well child visit milestones

Official websites use .gov

A .gov website belongs to an official government organization in the United States.

Secure .gov websites use HTTPS

A lock ( ) or https:// means you've safely connected to the .gov website. Share sensitive information only on official, secure websites.

Catch Up on Well-Child Visits and Recommended Vaccinations

Many children missed check-ups and recommended childhood vaccinations over the past few years. CDC and the American Academy of Pediatrics (AAP) recommend children catch up on routine childhood vaccinations and get back on track for school, childcare, and beyond.

Making sure that your child sees their doctor for well-child visits and recommended vaccines is one of the best things you can do to protect your child and community from serious diseases that are easily spread.

Well-Child Visits and Recommended Vaccinations Are Essential

Well-child visits and recommended vaccinations are essential and help make sure children stay healthy. Children who are not protected by vaccines are more likely to get diseases like measles and whooping cough . These diseases are extremely contagious and can be very serious, especially for babies and young children. In recent years, there have been outbreaks of these diseases, especially in communities with low vaccination rates.

Well-child visits are essential for many reasons , including:

• Tracking growth and developmental milestones
• Discussing any concerns about your child’s health
• Getting scheduled vaccinations to prevent illnesses like measles and whooping cough (pertussis) and  other serious diseases

It’s particularly important for parents to work with their child’s doctor or nurse to make sure they get caught up on missed well-child visits and recommended vaccines.

Routinely Recommended Vaccines for Children and Adolescents

Getting children and adolescents caught up with recommended vaccinations is the best way to protect them from a variety of   vaccine-preventable diseases . The schedules below outline the vaccines recommended for each age group.

See which vaccines your child needs from birth through age 6 in this easy-to-read immunization schedule.

See which vaccines your child needs from ages 7 through 18 in this easy-to-read immunization schedule.

The  Vaccines for Children  (VFC) program provides vaccines to eligible children at no cost. This program provides free vaccines to children who are Medicaid-eligible, uninsured, underinsured, or American Indian/Alaska Native. Check out the  program’s requirements  and talk to your child’s doctor or nurse to see if they are a VFC provider. You can also find a VFC provider by calling your  state or local health department  or seeing if your state has a VFC website.

COVID-19 Vaccines for Children and Teens

Everyone aged 6 months and older can get an updated COVID-19 vaccine to help protect against severe illness, hospitalization and death. Learn more about making sure your child stays up to date with their COVID-19 vaccines .

• Vaccines & Immunizations

Health Library 15 Month Well-Child Visit

Find another condition or treatment, healthy child development and behavior.

Below are milestones most children will reach between now and 18 months of age. Talk with your doctor at your child’s next well-visit if your child is not yet reaching these milestones or there are skills your child no longer shows each day.

Social and Emotional Milestones

• Moves away from you, but looks to make sure you are close by
• Points to show you something interesting
• Puts their hands out for you to wash them
• Looks at a few pages in a book with you
• Helps you dress them by pushing their arm through the sleeve or lifting up their foot

Language and Communication Milestones

• Tries to say three or more words (besides “mama” or “dada”)
• Follows one-step directions without any gestures, like giving you the toy when you say, “give it to me”

Thinking and Learning Milestones

• Copies you doing chores, like sweeping with a broom
• Plays with toys in a simple way, like pushing a toy car

Physical Development Milestones

• Walks without holding on to anyone or anything
• Scribbles with a crayon
• Drinks from a cup without a lid (may spill sometimes)
• Feeds themselves with their fingers
• Tries to use a spoon
• Climbs on and off a couch or chair without help

Healthy Ways to Help Your Child Learn and Grow

Development.

