The Year Ahead: Age 4

Physical Development

"Physical development consists of both gross motor (GM) and fine motor (FM) development," says Cheryl Wu, M.D., of Amaranth Pediatrics in New York City. "While every child develops at their own pace, there are certain milestones I expect most of my patients (90 to 95%) to achieve by their fourth birthday."

For example, by age 4, a child can:

• Balance for at least three seconds on one foot.
• Walk on a "tightrope" and hop on one foot.
• Copy drawing a cross, square, triangle, an X shape, and something that looks like a person.
• Zip up their coat without help.
• Work buttons without help.

"If your 4-year-old cannot walk up stairs without assistance, or run, that warrants a discussion with your pediatrician," says Brenda Rogers, M.D., an associate professor of pediatrics at UMKC School of Medicine, Children's Mercy Hospitals in Kansas City, Missouri. "We sometimes see children who are a bit behind in physical development, but way ahead in language, fine motor, and social skill development."

According to Anatoly Belilovsky, M.D., a Brooklyn-based pediatrician, lack of development isn't always because of delay. "It could be a lack of motivation on the child's part. Take a look at his surroundings: Does he have too many toys? Does he not spend enough time with other kids? Is he inside most of the time and does he need space to run around outside? Reaching these milestones isn't just about ability—it's ability coupled with motivation."

Behavior

A 4-year-old is all about testing boundaries. "Following direction can be a challenge because the child is exerting his independence," says Carl Sheperis, Ph.D., the vice provost and dean of graduate studies at Kutztown University of Pennsylvania. "And while you want to encourage that, there obviously needs to be rules to follow."

Be sure you acknowledge how your child feels, yet remain firm about the rules you are setting. Consistency lets a child know what to expect and can help prevent meltdowns.

Your 4-year-old has probably started school at this point, and with that comes a problem many parents worry about; bullying. "It starts early," says Dr. Sheperis. "That's why it's important to give your child the opportunity to interact with other kids from an early age. Parents need to keep an eye on how their kids behave with others, and when there is a negative interaction, the child loses a privilege. But be sure to catch good behavior too. When your child is playing nicely with others, be sure to compliment that so that you reinforce that positive interaction."

Language

Your child should speak clearly, with everyone able to understand most of what they're saying. "There are some sounds that might be difficult for him, particularly 'R,' 'S' and 'Th,'" says Lauren Krause, Chief of Speech-Language Pathology at La Rabida Children's Hospital in Chicago, IL. "But by age four, 90% of kids can pronounce all of their words clearly."

Don't be too concerned if your child has a slight lisp—it's common in some kids up until six. Krause says to encourage your child to learn new words and improve pronunciation through pretend play. "Playing out scenarios with your kids is a great way to promote vocabulary development. It can also help them become more familiar with their emotions so they are better able to express themselves."

Preschool will also help with your child's language development. They'll no doubt be learning letters, numbers, and colors. "Preschoolers are taught songs and even poems that they can recite by heart," says Krause. "This can also help language development."

Health

Your child's well-check visit will include weighing and measuring to make sure they're growing at a healthy rate. A 4-year-old gains about four pounds and grows about two inches during the year. The pediatrician will check immunization records and give any shots needed to start school, including the DTaP, polio, MMR, and varicella (chicken pox) vaccines. Depending on which state you live in, your child may receive the hepatitis A vaccine.

The doctor will draw blood for a lead test if you live in a high-risk area for lead poisoning and perform vision and hearing tests. Questions your doctor might ask include:

• How is your child eating?
• How are they sleeping?
• Has your child started preschool? If so, how is that going?
• What kinds of activities do they like to do? The doctor might speak to you about safety precautions.

If your child hasn't given up the pacifier or thumb-sucking, it's time to nip this in the bud. According to the American Academy of Pediatric Dentistry, kids who suck on pacifiers, thumb or fingers, or other objects will generally kick the habit between ages 2 and 4, which is important because, over time, sucking on objects can distort teeth alignment.

Nutrition

A 4-year-old can enjoy adult-size portions, but remember that we tend to super-size things, so make sure it's a reasonable amount of food.

Two big factors are sweets and snacking, says Amy Marlow, a New York-based registered dietician and certified nutritionist serving as an advisor for Happy Family, the nation's leading premium organic baby and toddler food maker. "Kids this age will start to request certain foods—and they're usually items that aren't good for them. You want to make sure they're still being offered healthy, nutritious foods at home."

