Definition

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

Alternative Names

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

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.