4 Years

At the four-year visit, children receive some of the immunizations required prior to entering school, including MMR and Varicella vaccinations.
It is rare for children to have any reaction to the second MMR vaccination. When a reaction does occur, it is typically a delayed reaction occurring six to 14 days later. A few children will develop a fever and body aches, and even less will develop a red blotchy rash, which is not contagious. This normal reaction may last two to three days.
About four percent of children will get a delayed reaction to the Varivax vaccine for chicken pox about three to four weeks after receiving the shot. These children may develop ten to twenty chicken pox spots, which usually start at the site of the injection. If this occurs, your child could be contagious. This is especially important if there are people who are immunocompromised in the home (for example, family members that may be undergoing chemotherapy for cancer, taking high-dose steroids for autoimmune diseases, have HIV, or are pregnant and never had the vaccine or the disease).

Use an approved car seat in the back seat of your car. If your child weighs more than forty pounds, use a booster seat with a high back. All children should stay in car seat devices until they weigh eighty pounds or have reached a height of four feet nine inches (4'9"). Seatbelts alone are unsafe and illegal for four-year olds.
Continue to teach your child about street safety, but never leave an unsupervised four-year old near any kind of street, cars, or traffic.
Always supervise your child near any water: the bathtub, a pool, a lake, the shore.
Install window guards or other safety devices on your windows. Four-year olds are curious and may explore a window; their body weight is sufficient to break through a screen.
Maintain a smoke-free home and car; avoid exposure to cigarette smoke.
Install smoke detectors and carbon monoxide detectors on every level of your home. Check smoke detectors twice a year.
Keep all medicines, machinery, matches and firearms safely out of reach and locked up.
Poison Control: 1-800-222-1222; keep this number by your phone.

Use 2% milk. Two to three servings of milk a day helps give your child the calcium needed for bone growth.
Limit juice as much as possible. Encourage drinking water instead of juice. We encourage orange juice supplemented with calcium for those children who won't drink milk.
The world is full of constant exposure to sweet and salty snacks. Carry some fruit or veggies with you as an alternative. Talk to your school or daycare about limiting cookies and birthday cupcakes, and substituting healthy alternatives. Be the parent who brings sliced oranges instead of sweets!
Keep brushing your child's teeth twice a day. Even though children may insist that they can brush teeth themselves, you need to keep brushing teeth for children at least twice a day.
Schedule dental visits every six months.

This is a great year of continued growth in all spheres of development: motor skills, language, social skills, and personality.
At four years old, children are active talkers. Most four-year olds can tell you long stories about their day. They often get reality and make-believe mixed up. This is normal. It is not unusual for exaggerations and fiction to be told along with facts.
Four-year olds like routines. Continue your bedtime routines.
This is often called the "Little Caesar" stage. Four-year olds can be bossy and may try and act "big." This is normal. Remember that testing limits is normal. Continue to set limits and be consistent.
Give your four-year old little chores. This helps them feel big and part of your family. It also helps develop a sense of responsibility.
Limit TV, videos, and computer games to less than one and one-half hours per day. Encourage (safe and supervised) outdoor play.
Read to your child daily. Help your child pick out letters and simple words. Notice letters and numbers in street signs, billboards, etc. Play rhyming games.
Allow for down time. Don't over-schedule your child.

Next visit: when your child is five years old.