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Developmental milestones record - 4 years

Normal childhood growth milestones - 4 years; Growth milestones for children - 4 years; Childhood growth milestones - 4 years; Well child - 4 years

Definition

The typical 4-year-old child will demonstrate certain physical and mental skills. These skills are called developmental milestones.

Information

All children develop a little differently. If you are concerned about your child's development, talk to your child's health care provider.

PHYSICAL AND MOTOR

During the fourth year, a child typically:

Gains weight at the rate of about 6 grams (less than one quarter of an ounce) per day
Weighs 40 pounds (18.14 kilograms) and is 40 inches (101.6 centimeters) tall
Has 20/20 vision
Sleeps 11 to 13 hours at night, most often without a daytime nap
Grows to a height that is double the birth length
Shows improved balance
Hops on one foot without losing balance
Throws a ball overhand with coordination
Can cut out a picture using scissors
May still wet the bed

SENSORY AND COGNITIVE

The typical 4-year-old:

Has a vocabulary of more than 1,000 words
Easily puts together sentences of 4 or 5 words
Can use the past tense
Can count to 4
Will be curious and ask a lot of questions
May use words they do not fully understand
May begin using vulgar words
Learns and sings simple songs
Tries to be very independent
May show increased aggressive behavior
Talks about personal family matters to others
Commonly has imaginary playmates
Has an increased understanding of time
Is able to tell the difference between two objects, based on things like size and weight
Lacks moral concepts of right and wrong
Rebels if too much is expected of them

PLAY

As the parent of a 4-year-old, you should:

Encourage and provide space for physical activity.
Show your child how to participate in and follow the rules of sporting activities.
Encourage play and sharing with other children.
Encourage creative play.
Teach your child to do small chores, such as setting the table.
Read together.
Limit screen time (television and other media) to 2 hours a day of quality programs.
Expose your child to different stimuli by visiting local areas of interest.

References

American Academy of Pediatrics website. Recommendations for preventive pediatric health care. www.aap.org/en-us/Documents/periodicity_schedule. Updated October 27, 2022. Accessed March 13, 2023.

American Academy of Pediatrics website. 2022 Recommendations for preventive pediatric health care. Pediatrics. 2022;150(1):e2022058044. PMID: 35921638 pubmed.ncbi.nlm.nih.gov/35921638/.

Carter RG, Feigelman S. The preschool years. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 24.

Marcdante KJ, Kliegman RM, Schuh AM. Normal development. In: Marcdante KJ, Kliegman RM, Schuh AM, eds. Nelson Essentials of Pediatrics. 9th ed. Philadelphia, PA: Elsevier; 2023:chap 7.

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Review Date: 10/31/2022

Reviewed By: Neil K. Kaneshiro, MD, MHA, Clinical Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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