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Checkups at 4 Years

What Can Your Child Do at Four?

  • He can sing a song.
  • She can climb a ladder and hop on 1 foot.
  • He has the ability to cut and paste. He can build a 10-block tower.
  • She uses the word AI@ correctly and can say her first and last names. She knows the difference between fantasy and reality.
  • He will name and match 4-5 colors and can count to 10. Strangers understand his speech.
  • She enjoys jokes.
  • He dresses and undresses with a little help.
  • She can draw a person with a face, arms, and legs.
  • He washes and dries his hands and brushes his teeth.

What Can Your Child Eat?

  • She should have a balanced diet.
  • Discourage his frequent snacking other than with fruits or vegetables and avoid extra salt.
  • Increase her intake of fiber by giving her cereals, whole-grain breads, fruits, and vegetables.
  • Make sure he brushes his teeth at least once a day.
  • She should not have red meat and eggs daily.
  • He will tend to eat like you eat. Try to make mealtime a nutritious and pleasant time.
  • She may be a picky eater especially compared to her first year. Offer her a balanced meal, but do not force her to eat. Do not let her dictate what you cook. If she does not eat the wholesome meal you serve, then she should remain hungry.
  • A multivitamin once a day may be a good idea if he is a picky eater.
  • If your home does not have fluoride in the water, a fluoride vitamin will be prescribed for her.

Immunizations

  • The following immunizations are needed in the fourth or fifth year:
  • Polio- a viral infection that causes paralysis.
  • DTP- a combined vaccine of diphtheria, tetanus, and pertussis.
  • MMR- a combined vaccine of measles, mumps, and rubella.
  • Your child will need no more immunizations for 5-6 years.

Tests to Be Done

Your child needs a lead test if:

  1. He lives or regularly visits a house built before 1960, an old house with peeling or chipping paint, a home with lead plumbing, a home on a major highway, or one near a lead-producing or battery recycling plant.
  2. You have given her any home remedies that contain lead.
  3. Any of his friends or brothers or sisters have had lead poisoning or he eats paint chips or dirt.
  4. She is around an adult who works with lead in construction, welding, pottery, bullets, fishing weights, a firing range, stained glass, refinishing furniture, or car repair.

Your child may have an analysis of her urine when she has her checkup. This checks for kidney disease, diabetes, and bladder infections. Silent kidney infections in young girls can lead to kidney damage over time.

A tuberculin (TB) skin test may be needed if your child has been exposed to someone with TB, a chronic cough, IV drug use, HIV disease (AIDS), recent prison time, time in a developing country, or if required by school or insurance.

Accident Prevention

  • He should not ride his bicycle without adult supervision. He should always wear a safety helmet.
  • Teach her to look for cars both ways at the curb or driveway before she walks forward.
  • Furniture with sharp edges should be padded or taken out of his play areas.
  • She should not swim without adult supervision even in wading pools.
  • He should not ride in the back of a pickup truck at any age.
  • By the time she is 40 pounds, she can wear a regular safety belt with a booster seat in the back seat. Airbags in the front seat make it unsafe for her to sit there.
  • Teach him to avoid running any time he is near the street.
  • Warn her to avoid strange animals.
  • Keep him away from power tools, electrical equipment, matches, guns, sharp tools, and poisons.
  • Storage batteries for toys and games can cause terrible problems if she swallows one.
  • Watch him at all times while he is on the playground to avoid injuries.
  • Do not leave her alone with plastic bags or balloons.
  • Protect him from common household poisons such as liquor, mothballs, furniture polish, drain cleaners, weed killers, insect and rat poisons, kerosene, bleach, cosmetics, and dishwasher detergents.
  • Iron vitamins are a very common cause of death by poisoning in children.
  • Remember that 25% of childhood poisonings occur at the grandparent's house.
  • The number for Poison Control is 1-800-POISON 1 (1-800- 764-7661). Be sure to have Ipecac in your home but do not give it without talking to your doctor or Poison Control.
  • Teach him to not go anywhere with strangers or let anyone touch him in his private areas.

Emotional and Social Development

  • She should be completely toilet trained during the day except for occasional accidents, but may still wet the bed for several years. This is more common in boys who are deep sleepers.
  • He should start to do chores such as cleaning the table after meals and keeping his room clean.
  • Each parent should have time alone with your child. This shows her that she is important to both of you. Encourage her to talk about her day.
  • Be quick to praise and slow to anger with him.
  • She will enjoy exploratory walks and trips, marbles, cards, and board games.
  • Allow your child to make choices whenever possible (red or yellow shirt, jelly or butter on his toast). This helps build his self-confidence by showing him that you trust his judgment.
  • Spend time each day reading to her.
  • Time spent on television and video games limit family interaction and discourage his creativity.
  • Give reprimands to your child privately so as not to embarrass him.
  • Provide appropriate and clearly stated limits, along with an explanation of the consequences of broken rules to your child.
  • Do not threaten punishment you are not willing to follow through on.
  • You cannot show too much affection toward her at this age.
  • Never joke about hurting or abandoning him. He just might take this seriously.
  • She should have a regular bedtime with a short bedtime ritual.
  • It is normal for him to have a favorite security object such as a blanket or stuffed animal.

Moral Development of Your Child

  • She will learn more from your example than from what you tell her. If you model smoking and frequent drinking, she will likely do these when she is older. If you model divorce or sexual activity with many partners, she will likely repeat this in adulthood. If you eat too much, swear often, and are self-centered, your child will likely be just like you 15 years from now.
  • Limit his exposure to undesirable influences such as the undisciplined child next door, television, movies, and some printed material. All of these affect how he thinks and the values he develops. Let him be a child for as long as possible.
  • Television and movies are special problems because children watch so much, adult activities such as sex and violence can be "understood" to a degree by young children, the impressive technology seems "truthful" and they appear more exciting than ordinary life, giving a skewed view of reality.
  • Teach her what is good and bad morally about what she sees on TV or movies.
  • Irresponsible sex is shown on TV as glamorous and without risks. About 80-90% of the sex shown on television is premarital, extramarital, or violent, and most of the marital sex is depicted as unenjoyable. Seldom is an unintended pregnancy, disease, or divorce mentioned. Most parents disagree with this type of irresponsible sex, yet do not realize how their child is being trained by what he sees.
  • Violence as shown in movies and television is usually self-serving or vengeful. If parents do not want their child to think of violence as acceptable behavior when angry or selfish, they need to limit her exposure to that philosophy.
  • It is philosophically difficult to maintain firm moral standards without some form of religious instruction. Traditional Christianity and Judaism place value on the individual, the healthy family, and compassion toward others. The media and most other world views emphasize selfishness, irresponsible lives, and hunger for possessions. This is one of the main reasons so many children, teenagers, and young adults are confused and in trouble.
  • We strongly encourage you to provide your child with religious instruction. Otherwise his values will be shaped by others with whom you may not agree. One of the greatest gifts you can give your child is to join a traditional Christian church or Jewish synagogue that has a good children's program.
  • Moral instruction begins at a young age. Waiting to begin until your child is a teenager is too late.

 

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The information contained within this website is no substitution for timely medical care.

Feel free to copy the information on this web site and give to friends and family. Contact Dr. Glenn Wood at Carousel Pediatrics (512) 744-6000
We are located at 7112 Ed Bluestein Blvd., #100 - Austin, TX 78723

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