Advanced Pediatrics

100 East Street SE, Suite 301

Vienna, VA 22180
(P) 703.938.5555

(F) 703.319.8580

4 Years Old

Full of energy and questions, you will have few quiet moments with your 4 year old around.  He will ask lots of questions of you as he strives to understand his world.  At moments he will appear confident and in charge and at others he will waffle on the side of insecurity.  As quickly as he will melt down at the slightest disappointment he will just as quickly move on to the next distraction that interests him.

This will make for an unpredictable year and unpredictable days.  Much success comes from mastering successful routines and setting clear expectations. 

Vaccinations for this visit

We recommend the following vaccines:

  • DTaP
  • IPV
  • Proquad
  • Flu vaccine (seasonal)

​Recommended Tests

The following tests are only done based upon risk factors being present.  Please take a few moments to help us determine whether these tests are warranted for your child:


Motor & Hand Skills

  • Hops, somersaults

  • Swings, climbs

  • May be able to skip

  • Copies triangle and other geometric patterns

  • Prints some letters

  • Uses fork, spoon, and (sometimes) a table knife

  • Dresses and undresses without assistance

Language​ & Cognitive

  • Recalls part of a story

  • Says name and address

  • ​Speaks sentences of more than five words

  • Uses future tense

  • Knows about things used every day in the home (money, food, appliances)

  • Correctly names at least four colors

  • Can count ten or more objects​

Social & Emotional​

  • More likely to agree to rules

  • Shows more independence and may even visit a next-door neighbor by herself

  • Sometimes demanding, sometimes eagerly cooperative

  • Wants to be liked and to please his friends and perhaps has a best friend which could be of either sex

  • Able to distinguish fantasy from reality

  • Shows more independence — able to brush his teeth and get dressed by himself

Parenting Tips

  • Make Rules & Be Consistent:​   Ever wonder how teachers at pre-school mantain order?  It is all about establishing rules.  They are also a great place for you to begin in making your own.   Common rules that a 4-year-old can follow are not getting up during meals, asking to be excused from the table and, of course, saying “please” and “thank you.”  Kids need the security of rules, even though sometimes they will test them.
  • Safety is Learned:​  While your child has acquired many physical skills, good judgment is not among them.  He will need to be reminded to wait and hold hands before crossing the street and although he probably loves water and wants to swim, never leave him unattended. If you haven't already tried swimming lessons, this is a good age to introduce them so your child can learn water safety, but remember that it does not mean he should be left alone in water - remember that poor judgment?
  • Punishments that Fit the Crime:  ​React calmly when your child misbehaves.  Anger begets anger. 'Time-outs' are an effective form of punishment for this age. Usually it's recommended one minute per year, so try a four-minute time-out. Be patient and remember that they are still learning  their place in the world — and looking to you to help them learn.  Firm but supportive is the rule.
  • The Perfect Age for Chores:  ​Giving your child chores such as setting the table, making her bed, or putting her laundry in the hamper demonstrate to her that what she knows and learns has an impact on our family.  Children look for purpose and our approval.  Chores are a wonderful opportunity to build self esteem and this sense of purpose.