Health Library
4 Year Well-Child Visit

Healthy Child Development and Behavior

Below are milestones most children will reach between now and 5 years of age. Talk with your doctor at your child’s next well-visit if your child is not yet reaching these milestones or there are skills your child no longer shows each day.

Social and Emotional Milestones

  • Follows rules or takes turns when playing games with other children
  • Sings, dances or acts for you
  • Does simple chores at home, like matching socks or clearing the table after eating

Language and Communication Milestones

  • Tells a story they heard (or made up) with at least two events. For example, “A cat was stuck in a tree, and a firefighter saved it.”
  • Answers simple questions about a book or story after you read it or tell it
  • Keeps a conversation going with more than three back-and-forth exchanges
  • Uses or recognizes simple rhymes (bat-cat, ball-tall)

Thinking and Learning Milestones

  • Counts to 10
  • Names some numbers between one and five when you point to them
  • Uses words about time, like “yesterday,” “tomorrow,” “morning” or “night”
  • Pays attention for five to 10 minutes during activities. For example, during story time or making arts and crafts (screen time does not count)
  • Writes some of the letters in their name
  • Names some letters when you point to them

Physical Development Milestones

  • Buttons some buttons
  • Hops on one foot

Healthy Ways to Help Your Child Learn and Grow


  • When talking with your child, use complete sentences with “grown up” words. Help your child use correct words and phrases.
  • Teach your child about colors, shapes and sizes of items seen throughout the day.
  • Be patient when answering your child’s “why” questions. If you don’t know the answer to a question, say “I don’t know,” then help your child find the answer in a book or by using the internet.
  • Let your child help with simple household chores.
  • Provide your child with toys or other items that encourage “pretend play,” such as dress-up clothes, building blocks, or pots and pans for pretend cooking.
  • Teach your child about others’ feelings and how to react positively to them. For example, when a friend is sad, your child can offer a stuffed animal or a gentle pat on the back.


  • Teach your child to use words to ask for things and to solve problems. For example, if your child takes a toy away from a friend without asking, teach your child to ask, “Can I have a turn?”
  • Give your child more attention and praise for good behavior. Limit attention or ignore unwanted behavior.
  • Use simple words to tell your child why they cannot do something you don’t want them to do (unwanted behavior). Offer them a choice of what they can do instead. For example, “You can’t have ice cream before dinner, but you can have some yogurt or a banana.”

Preparing for School

  • Allow your child time to play with other children of the same age. This will teach your child how to share and make friends.
  • Read books together every day to help your child develop language and reading skills. Ask your child questions about the story and what might happen next.
  • Help your child express feelings using words. Praise your child for being kind to others. Teach your child how to say sorry when they hurt someone’s feelings.
  • Be patient while your child is speaking. Give plenty of time for your child to finish sentences.

Healthy Habits

  • Give water and 16–24 ounces of whole milk each day. Limit juice to help prevent tooth decay.
  • Eat meals together as a family when possible. Let your child see you eating healthy foods, such as vegetables, fruits and lean meat, and drinking milk or water.
  • Encourage your child to play and be active throughout the day. Model this behavior by being active together as a family as often as possible.
  • Children this age need 10–13 hours of sleep a day, including a nap. Have a steady routine for bed (bathing, brushing teeth, books, bedtime). The hour before bedtime should be calm.
  • Help your child brush teeth two times each day (after breakfast and before bed). Use a pea-sized amount of fluoride toothpaste. Take your child to the dentist twice each year.
  • Limit screen time to one hour per day of high-quality, educational programs. Avoid putting a TV in your child’s bedroom.

Vehicle Safety

Water Safety

  • Drowning is silent and can happen quickly. Do NOT leave your child alone near any water (including bathtubs, toilets, pools, ponds, whirlpools). Teach your child to swim. Install a four-foot-tall fence with a self-closing and self-latching gate around home pools. Learn more about water safety.

Body Safety

  • Use correct terms for all body parts as your child becomes interested in how boys and girls differ from each other. Teach your child about safe and unsafe touches. Tell your child what to do if someone gives an
  • unsafe touch using “No, Go, Tell.”
    • No—Say “no” or “stop” loudly so the person can hear you.
    • Go—Run away from the person and find a nearby safe adult.
    • Tell—Tell that adult and me what happened so we can help keep you safe.
  • Learn more tips for teaching children about body safety.

This information is to support your visit with your child’s doctor. It should not take the place of the advice of your pediatrician.

Sources: Centers for Disease Control and Prevention, Bright Futures (4th Edition) by the American Academy of Pediatrics

Last Updated 06/2023

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