• Teach your child to talk by using simple words and phrases. Repeat and add to what your child says. Describe feelings and emotions. Read books together and use simple words to talk about the pictures.
• Encourage empathy for others by teaching your child to comfort someone who is sad with a hug or pat on the back.
• Play with puzzles and blocks to encourage problem-solving. Practice throwing, rolling and kicking a ball. Use pretend play toys that require imagination, like dolls or play telephones.
• Nurture independence by letting your child dress and feed themselves.
• Teach your child “wanted behaviors.” Give your child attention and praise when behaving well.
• Tantrums are common at this age. Below are tips to help you manage tantrums:
• Use distraction to stop tantrums when you can.
• Set limits to teach and protect your child, not to punish them. Always tell or show your child what they should do instead.
• Limit the need to say “no” by making your home and yard safe for play.
• Let your child choose between two good options when possible.
• It is normal for your child to be anxious or shy around new people. Be sure to comfort your child.
• Give water and 16–24 ounces of whole milk each day. Avoid sugary drinks like juice.
• Cut food into small pieces to help prevent choking.
• Offer your child three meals and two–three healthy snacks each day. Encourage drinking from a cup and using a spoon or fork. Wean your child from the bottle.
• Toddlers need less food because they don’t grow as fast as babies. Don’t worry if your child is picky or eats inconsistently. Let your child choose between healthy options.
• Your child may sleep up to 12–14 hours in a 24-hour period, including one–two naps during the day.
• Have a consistent routine for bed (bathing, brushing teeth, books, bedtime). The hour before bedtime should be calm. Avoid giving your child a bottle or cup in bed.
• If your child wakes during the night, avoid giving enjoyable attention. Use words to reassure them and give a blanket or toy to hold for comfort.

Digital Media Use

• Limit screen time. Smart phones, tablets and TVs are not recommended for children younger than 2 years of age. Children learn best by talking and playing with others.

Water Safety

• Drowning is silent and can happen quickly. Do NOT leave your child alone near any water (including buckets, bathtubs, toilets, pools, ponds, whirlpools). Install a four-foot-tall fence with a self-closing and self-latching gate around home pools. Learn more about water safety .

Vehicle Safety

• Your child’s car seat should stay rear facing in the backseat until they reach the highest weight or height allowed by the car safety seat manufacturer. Learn more about car seat safety and installation.

Home Safety

• Lock up medicines and cleaning supplies. Save the Poison Help Line number (1-800-222-1222) in all phones.
• Keep small electronics that use button batteries out of reach (for example, remote controls, key fobs, calculators, musical greeting cards, flashing holiday jewelry). Learn more about swallowing hazards.
• Store any guns unloaded and locked in a safe. Keep the ammunition locked separately.

This information is to support your visit with your child’s doctor. It should not take the place of the advice of your pediatrician.

Sources: Centers for Disease Control and Prevention, Bright Futures (4th Edition) by the American Academy of Pediatrics

Last Updated 06/2023

Cincinnati Children’s has primary care services at locations throughout Greater Cincinnati.

Translations

• Japanese Translation
• Spanish Translation

Connect With Us

3333 Burnet Avenue, Cincinnati, Ohio 45229-3026

© 1999-2024 Cincinnati Children's Hospital Medical Center. All rights reserved.

Doctor Visits

Make the Most of Your Child’s Visit to the Doctor (Ages 1 to 4 Years)

Take Action

Young children need to see the doctor or nurse for a “well-child visit” 7 times between ages 1 and 4 years.

A well-child visit (also called a checkup) is when you take your child to the doctor to make sure they’re healthy and developing normally. This is different from visits for sickness or injury.

At a well-child visit, the doctor or nurse can help catch any problems early, when they may be easier to treat. You’ll also have a chance to ask questions about things like your child’s behavior, eating habits, and sleeping habits.

Learn what to expect so you can make the most of each visit.

Well-Child Visits

How often do i need to take my child for well-child visits.

Young children grow quickly, so they need to visit the doctor or nurse regularly to make sure they’re healthy and developing normally.

Children ages 1 to 4 years need to see the doctor or nurse when they’re:

• 12 months old (1 year)
• 15 months old (1 year and 3 months)
• 18 months old (1 year and 6 months)
• 24 months old (2 years)
• 30 months old (2 years and 6 months)
• 3 years old
• 4 years old

If you’re worried about your child’s health, don’t wait until the next scheduled visit — call the doctor or nurse right away.

Child Development

How do i know if my child is growing and developing on schedule.

Your child’s doctor or nurse can help you understand how your child is developing and learning to do new things — like walk and talk. These are sometimes called “developmental milestones.”

Every child grows and develops differently. For example, some children will take longer to start talking than others. Learn more about child development .

At each visit, the doctor or nurse will what new things your child is learning to do. They may also ask how you’re feeling and if you need any support.

Ages 12 to 18 Months

By age 12 months, most kids:.

• Stand by holding on to something
• Walk with help, like by holding on to the furniture
• Call a parent "mama," "dada," or some other special name
• Look for a toy they've seen you hide

Check out this complete list of milestones for kids age 12 months .

