There are skills and growth markers expected in a typical 4-year-old child. These milestones are physical and mental developments considered normal for this age group.

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 per day
• Grows to a height that is double the length at birth
• Shows improved balance
• Hops on one foot without losing balance
• Throws a ball overhand with coordination
• Can cut out a picture using scissors
• May not be able to tie shoelaces
• May still wet the bed (normal)

SENSORY AND COGNITIVE

The typical 4-year-old:

• Has a vocabulary of more than 1,000 words
• Easily composes sentences of four or five words
• Can use the past tense
• Can count to four
• Will ask the most questions of any age
• May use words that aren't fully understood
• May begin using vulgar terms, depending on their exposure
• 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 distinguish between two objects based on simple criteria such as size and weight
• Lacks moral concepts of right and wrong
• Is rebellious if expectations are excessive

PLAY

As the parent of a 4-year-old, you should:

• Encourage and provide the necessary space for physical activity
• Instruct the child on how to participate in, and follow the rules of sporting activities
• Encourage play and sharing with other children
• Encourage creative play
• Teach children to do small chores, such as setting the table
• Read together
• Monitor both the time and content of television viewing (preferably less than 1.5 hours of TV, no more than 3 hours maximum)
• Expose the child to different stimuli by visiting local areas of interest

Feigelman S. The preschool years. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 10.