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

Definition

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

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 or one third to one half pound (about 180 grams) per month
  • 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 Committee on Practice & Ambulatory Medicine. 2024 Recommendations for preventive pediatric health care: Policy statement. Pediatrics. 2024;154(1):e2024067201. PMID: 38910527 pubmed.ncbi.nlm.nih.gov/38910527/.

Carter RG, Feigelman S. The preschool years. In: Kliegman RM, St. Geme JW, Blum NJ, et al, eds. Nelson Textbook of Pediatrics. 22nd ed. Philadelphia, PA: Elsevier; 2025:chap 25.

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: 10/20/2024

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.


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