By age 15 months, most kids:

• Follow simple directions, like "Pick up the toy"
• Show you a toy they like
• Try to use things they see you use, like a cup or a book
• Take a few steps on their own

Check out this complete list of milestones for kids age 15 months.

By age 18 months, most kids:

• Make scribbles with crayons
• Look at a few pages in a book with you
• Try to say 3 or more words besides “mama” or “dada”
• Point to show someone what they want
• Walk on their own
• Try to use a spoon

Check out this complete list of milestones for kids age 18 months . 

Ages 24 to 30 Months

By age 24 months, most kids:.

• Notice when others are hurt or upset
• Point to at least 2 body parts, like their nose, when asked
• Try to use knobs or buttons on a toy
• Kick a ball

Check out this complete list of milestones for kids age 24 months . 

By age 30 months, most kids:

• Name items in a picture book, like a cat or dog
• Play next to or with other kids
• Jump off the ground with both feet
• Take some clothes off by themselves, like loose pants or an open jacket

Check out this complete list of milestones for kids age 30 months .

Ages 3 to 4 Years

By age 3 years, most kids:.

• Calm down within 10 minutes after you leave them, like at a child care drop-off
• Draw a circle after you show them how
• Ask “who,” “what,” “where,” or “why” questions, like “Where is Daddy?”

Check out this complete list of milestones for kids age 3 years . 

By age 4 years, most kids:

• Avoid danger — for example, they don’t jump from tall heights at the playground
• Pretend to be something else during play, like a teacher, superhero, or dog
• Draw a person with 3 or more body parts
• Catch a large ball most of the time

Check out this complete list of milestones for kids age 4 years . 

Take these steps to help you and your child get the most out of well-child visits.

Gather important information.

Take any medical records you have to the appointment, including a record of vaccines (shots) your child has received.

Make a list of any important changes in your child’s life since the last doctor’s visit, like a:

• New brother or sister
• Serious illness or death in the family
• Separation or divorce — or a parent spending time in jail or prison
• Change in childcare

Use this tool to  keep track of your child’s family health history . This information will help your doctor or nurse know if your child is at risk for certain health problems. 

Ask other caregivers about your child.

Before you visit the doctor, talk with others who care for your child, like a grandparent, daycare provider, or babysitter. They may be able to help you think of questions to ask the doctor or nurse.

What about cost?

Under the Affordable Care Act, insurance plans must cover well-child visits. Depending on your insurance plan, you may be able to get well-child visits at no cost to you. Check with your insurance company to find out more.

Your child may also qualify for free or low-cost health insurance through Medicaid or the Children’s Health Insurance Program (CHIP). Learn about coverage options for your family.

If you don’t have insurance, you may still be able to get free or low-cost well-child visits. Find a health center near you and ask about well-child visits.

To learn more, check out these resources:

• Free preventive care for children covered by the Affordable Care Act
• How the Affordable Care Act protects you and your family
• Understanding your health insurance and how to use it [PDF - 698 KB]

Ask Questions

Make a list of questions you want to ask the doctor..

Before the well-child visit, write down a few questions you have. This visit is a great time to ask the doctor or nurse any questions about:

• A health condition your child has (like asthma or an allergy)
• Changes in sleeping or eating habits
• How to help kids in the family get along

Here are some questions you may want to ask:

• Is my child up to date on vaccines?
• How can I make sure my child is getting enough physical activity?
• Is my child at a healthy weight?
• How can I help my child try different foods?
• What are appropriate ways to discipline my child?
• How much screen time is okay for young children?

Take notes so you can remember the answers later.

Ask what to do if your child gets sick. 

• Make sure you know how to get in touch with a doctor or nurse when the office is closed.
• Ask how to reach the doctor on call — or if there's a nurse information service you can call at night or during the weekend. 

What to Expect

Know what to expect..

During each well-child visit, the doctor or nurse will ask you questions about your child, do a physical exam, and update your child's medical history. You'll also be able to ask your questions and discuss any problems you may be having.

The doctor or nurse will ask questions about your child.

The doctor or nurse may ask about:

• Behavior: Does your child have trouble following directions?
• Health: Does your child often have stomachaches or other kinds of pain?
• Activities: What types of pretend play does your child like? What toys or other things do they most like playing with?
• Eating habits: What does your child eat on a normal day?
• Family: Have there been any changes in your family since your last visit?
• Learning: What’s something new your child learned recently?

