Your Child at 4 Years

Pediatric Development Guide from Westside Pediatrics

The board-certified pediatricians at Westside Pediatrics have provided this pediatric development guide to help educate parents on some of the amazing things their child can do at this age and tips around care including tips for car safety and preparing for kindergarden.  Call (585) 247-5400 to schedule an appointment at our pediatric office in Rochester, NY.

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  • Likes words and silly sounds—he knows many words…

  • Imitates adult activities—has a good imagination…

  • May have imaginary friends and an active fantasy life…

  • Wants to play with children his age…

  • Is better, able to share, take turns, accept rules …

  • Cannot differentiate well between fantasy and reality…

  • Recalls part of a story…

  • Draws circles and squares…

  • Draws a person with two to four body parts…

What you can do with your 4 year old child

Let your child play safely both indoors and outside. A daily quiet time is still important.

Read books with pictures with your child. Take him to story hour at the public library.

Let him help with some adult activities such as dusting, cooking or feeding pets.

Don’t make fun of your child’s fantasies. Accept them.

Encourage your child to play with other children by getting involved in a play group or nursery school in your neighborhood.

Expect your child to take simple responsibilities and follow rules or directions.

Being a parent is enjoyable, but hard work. There is so much to learn! Sometimes it helps to talk to other parents or get some advice from someone outside the family. If you would like to find out more, call this number and ask about parenting programs in your area.




Whether your child is heading off to nursery school or kindergarten in the coming year, he needs to learn how to be safe when you are apart.

Teach Your Child

–his full name and address including zip code, and telephone number

–your full name and your work or school telephone number

–how to dial “911”

–the difference between a friend and a stranger.

–never to go with, talk to or accept gifts from strangers

–to establish a code word known only to you and your child. This can be used in case of an emergency if you need to send a friend to pick up your child.

–no one has the right to touch them or ask them to keep a secret from you

–to always use the buddy system when they can

Car Safety

Car crashes are the biggest danger to your child’s life and health. Even at low speed, the crushing forces on your child’s brain and body in an accident or sudden stop can kill or severely injure him.

To prevent car injuries and deaths you must use car safety seats or seatbelts every time your child is in the car.

In New York State all children under 4 or 40 pounds must use a car seat at all times. Children under age 8 must use a booster seat at all times. They let children see out the window and make the seat belts fit better which is safer for your child.

–teach your child to buckle his seat belt himself. Always check to be sure he’s buckled before you start.

–Set a good example. Make sure you and everyone else in the car buckles up!

–Talk about safety as a “grown up” behavior and praise your child whenever he voluntarily buckles up.

–Make up games about how your child is an astronaut, pilot or race car driver and needs to wear his seat belt for his “job”.

–Explain to your child why wearing a seat belt is so important.

Seventy-five percent of all traffic accidents occur within 25 miles of a person’s home at speeds of less than 40 mph.

Use your car seat or seat belt for every ride your child takes even if it’s just a quick trip to the local store!

Helping you and your child prepare for kindergarten

As your child begins kindergarten you may have many questions and concerns. If this is your child’s first experience away from you, you both probably have mixed feeling about being separated.

It is a good idea to have your child evaluated by your school district for kindergarten. They test your child to see how developed his coordination, pre-reading skills, and pre-math skills are. They also evaluate his maturity and ability to handle a structured school day.

Most children will have vision and hearing testing done at the four year old checkup. This will also help prepare your child for school.

Some children are placed in a “pre-kindergarten” class. This does not mean that your child is not smart enough. It just means that your child is not ready for a structured day yet. A year in “pre-K” will help prepare him.

It helps your child to know where he will be going in the fall.

If possible, take your child to visit his school and his classroom. It would also be helpful for him to meet his teacher during the summer.

Most schools have an “introduction to the school bus” program when your child will actually have the experience of getting on and off the bus and taking a short ride. This is usually done a few weeks before the beginning of the school year at a time when parents are able to accompany the child to the school.

Introducing your child to the school bus experience in a reassuring and friendly atmosphere helps to eliminate apprehension and fear of the unknown on the first day of school.

Your child may have trouble waking up for school. Try to get him used to a regular bedtime so he won’t be tired in the morning.

If your child has problems getting dressed in the morning try making a game out of dressing. One day you dress him, the next day he dresses himself.

Your child should eat breakfast before school. Encourage him to get up early enough so that he doesn’t feel rushed in the morning.

If your child has friends who eat breakfast at school, he may enjoy eating with them. Depending on whether your child attends an “all day” kindergarten, or a “half day” session, he will probably have lunch or a snack period at school.

Plan something to do for yourself while your child is in school. Whether this means going back to school yourself, getting a job or just visiting friends, it will help to make the change go more smoothly for both of you.

Remember that although your child will be meeting many new and important people in his life, you will remain the central person in his life for many years to come.

Imaginary & invisible friends

Invisible Friends

Invisible friends are not harmful to your child. Like stuffed animals or dolls, they can help to reveal your child’s feelings.

You and your child can have playful conversations with the invisible friends. Don’t worry, your child will eventually lose interest in his invisible friend.

Imaginary Friends

A child who treats dolls or stuffed animals as friends is building social skills which help him to make real friends. They feel love and caring toward these imaginary friends. It is a chance for them to practice their sharing skills. When your child is talking with his doll, you can listen in on his feelings.

Try to remember the names of the dolls or stuffed animals and treat them as honored members of the family. Don’t buy too many dolls or stuffed animals. It is hard to form close ties to many dolls.

Talk directly to the doll and assume the doll has feelings. This will allow your child to recognize and express his own feelings.

Use the doll to act out any problem situations your child. For example, “Teddy will be brave when he goes to the dentist”.

Things you may be worried about at 4 years old

Young children frequently have nightmares and night terrors. They are different problems with different ways of handling them.

Nightmares: Scary dreams followed by waking

Usually caused by emotional conflicts that happen in the daytime, for example, starting nursery school or a new baby in the family. Respond by holding and calming him. Show him that you will take care of him and that you are in control. Your child may have trouble falling asleep because he feels afraid.

Night Terrors: Partial waking with full screaming and crying from a very deep non-dreaming sleep

Not usually caused by problems during the day. May be due to an overtired child or being off a regular sleep pattern.

During a night terror your child will not be aware of your presence. You cannot comfort him at this time. In fact, he may become more upset if you try to hold him. After a night terror your child will usually fall back to sleep quickly. He will usually not even remember screaming.

If either of these problems continues past age 5 or if they happen very frequently over a 1-2 month period, talk to your pediatrician. Professional counseling may be needed.


Television viewing affects young children. It can be a very good tool to help children learn. Shows like Sesame Street have interesting animals and short segments. This is important because young children only watch television for short periods of time because they have short attention spans. Watching programs about other people also helps your child to accept differences in people.

Television is not a substitute parent. Spend some special time with your child talking about what he sees on television. When your child watches violent show, it results in more aggressive play. It is up to you as the parent to change the channel if a program is not right for your young child.

Studies reveal that children who watch a lot of television are less creative and more easily bored. Monitor your child’s television viewing.





Before his next checkup, your child may:

  • Hop on one foot and do somersaults…

  • Tie his own shoes…

  • Count ten or more objects…

  • Use four letter words to see the reaction he will get from you…

  • Begin to develop some feelings of insecurity…

  • Know his full name, address and telephone number…

  • Understand better the concept of time…

  • Tell longer stories…

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Schedule an Appointment

If you have more questions regarding pediatric development milestones or your child’s development, call our pediatric clinic in Rochester, NY at (585) 247-5400 to request an appointment with one of our exceptional pediatricians.

(585) 247-5400