
  • Be clear and consistent with discipline. Make sure your child understands what you are saying and knows what you want.
  • Address the behavior, not the child. Do not use general statements like "You are a naughty boy."
  • Choose your battles.

 

Source: Allina Health's Patient Education Department, Guide for the Care of Children: Ages Birth to 5 Years Old, fifth edition

To avoid awkward sentences, instead of referring to your child as "he/she" or "him/her," this guide will alternate between "he" or she" and "him" or "her."

First published: 02/01/2010
Last updated: 01/01/2014

Reviewed by: Allina Health's Patient Education Department experts, including the Pediatric Department of Allina Health Coon Rapids Clinic