Your Four Year Old - What You Need To Know

Ages and Stages

Children having lunch in the outside
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Preschool Nutrition

Your child's nutrition is important to his overall health. Proper nutrition, which should include eating three meals a day and two nutritious snacks, limiting high sugar and high fat foods, eating fruits, vegetables, lean meats and low-fat dairy products, including 3 servings of milk, cheese or yogurt to meet their calcium needs can also prevent many medical problems, including becoming overweight, developing weak bones, and developing diabetes. It will also ensure that your child physically grows to his full potential.

The best nutrition advice to keep your child healthy includes encouraging him to:

  • Eat a variety of foods
  • Balance the food you eat with physical activity
  • Choose a diet with plenty of grain products, vegetables and fruits
  • Choose a diet low in fat, saturated fat, and cholesterol
  • Choose a diet moderate in sugars and salt
  • Choose a diet that provides enough calcium and iron to meet their growing body's requirements

You can also help promote good nutrition by setting a good example. Healthy eating habits and regular exercise should be a regular part of your family's life. It is much easier if everyone in the house follows these guidelines, than if your child has to do it alone. You should also buy low-calorie and low-fat meals, snacks and desserts, low-fat or skim milk and diet drinks. Avoid buying high-calorie desserts or snacks, such as snack chips, regular soft drinks or regular ice cream.

The Food Guide Pyramid for young children was designed by the US Dept. of Agriculture to promote healthy nutrition in children over two years of age. It is meant to be a general guide to daily food choices. The main emphasis of the food pyramid is on the five major food groups, all of which are required for good health. It also emphasizes that foods that include a lot of fats, oils and sweets should be used very sparingly.

To prevent feeding problems, teach your child to feed himself as early as possible, provide him with healthy choices and allow experimentation. Mealtimes should be enjoyable and pleasant and not a source of struggle. Common mistakes are allowing your child to drink too much milk or juice so that he isn't hungry for solids, forcing your child to eat when he isn't hungry, or forcing him to eat foods that he doesn't want.

An important way that children learn to be independent is through establishing independence about feeding. Even though your child may not be eating as well rounded a diet as you would like, as long as your child is growing normally and has a normal energy level, there is probably little to worry about. Also, most children do not eat a balanced diet each and every day, but over the course of a week or so, their diet will usually be well balanced. You can consider giving your child a daily vitamin if you think he is not eating well, although most children don't need them.

Other ways to prevent feeding problems are to not use food as a bribe or reward for desired behaviors, avoid punishing your child for not eating well, limit mealtime conversation to positive and pleasant topics, avoid discussing or commenting on your child's poor eating habits while at the table, limit eating and drinking to the table or high chair, and limit snacks to two nutritious snacks each day.

Feeding practices to avoid are giving large amounts of sweet desserts, soft drinks, fruit-flavored drinks, sugarcoated cereals, chips or candy, as they have little nutritional value. Also be careful with foods that your child can choke on, such as raw carrots, peanuts, whole grapes, tough meats, popcorn, chewing gum or hard candy.

For more information on your preschooler's nutrition:

Preschool Growth and Development

At this age you can expect your child to dress himself, brush his teeth without help, play board and card games and follow simple rules, name 4 colors, hop, walk down stairs alternating feet, talk in 4-5 word sentences, sing songs, listen to stories, shares things spontaneously, count to 4, and his speech should be fully understandable. Over the next few years he will be able to count to ten, recognize letters of the alphabet, and be able to learn his phone number and address.

Most four year olds take one nap during the afternoon of about 1 hour in length (he will give up this nap between 3-6 years of age) and are able to sleep all night for at least eleven and a half hours. If not, check to make sure that he has a good bedtime routine and has developed the proper sleep associations.

For more information on your preschooler's growth and development:


Accidents are the leading cause of death for children. Most of these deaths could easily be prevented and it is therefore very important to keep your child's safety in mind at all times. Here are some tips to keep your preschooler safe:

