• Teach your child about the food pyramid and offer foods that are lower in salt and sugar.
  • Encourage consumption of fresh vegetables, poultry, and fish, trimmed lean meats. Discourage processed meats, chips, candy and soft drinks.
  • Limit fast food and discourage eating in front of the television. Food habits now influence eating habits in later life.
  • The American Academy of Pediatrics now recommends a daily multivitamin for all children. The goal is Vitamin D 400 IU and Iron 15 mg daily. Most multivitamins supply these nutrients
  • Lunch box strategy: tuna fish, PBJ, chicken and turkey, raw veggies, soup, whole grain breads, fresh or dried fruits, nonfat milk and water. The best fast foods are pizza, roast chicken, salad, and fruits.


  1. Children should remain in a 5 point harness car seats until they are six years old. After that time, children can be transitioned to a booster seat. Plan for your child to be in the booster seat until 4 feet 9 inches.
  2. Don’t take your child’s “common sense” for granted. Lock up all medications and household poisons including cleaners, paint thinners, and drain cleaners. Do not store these products in containers that resemble food containers.
  3. Guns in the home are a danger to the family. If guns are kept, store the gun and ammunition locked up and in separate locations.
  4. One on one supervision is still necessary at the pool, street and bath.
  5. Discuss water safety. Knowing how to “swim” does not ensure the child’s safety in water at this age.
  6. Call the Poison Control Center if you suspect your child ate a poison: 800-222-1222. Do not administer syrup of ipecac until speaking with the Poison Control Center first.


  • By age 4, approximately 75% of children are dry at night. Avoid punishment or teasing for bedwetting if your child is in the other 25%. Half of kids who are still wet at night will become dry within the next 12 months without any intervention.
  • Now is a good time to introduce chores such as setting the table for meals and helping to clean afterwards.
  • Masturbation is quite common as part of self-discovery and learning to associate genital stimulation with pleasant sensations. Masturbation is normal if it is private and not highly preferred over most other activities. Avoid shaming your child for masturbating. Rather inform him/her that it is a private act and that no one else should touch their private parts.

Screen Time: Screen Time is any time spent in front of T.V., computer, tablets, or smart phones.

  • Television time and kind of programs watched should be carefully monitored. Violence on TV is linked to aggressive behavior.
  • There is a relationship between the amount of TV watched and a child’s weight. Limit TV to 1 hour daily.
  • Watch shows with your child and use them to stimulate topics of conversation. Discourage programs that are linked with toy sales.
  • Keep TV sets and computers out of the bedrooms..


Discipline at this age is challenging. We recommend that parents reprimand children for bad behavior in private, providing appropriate and clearly stated limits and consequences if rules are broken. Nagging and idle threats by parents are ineffective. Follow through with stated consequences when rules are broken. Social isolation (time out) remains an effective consequence for many children. The positive effects of praise are often more powerful behavior modifiers than negative reinforcement (such comments as “I really like it when you let your friends play with your toys,” or “thank you for waiting quietly while your father and I talked”).

TODAY’S IMMUNIZATIONS/TESTS: Kinrix (DTaP #5, IPV #5) & Proquad (MMR #2, Varivax #2)

(Please see the CDC website for the Vaccine Information Sheet )

It is not uncommon for there to be a delayed reaction by 7-10 days for today’s immunizations. Mark your calendar so that you are not surprised if your child has a fever and/or a rash next week. For the fever, we offer acetaminophen or ibuprofen as needed. The rash typically does not itch or hurt and therefore needs no special treatment.

We will attempt to check vision and hearing though these tests require the cooperation of the child which is sometimes not feasible. If risk factors are present, we will do a PPD (Tuberculosis test), lead test, or cholesterol screen.

Recommended Books:

How to Talk So Kids Will Listen & Listen So Kids Will Talk. Adele Faber.
Setting Limits: How to Raise Responsible, Independent Children by Providing Clear Boundaries. Robert MacKenzie.

NEXT VISIT: Your child’s next routine visit is at 5 years of age.

NEED DAYCARE FORMS? Don’t forget to drop off your health forms at the front desk or submit them after your check-up here.