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3020 Hamaker Court, Suite 200, Fairfax, Virginia 22031 131 Elden Street, Suite 312, Herndon, Virginia 20170 737 Walker Road, Suite 4, Great Falls, Virginia 22066 703-573-2432
4 year Check-up
Normal Development: Your child may… Social-Emotional
Motor
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Describe features of self- including, gender, age, interests, and strengths
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Hop on one foot
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Balance on one foot for 2 seconds
Act appropriately for the community’s or family’s cultural values
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Copy a cross and a square
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Engage in fantasy play
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Draw a person with 2 body parts (head and one other)
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Build a tower of 8 blocks
Communication/Language
Cognitive
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Be able to say first and last name
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Name 4 colors
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Sing a song or say a poem from memory
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Be aware of gender (of self and others)
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Explain what to do if cold, tired, or hungry
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Play board games and card games
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Be clearly understandable with most speech efforts
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Express thoughts on what will happen next in a book
Diet • A poor appetite or limited food preference is not a major concern if your child’s growth rate has been normal. Create a pleasant atmosphere at mealtimes by turning off the TV and having table conversation that includes your child. • Offer a variety of nutritious foods at each meal. You decide what goes on your child’s plate. Your child decides how much to eat. • If your child has a balanced diet, there is no need to add vitamins or iron. If your child is a particularly picky eater, your pediatrician may recommend a chewable multi-vitamin. • Your child should get a majority of daily fluids from water and low fat milk. Juice is not necessary. If you give juice, limit to 4 ounces per day of 100% fruit juice. Sleep • A 4 year old sleeps about 9-10 hours a day. About 50% of 4 year olds still nap. • Create a calm bedtime ritual that includes reading or telling stories. This will help promote language development and pre-reading skills while helping your child to sleep peacefully • Nightmares and night terrors are common at this age. If your child awakes from one of these, gently reassure and encourage your child to go back to sleep. • Children at this age will still be wet at night. This should become less and less frequent over time. Hygiene • Your child should brush teeth twice a day with a pea-sized amount of fluoridated toothpaste. Have your child spit out the toothpaste after brushing, but try not rinse his mouth with water. Your child will still need assistance and supervision with tooth brushing until around 6-8 years old. • Your child should visit the dentist for regular check-ups every 6 months. VPG 4 yo Well Check Handout-Revised 12/2015, based on Bright Futures 3rd Edition (2008) and healthychildren.org (2015)
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Stimulation • Children this age ask many questions. It is best to keep answers short, simple, and factual. Be careful not to offer too much information. • Model apologizing if you are wrong or have hurt someone’s feelings. Help your child apologize for hurting others’ feelings, too. Praise your child when she demonstrates sensitivity to the feelings of others. • Read interactively with your child. Reading with your child is important to help nurture a love of reading and readiness for school. • As your child shows interest in words, engage by pointing out letters, particularly the ones that begins your child’s name (“It's a T like in Taylor!”). Play with sounds by making rhymes of real and nonsense words (“oodles and boodles of noodles and foodles”). • Enlarge your child’s experiences through trips and visits to parks and other places of interest. Take your child often to the library. Get a library card and let your child choose books of interest. • Consider some type of structured learning environment for your child, whether in Head Start, preschool, Sunday school, or a community program or child care center. • Children may show some lack of fluency (stuttering) when speaking. As children develop speech and language skills, they often experience normal disfluencies such as repetitions of whole words, and false starts and revisions in sentences. Most children outgrow stuttering. Allow children to finish sentences and thoughts. Resist interrupting, speak in a relaxed tone, and pause before responding. • Anticipate your child’s normal curiosity about his body and the differences between boys and girls. Use correct terms for all body parts, including genitals. Explain to your child that certain parts of the body (those areas normally covered