Watch out for excessive snacking, which kids often do after school. "Kids don't need to snack consistently at this age—just a small snack when they come home is more than enough," says Marlow. She recommends a half-cup of fruit, veggies, and hummus, or a handful of whole-grain crackers.

Sleep

A child at age 4 needs between 10 and 13 hours of sleep in a 24-hour period. The big news: The majority of kids have given up napping, but that doesn't mean they don't need some rest during the day. "Once your child gives up the daily nap, make sure he has some quiet time in the late afternoon—looking at books in his room, for example—and move his bedtime up by about one hour," says Kim West, LCSW-C, aka The Sleep Lady.

Kids are in preschool or Pre-K by this age, and school plays a factor in a child's sleep schedule. You should have your child up in the morning between 6 A.M. and 7:30 A.M. "Watch for sleep cues like yawning, eye-rubbing, thumb-sucking, or crankiness," says West. "If your tot gets that cortisol-fueled second wind, start getting him to bed a half-hour or so earlier from now on. If he starts nodding off during his bedtime routine or falls asleep the very second you turn out the lights, you're probably putting him to bed too late, so move bedtime earlier by 15 to 30 minutes."

What if your little one is waking up at the crack of dawn, ready to play or watch TV? That's also a sign he's going to bed too late, says West. "Anything before 6 A.M. is too early," she explains.

Social Development

Your child is probably in preschool, and some kids have a harder time than others adjusting to the social dynamics of this new experience.

"Preschool is, of course, about learning how to get along well with others, to make friends, and to play," says Jessica Mercer Young, Ph.D., a research scientist at Education Development Center in Newton, MA. "If your child is having a hard time in school, it may help to have her bring in something that they are interested in from home."

A favorite book about a topic your child particularly enjoys may engage other children. This can help open up opportunities to talk with other children and find others who also love, for instance, dinosaurs or fairies. "Just be sure to check with your preschool about what is allowed, as sometimes toys from home are not welcome," says Dr. Young.

Avoid labeling your child as "shy," especially when you're speaking in front of them. You don't want them to feel that there is anything wrong with their behavior—it could be that your child simply needs some time to warm up to new people and situations.

Education

Children need to learn self-help skills such as serving food to themselves using a spoon or fork, and pouring from a pitcher, says Susan Cooper, M.Ed., early child development expert at Applied Scholastics. "While the school is there to teach this, as a parent, I'd rather they concentrate on academic-type subjects like colors and numbers than self-help skills."

Another important self-help skill is good bathroom hygiene. Females should learn to wipe front to back, and males and females should learn good hand-washing skills. "The child who does not wash his or her hands after going to the bathroom is subject to more health risks than the child who didn't truly understand colors the first time through," explains Cooper.

On the academic front, a 4-year-old will learn comparisons, like big and small and long and short. They should also learn their full name, age, gender, address, and phone number—very important in case a child is lost or gets separated from you in a public setting.

Separation Adjustments

One common concern among parents about their kids starting preschool is the adjustment from spending all their time with a parent or caregiver to suddenly attending school. And while seasoned parents may give a sympathetic nod and try to say that everything will be fine, the worry about such a big adjustment is valid.

"The best way to prepare a toddler for preschool is to leave him with a babysitter every once in a while so he'll get used to the fact that Mom drops him off but still comes back to get him," says Cooper.

Try a separation class at your local library or Mommy and Me before the school year starts.

"Also, potty training and teaching how to put on clothes is a great way to prepare him to be more independent so that he'll feel comfortable without you." Be sure to visit the preschool ahead of time to see the layout. Will your child have to go up and down stairs? If so, start teaching them how to do that. Remember, the teacher will have other kids to keep an eye on, so you can't rely on them to teach all of the self-help skills.

Social Skills

Your 4-year-old is spending more time with peers now that they're in school, and one of the best ways to help them succeed in this new environment is through pretend play, says Dr. Young.

"Model appropriate behaviors, such as helping to care for a baby doll, making the dolls or animals take turns, having a tea party or a picnic where you are expected to interact with one another, take turns, and sit and behave. As he gets older, you can even enjoy games with rules, such as board games, so that he learns to follow direction."