They may also ask questions about safety, like:

• Does your child always ride in a car seat in the back seat of the car? 
• Does anyone in your home have a gun? If so, is it unloaded and locked in a place where your child can’t get it?
• Is there a swimming pool or other water around your home? Is there a locked door or gate to keep your child from getting to the pool without an adult?
• What steps have you taken to childproof your home? Do you have gates on stairs and latches on cabinets?
• Does everyone who cares for your child know when and how to call Poison Control (1-800-222-1222)?

Your answers to questions like these will help the doctor or nurse make sure your child is healthy, safe, and developing normally. Be honest, even if you’re worried you’re doing something wrong — the doctor or nurse is there to help you.

Physical Exam

The doctor or nurse will also check your child’s body..

To check your child’s body, the doctor or nurse will:

• Measure your child’s height and weight
• Check your child’s blood pressure
• Check your child’s vision
• Check your child’s body parts (this is called a physical exam)
• Give your child any vaccines they need

Learn more about your child’s health care:

• Find out how to get your child’s shots on schedule
• Learn how to take care of your child’s vision

Content last updated July 10, 2024

Reviewer Information

This information on well-child visits was adapted from materials from the Centers for Disease Control and Prevention and the National Institutes of Health.

Reviewed by:

Sara Kinsman, MD, PhD Director, Division of Child, Adolescent, and Family Health Maternal and Child Health Bureau Health Resources and Services Administration (HRSA)

You may also be interested in:

Help Your Child Stay at a Healthy Weight

Take Care of Your Child's Teeth

Healthy Snacks: Quick Tips for Parents

The office of disease prevention and health promotion (odphp) cannot attest to the accuracy of a non-federal website..

Linking to a non-federal website does not constitute an endorsement by ODPHP or any of its employees of the sponsors or the information and products presented on the website.

You will be subject to the destination website's privacy policy when you follow the link.

The 2-Year-Old Checkup

Medically reviewed to ensure accuracy.

The physical checkup

Developmental milestones, more about your toddler, 2-year-old vaccines, questions to ask your doctor.

Believe it or not, the time of frequent well-baby visits is coming to an end. After taking your child for another appointment around her half birthday (when she's 30 months old), you'll book a 3-year checkup . Trusted Source American Academy of Pediatrics AAP Schedule of Well-Child Care Visits See All Sources [3] From then on, it’s just a single yearly visit.

About What to Expect

Popular articles, tools & registry.

A Comprehensive Guide to Well-child Visits

Schedule online or call to make an appointment.

• Norton Children’s Pediatricians
• FAQs: Back-to-School Physicals and Sports Physicals
• Pediatrician Offices
• Flu in Children
• Child Development Milestones From Birth Through Age 18
• Recommended Vaccines for Kids From Birth to 18 Years
• Parent & Baby Care Resources
• New Parents: Frequently Asked Questions
• New Parent Classes

The Importance of Well-child Visits at Every Age

Norton children’s medical group.

Keep on top of your child’s health by scheduling a well-child visit today. Our pediatrician offices are conveniently located across Kentucky and Southern Indiana.

Book your appointment directly by choosing a location or provider.

Every parent wants to know that their child is growing and healthy. A well-child visit is a crucial part of every child’s health care journey, from the time they are born until they reach adulthood.

A well-child visit is a regularly scheduled health check up with your child’s pediatrician . These appointments serve many important purposes. They focus on your child’s overall health, preventive care, growth and developmental milestones, immunizations, plus serve as a time for parents to discuss any questions or concerns they may have about their child’s health or parenting. These visits also can help catch any potential health issues early and connect your child with additional support if needed for specific physical or mental health concerns. Building a strong relationship with a pediatrician is an important part of your child’s health care journey. Pediatricians are specially trained to focus on children’s health. They will conduct physical and mental health screenings, along with a full physical health assessment, and offer medical guidance to your child and family. The benefit of your child seeing a pediatrician is the continuity it provides of your child seeing the same doctor(s) as they grow up.

Well-child visits may seem like a routine part of your child’s growth, but they play an important role in their overall health care, including their physical, mental, social and emotional well-being. How often you need to schedule your child’s well-child visits will vary based on their age and developmental needs.