by a bathing suit) are private and should not be touched by others without his permission. • Limit TV/video/computer/tablet/smart phone watching to no more than 1 to 2 hours per day. Choose alternatives for together time, such as reading, listening to music, or playing games. Watch together and talk about what you see. Be aware that though the TV show may be appropriate for your child, the commercials may not. Children should not have televisions or DVD players in their bedrooms Behavior/Discipline • Listen to and respect your child as well as your partner. Serve as a positive ethical and behavioral role model. • Model apologizing when you have hurt someone’s feelings. Have your child apologize if he/she has hurt someone else’s feelings. Praise your child for being sensitive to others. • Teach your child the difference between right and wrong. The goal of discipline is teaching appropriate behavior, not punishment. • Help your child manage anger and resolve conflicts without violence. Do not allow hitting, biting, or other violent behavior. • Encourage self-discipline and impulse control in your child by modeling these behaviors and by praising efforts at selfcontrol. Safety • Car Safety: In the car, make sure everyone wears a safety belt. Your child should remain in a harness car seat as long as possible, until reaching the maximum weight or height allowed by the manufacturer. When your child outgrows the harness car seat, transition to a belt-positioning booster seat. • Supervision: Never leave your child alone in the car, house, or yard. Supervise all play near streets or driveways. Your child must hold an adult’s hand to cross the street. Do not expect brothers or sisters to watch over your child. • Safety with Adults: We used to be worried about strangers. Now we know that abusers are often a person the child should be able to trust. Teach your child rules for how to be safe with other adults, using these 3 principles: 1) no adult should tell a child to keep secrets from parents 2) no adult should express interest in private parts 3) no adult should ask a child to help with his or her private parts. • Home Safety: Many young children are excellent climbers. Keep furniture away from windows and install operable window guards on second story and higher windows. • Poison Control: Lock up all medications and keep all household cleaners and poisons out of reach. Keep the Poison Control Center number handy 1-800-222-1222. If you know or suspect that your child has ingested a potentially poisonous substance, call this number immediately. Do not make your child vomit. • Water Safety: A supervising adult should be within an arm’s reach providing “touch supervision” whenever young VPG 4 yo Well Check Handout-Revised 12/2015, based on Bright Futures 3rd Edition (2008) and healthychildren.org (2015)
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children are in or around water. Be sure that swimming pools in your community, apartment complex, or home have a 4-sided fence with a self-closing, self-latching gate. • Helmets: Be sure that your child wears a helmet when riding on a tricycle, bicycle, or in a seat on an adult’s bicycle. Wear a helmet yourself. • Guns: The best way to keep your child safe from injury or death from guns is to never have a gun in the home. If it is necessary to keep a gun in your home, it should be stored unloaded and locked, with the ammunition locked separately from the gun. Make sure every house your child visits follows these same standards. • Smoke Detectors: Make sure you have a working smoke detector on every level of your home, especially in the furnace and sleeping areas. Test smoke detectors every month. Health Maintenance • • •
Immunizations: Vaccinating your child is one of the most important things you can do to keep your child healthy. o Vaccines recommended at today’s visit: Kinrix (DTaP #5, IPV #4), Flu (if in season) Your next visit will be when child is 5 years old. We look forward to seeing you then! Reasons to call us: o Fever alone is not an emergency. Call us right away if your child has a fever (temperature 100.4 and above) plus any of the concerning symptoms below. If your child has a fever, but is otherwise well, you can manage at home with comfort measures until able to be seen in the office. For Tylenol and Motrin dosing see our website at www.vapg.com. Please make an office visit for any fever that lasts longer than 4 days. o If your child is showing signs of dehydration and making urine less than every 6 hours. o If your child appears to have difficulty breathing shown by fast breathing, retractions (sucking in of the skin above the collarbone, between ribs, and below ribs), or flaring of nostrils with each breath. o If your child is lethargic, difficult to arouse, and not responsive to auditory or tactile stimuli. o If you have any questions or concerns about your child. We are always here to help.
Care Plan: _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ For more information see our website at www.vapg.com and the Healthy Children website from the American Academy of Pediatrics www.healthychildren.org
VPG 4 yo Well Check Handout-Revised 12/2015, based on Bright Futures 3rd Edition (2008) and healthychildren.org (2015)
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