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Milestones for 4-Year-Olds

Overview

Children usually progress in a natural, predictable sequence from one developmental milestone to the next. But each child grows and gains skills at their own pace. Some children may be advanced in one area, such as language. But they may be behind in another area, such as sensory and motor development.

Milestones usually are grouped into five major categories: physical growth, cognitive development, emotional and social development, language development, and sensory and motor development.

Physical growth and development

Most children by age 4:

  • Have gained about 4 lb (2 kg) and grown about 3 in. (8 cm) since their third birthday.

Go to www.cdc.gov/growthcharts to see the high and low percentiles for normal weight and growth.

Thinking and reasoning (cognitive development)

Most children by age 4:

  • Can say their first and last names.
  • Understand the concept of counting. They may know some numbers.
  • Better understand concepts of time.
  • Can name some colors.
  • Understand the difference between things that are the same and things that are different.
  • Are aware of their own gender and can identify the gender of others.
  • Understand that events are connected. But their interpretation may not always be logical. For example, a child may understand the logic that glass may break if hit with a rock. But a child may still throw the rock thinking that it won't break this time (magical thinking).
  • Know the difference between fantasy and reality. But they still play "pretend," which becomes increasingly inventive. They also may blur fantasy and reality when they are stressed or have extreme emotions. They may form new fears as a result of their active imaginations.

Emotional and social development

Most children by age 4:

  • View themselves as whole people, with a body, mind, and feelings.
  • Are aware that they can be hurt physically, which sometimes causes them to be very sensitive about their bodies.
  • Are interested in new experiences.
  • Cooperate with other children. And, with help, they can negotiate solutions to conflicts.
  • Switch between being demanding and cooperative.
  • Dress and undress themselves.
  • Pretend to be a mom or dad during play.
  • Are noticeably more independent.

Language development

Most children by age 4:

  • Use sentences of 5 to 6 words.
  • Speak clearly enough for strangers to understand them.
  • Can describe something that has happened to them.
  • Sing songs.
  • Tell a short story as well as recall parts of a story.

Sensory and motor development

Most children by age 4 can:

  • Stand on one foot.
  • Move forward and backward easily.
  • Go up and down stairs without holding on to anything for support.
  • Ride a tricycle or a bicycle with training wheels.
  • Throw a ball overhand and sometimes catch a bounced ball. They also can kick a ball forward.

By age 4, most children can use their hands and fingers (fine motor skills) to:

  • Build a tower of 10 blocks.
  • Draw a circle and squares.
  • Draw a person with 2 to 4 parts.
  • Use scissors.
  • Write some capital letters.

Credits

Current as of: October 24, 2023

Author: Ignite Healthwise, LLC Staff
Clinical Review Board
All Healthwise education is reviewed by a team that includes physicians, nurses, advanced practitioners, registered dieticians, and other healthcare professionals.

Current as of: October 24, 2023

Author: Ignite Healthwise, LLC Staff

Clinical Review Board
All Healthwise education is reviewed by a team that includes physicians, nurses, advanced practitioners, registered dieticians, and other healthcare professionals.

Dear patient

I am excited to announce that I will be relocating my practice to Houston Methodist DeBakey Cardiology Associates. Starting November 4, 2024, my new address will be:

Houston Methodist DeBakey Cardiology Associates
6550 Fannin St.
Smith Tower, Suite 1901
Houston, TX 77030

Please note that my phone number and fax number will also change to the following:
24-Hour Telephone: 713-441-1100
Fax: 713-790-2643
Clinical Support Telephone (M-F, 8-5): 713-441-3515

I am excited about caring for you in my new office and hope you will make the transition with me. I will also continue to refill your medications as I have in the past. To assist, please provide your pharmacy with my new contact information.

Please consider checking your prescription refills to verify that you have enough medication on hand to last you until your next visit. Please note that your medical records will remain at my former office until you authorize their transfer. If you choose for me to continue providing your medical care, please complete and sign the enclosed “Authorization for Release of Medical Records” form and fax it to 713-790-2643. Once we receive your authorization, we will be happy to process the request for you.

Thank you for entrusting me with your medical care. My new team and I are dedicated to making this transition as seamless as possible. For help scheduling an appointment and transitioning your care, please call my new office number above.

I look forward to continuing your care at my new location.

Sincerely,
Gopi A. Shah, MD

Dear patient

Dr. Albert Raizner, Dr. Michael Raizner, and Dr. Mohamed El-Beheary are excited to announce that our practice, Houston Cardiovascular Associates, will merge with Houston Cardiovascular Associates on November 1, 2024.

Our new offices are similarly located in Houston, near the Texas Medical Center and in Sugar Land. Our in-hospital care will continue at Houston Methodist Hospital in the Texas Medical Center and Houston Methodist Sugar Land Hospital. Importantly, our new offices expand our services with state-of-the-art equipment and amenities. Our core values will always be, as they began over 40 years ago when Dr. Albert Raizner founded HCA:

Integrity – Compassion – Accountability

Our new address and contact information are:

Your medical records are confidential and remain available at our new locations. We consider it a privilege to serve as your cardiologists and look forward to your continuing with us. However, should you desire to transfer to another physician, you may request a copy of your records by contacting us at our new addresses and phone numbers listed above.

We thank you for your trust and loyalty. As always, we will continue to be here to take care of you. Please do not hesitate to contact us if you have any questions or concerns.

Sincerely,

Dr. Albert Raizner,
Dr. Michael Raizner,
Dr. Mohamed El-Beheary