  • According to latest car seat guidelines, once they are two years old (or, regardless of age, have outgrown their rear-facing car seat) children should sit in a forward-facing car seat with harness straps as long as possible and until they reach the weight and height limits of their car seat before moving to a booster seat. Keep in mind that many convertible car seats and combination car seats have forward-facing weight limits of 65 to 80 pounds when used with harness straps.
  • Do not allow your child to ride in the cargo area of a pickup truck, even if it is enclosed. In an accident, children in the back of a pickup truck have little protection from serious injury or death.
  • Always wear a bicycle helmet and avoid bicycling near traffic.
  • Practice sports safety: teach your child to always wear all of the appropriate safety equipment made for each sport (helmets, mouth guards, pads, etc.).
  • Teach pedestrian (crossing streets, etc.) and playground safety (including not playing on trampolines).
  • Teach stranger awareness (review scenarios that predators may use, including offering candy or toys to get in the car, asking to help look for a lost pet, or being told they are picking your child up because you are sick).
  • Avoid exposing your child to too much sun (use sunscreen).
  • Install smoke and carbon monoxide detectors and use flame retardant sleepwear.
  • Practice food safety: wash fruits and vegetables, do not eat undercooked meats or poultry or drink unpasteurized milk or juices.
  • If you must have a gun in the house, keep it and the bullets in a separate locked place.
  • Practice water safety: teach your child to swim, do not let your child play around any water (lake, pool, ocean, etc.) without adult supervision (even if he is a good swimmer), always wear a life preserver or safety vest when on a boat, and childproof the pool by enclosing it in a fence with a self-closing, self-latching door.
  • Be cautious of certain dog breeds (Rottweilers, pit bulls, German Shepards) that account for over fifty percent of fatal dog bites and closely supervise children when in the presence of animals.
  • Help him brush his teeth with a fluoride toothpaste twice a day and have regular dental checkups (every six months). The first visit to the dentist is by age 3 years a the latest. Daily flossing is also usually a good idea at this age if your child's teeth are touching and you can't brush all around the tooth. Remember that kids need help with brushing and flossing until about age 8 years.
  • Limit screen time, including video games and television, and encourage reading and storytelling.
  • Supervise your child's use of computers (a child at this age should not have unsupervised access to the Internet), computer games, movies, and know what they have access to at their friend's homes.
  • Child Proof the House (Set the temperature of your hot water heater to 120 degrees F, use gates on stairs, covers on electrical outlets and latches on cabinets, keep household cleaners, chemicals and medicines completely out of reach and always store them in their original container and know the Poison Control Center number (1-800-222-1222), do not carry hot liquids or food near your child and do not allow your child near stoves, heaters or other hot appliances (especially curling irons), and when cooking, use the back burners and turn pot handles inward, to prevent drowning, empty all water from bathtubs and pails, keep the door to the bathroom closed and never leave your child alone near any container of water, keep a list of emergency numbers near the phone, and lock rooms that are not child proof).
  • Be a good example for your child by always using a seat belt, helmet, etc.

For more information on your preschooler's safety:

Common Preschool Problems

  • Constipation: a very common and frustrating problem in children. It is usually defined as the passage of hard and painful stools or going four or more days without a bowel movement. Constipation is most commonly caused by a diet that is low in fiber, but can also be caused by drinking too much milk (more than 16 to 24oz/d), not drinking enough water or waiting too long to go to the bathroom. Initial treatment is increasing the amount of fluids he drinks and increasing the amount of fiber and bran in his diet. It is usually also helpful to decrease the amount of constipating foods in his diet, including cow's milk, yogurt, cheese, cooked carrots, and bananas. Stool softeners may be necessary if these steps don't work.
  • Upper Respiratory Infections: these are very common and include symptoms of a clear or green runny nose and cough and are usually caused by cold viruses. The best treatment is to use salt water nasal drops and a bulb suctioner to keep their nose clear. Call your Pediatrician if your child has high fever, difficulty breathing or is not improving in 7-10 days
  • Vomiting: usually accompanies diarrhea as part of a viral infection. If your child starts vomiting, it is best to give them a break from eating and drinking for an hour or so and then start to give small amounts of Pedialyte (1 teaspoon) every five or ten minutes. Once your child is able to tolerate drinking these small amounts you can increase the Pedialyte to about a tablespoon every five or ten minutes and then larger amounts as tolerated and then change back to his regular formula. Avoid giving just Pedialyte for more than 12 hours. Call your Pediatrician if the vomit has blood in it, if it is dark green, or if your child is showing signs of dehydration (which includes not urinating in 6-8 hours, having a dry mouth and weight loss).
  • Diarrhea: a common problem and is often caused by a viral infectionCall your Pediatrician if the diarrhea has blood or pus in it, if it is not getting better in 1-2 weeks or if you see signs of dehydration (which includes not urinating in 6-8 hours, having a dry mouth and weight loss). You should continue with their regular diet, but may give 1-2 ounces of Pedialyte each time that he has large diarrhea stool to prevent dehydration.

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    Taking Your Child to your Pediatrician

    At the four year checkup, you can expect:

    • An examination of your preschooler's growth and development.
    • A review of feeding and sleep schedules.
    • Measurement of his height, weight and blood pressure.
    • Counseling for injury prevention, dental health, and a proper diet.
    • A discussion of toilet training progress.
    • Immunizations: DTaP, IPV, Varivax (if your child has not had chickenpox), and MMR boosters.
    • Screening test: vision test and hearing test.

    The next check up with your pediatrician will be when your child is five years old.

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