URL of this page: //medlineplus.gov/ency/article/002015.htm

Developmental milestones record - 4 years

The typical 4-year-old child will demonstrate certain physical and mental skills. These skills are called developmental milestones.

Information

All children develop a little differently. If you are concerned about your child's development, talk to your child's health care provider.

PHYSICAL AND MOTOR

During the fourth year, a child typically:

  • Gains weight at the rate of about 6 grams (less than one quarter of an ounce) per day
  • Weighs 40 pounds (18.14 kilograms) and is 40 inches (101.6 centimeters) tall
  • Has 20/20 vision
  • Sleeps 11 to 13 hours at night, most often without a daytime nap
  • Grows to a height that is double the birth length
  • Shows improved balance
  • Hops on one foot without losing balance
  • Throws a ball overhand with coordination
  • Can cut out a picture using scissors
  • May still wet the bed

SENSORY AND COGNITIVE

The typical 4-year-old:

  • Has a vocabulary of more than 1,000 words
  • Easily puts together sentences of 4 or 5 words
  • Can use the past tense
  • Can count to 4
  • Will be curious and ask a lot of questions
  • May use words they do not fully understand
  • May begin using vulgar words
  • Learns and sings simple songs
  • Tries to be very independent
  • May show increased aggressive behavior
  • Talks about personal family matters to others
  • Commonly has imaginary playmates
  • Has an increased understanding of time
  • Is able to tell the difference between two objects, based on things like size and weight
  • Lacks moral concepts of right and wrong
  • Rebels if too much is expected of them

PLAY

As the parent of a 4-year-old, you should:

  • Encourage and provide space for physical activity.
  • Show your child how to participate in and follow the rules of sporting activities.
  • Encourage play and sharing with other children.
  • Encourage creative play.
  • Teach your child to do small chores, such as setting the table.
  • Read together.
  • Limit screen time (television and other media) to 2 hours a day of quality programs.
  • Expose your child to different stimuli by visiting local areas of interest.

Alternative Names

Normal childhood growth milestones - 4 years; Growth milestones for children - 4 years; Childhood growth milestones - 4 years; Well child - 4 years

References

American Academy of Pediatrics. Recommendations for preventive pediatric health care. Updated October 2015. www.aap.org/en-us/Documents/periodicity_schedule.pdf. Accessed January 12, 2017.

Feigelman S. The preschool years. In: Kliegman RM, Stanton BF, St. Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier; 2016:chap 12.

Marcdante KJ, Kliegman RM. Normal development. In: Marcdante KJ, Kliegman RM, eds. Nelson Essentials of Pediatrics. 7th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 7.

Review Date 12/9/2016

Updated by: Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.