Health Library

Developmental milestones record - 4 years

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

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

I Would Like to Learn About:

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.

References

American Academy of Pediatrics website. Recommendations for preventive pediatric health care. www.aap.org/en-us/Documents/periodicity_schedule. Updated October 27, 2022. Accessed March 13, 2023.

American Academy of Pediatrics website. 2022 Recommendations for preventive pediatric health care. Pediatrics. 2022;150(1):e2022058044. PMID: 35921638 pubmed.ncbi.nlm.nih.gov/35921638/.

Carter RG, Feigelman S. The preschool years. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 24.

Marcdante KJ, Kliegman RM, Schuh AM. Normal development. In: Marcdante KJ, Kliegman RM, Schuh AM, eds. Nelson Essentials of Pediatrics. 9th ed. Philadelphia, PA: Elsevier; 2023:chap 7.

Review Date: 10/31/2022  

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

A.D.A.M., Inc. is accredited by URAC, for Health Content Provider (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics. This site complies with the HONcode standard for trustworthy health information: verify here.

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. No warranty of any kind, either expressed or implied, is made as to the accuracy, reliability, timeliness, or correctness of any translations made by a third-party service of the information provided herein into any other language. © 1997- 2024 A.D.A.M., a business unit of Ebix, Inc. Any duplication or distribution of the information contained herein is strictly prohibited.