Anticipatory Guidance 4 Year Checkup


  • Allow 1:1 time for each child in the family
  • Maintain consistent family routine
  • If in pre-school, advocate with teacher for child with school difficulties/bullying

Development and Behavior

  • Encourage child to tell the story his/her way
  • Establish daily chores to develop sense of accomplishment and self-confidence
  • Limit TV/computer time to 1-2 hours/day
  • Show affection/praise for good behaviors
  • Encourage constructive conflict resolution, demonstrate at home
  • Encourage self-dressing and allow to choose own clothing at times
  • Establish consistent limits/rules and consistent consequences
  • Read and discuss story daily


  • Provide nutritious 3 meals and 2 snacks; limit sweets/sodas/high-fat foods

Routine Care

  • Establish routine and assist with tooth brushing with soft brush twice a day
  • Encourage supervised outdoor play for 1 hour/day
  • Establish consistent bedtime routine


  • Lead risk assessment
  • Develop a family plan for exiting house in a fire/establish meeting place after exit
  • Lock up guns
  • No shaking baby (Shaken Baby Syndrome)
  • Provide home safety for fire/carbon monoxide poisoning
  • Provide safe/quality after-school care
  • Supervise when near or in water even if child knows how to swim
  • Teach child parents’ names/home address/telephone numbers
  • Teach how to answer the door/telephone
  • Teach self-safety for personal privacy
  • Teach street safety/running after balls/do not cross alone
  • Use of booster seat in back seat of car if 40 pounds, until 4ft 9in or 8 years old
  • Use of helmet when riding tricycle or bicycle



Last updated February 26, 2015