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 LaGuardia Place 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 percent) to achieve by their fourth birthday." By four years of age, a child can balance for at least three seconds on one foot, walk on a "tightrope," and hop on one foot. A 4-year-old can also copy a cross, draw a square, and draw something that looks like a person. She can definitely zip up her coat and work buttons.

"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., a pediatrician at Children's Mercy Hospitals and Clinics 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 director of doctoral programs for Walden University's School of Counseling and Social Service. "And while you want to encourage that, there obviously needs to be rules to follow." Be sure you acknowledge how your child is feeling, 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 be speaking clearly, with everyone able to understand the majority of what he's 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 percent of kids can pronounce all of their words clearly." Don't be too concerned if your child has a slight lisp -- it's normal in some kids up until the age of six. Continue to encourage your child to learn new words and improve pronunciation through pretend play, says Krause. "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. He'll no doubt be learning his 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 he's 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 he might ask include:

• How is your child eating?
• How is he sleeping?
• Has he started preschool? If so, how is that going?
• What kinds of activities does he 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, most children stop sucking on thumbs, pacifiers, or other objects on their own between 2 and 4 years of age, but some continue these habits over long periods of time. As a result, the upper front teeth may tip toward the lip or not come in properly. Frequent or intense habits can how the child's teeth bite together, as well as the growth of the jaws and bones that support the teeth.

Nutrition

A 4-year-old can enjoy adult-size portions (we have a tendency 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 years needs 11 ? hours at night. 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 her. You don't want her to feel that there is anything wrong with her behavior -- it could be that she 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 www.appliedscholastics.org. "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. Girls should learn to wipe front to back, and both boys and girls 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. He should also learn his full name, age, gender, address, and phone number -- very important in case a child is lost or gets separated from you in a store.

Challenge

The Challenge: Starting preschool

"My son Hayden is starting preschool. We stumbled upon a school on our street and decided to sign him up," says Karen Jacobsen of New York City. "I'm told by experienced moms he'll be fine, but it is a huge change for him to go from being with me full-time to being in school five days a week."

The Solution: Prepare in advance

"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 him how to do that. Remember, the teacher will have other kids to keep an eye on, so you can't rely on her to teach all of the self-help skills.

Make the Most of It

Your 4-year-old is spending more time with peers, now that he's in school, and one of the best ways to help him 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."

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