During a baby’s first year, they grow rapidly and will require more frequent visits with the pediatrician to ensure they are reaching their developmental milestones on time. Toddlers will continue to see their pediatrician at regular intervals throughout the year, and young children will need to check in with their pediatrician at least once a year. The full well-child visit schedule recommended by the American Academy of Pediatrics, is listed below:

By becoming a part of your family’s medical home, the pediatricians with Norton Children’s Medical Group , can get to know your family on an individual basis, become familiar with your child’s health care needs and unique personality, plus offer the best tools, information and guidance to empower every child and parent to live a healthy lifestyle.

Although well-child visits, on their own, are not legally mandated, health physicals often are required for entry into school or day care and for participation in sports. Many state laws require these types of health check ups and immunizations for school children, and the well-child visit can serve as a great time to complete these requirements with a health care professional. Regularly scheduled check ups with your child’s pediatrician are strongly recommended by medical professionals to make sure your child receives the proper care at every stage of their growth.

During your child’s visit, you can expect your pediatrician to do the following:

• The pediatrician will perform a thorough physical exam to assess your child’s general health, growth and any potential physical concerns. This includes regular screenings for physical and mental health issues.
• Observing your child’s developmental progress and behavior helps identify any developmental delays or behavioral issues.
• The pediatrician provides guidance on proper nutrition and feeding practices tailored to your child’s age and needs.
• Updating your child’s medical history and sharing any family health history helps the pediatrician make informed decisions about your child’s care.
• Well-child visits include getting recommended vaccinations to protect your child from various diseases. Keeping vaccinations up to date is crucial for their health and safety.
• Well-child visits provide a place for you to ask questions, share concerns and seek guidance on parenting, health and development.
• Having a record of your child’s medical history and vaccinations helps ensure accurate and effective care.
• If your child is a patient at one of our pediatrician offices, parents or guardians have proxy access to the child’s Norton MyChart account to review medical history and immunization records.
• Inform the pediatrician about any medications your child takes. It helps to bring the specific prescription bottles to confirm the name and dosage of the medications.
• Sharing recent health changes or concerns (both physical and mental) ensures that the pediatrician has the most up-to-date information to provide appropriate care.
• Mention any developmental milestones your child has reached since the last visit or if they have experienced any backslides.
• Bringing a notebook and pen or device (such as the Notes app or voice recorder on your phone) to take notes on the pediatrician’s recommendations and advice helps you remember and put their guidance into practice.
• Many insurance plans cover well-child visits as preventive care. At Norton Children’s Medical Group, we accept Medicaid and most commercial insurance plans.
• Understanding your coverage helps you plan financially. Confirming your insurance coverage before the visit helps you avoid unexpected expenses. Staying within your insurance network can help minimize out-of-pocket costs for well-child visits.

Well-child check ups are more than just routine appointments. They are a cornerstone for monitoring and supporting your child’s overall health and development. It is important to follow the recommended well-child visit schedule to ensure your child’s pediatrician can screen them for any health issues, provide necessary preventive care and immunizations, and give them the physical and mental support they need to achieve optimal health. It’s also a time for parents to receive support and helpful information from the pediatrician. Prioritizing your child’s health can help set them up for a brighter, healthier and happier future. Building a strong relationship with a pediatrician can help encourage more positive health care experiences and better long-term health later in life.

Benefits of Norton Children’s Medical Group

• Convenient locations with more than 25 pediatrician offices in Louisville and surrounding areas in Kentucky and Southern Indiana
• New patients can be seen within 24 hours
• Same-day sick appointments are available
• Schedule appointments online, get appointment reminders, communicate with your child’s medical provider, view and request immunization records, refill prescriptions and more through your free Norton MyChart account
• Night and weekend hours are available
• Access to Norton Children’s After Hours Care and the after-hours nurse care line
• Medicaid and most major commercial insurance plans accepted

Related Stories

How do I limit screen time for kids?

Norton Healthcare, Norton Children’s expanding care in Bowling Green

Norton Healthcare, Norton Children’s expand services in Westport Plaza

Genetic tests provided as part of study for kids referred for possible autism

Internet Explorer Alert

It appears you are using Internet Explorer as your web browser. Please note, Internet Explorer is no longer up-to-date and can cause problems in how this website functions This site functions best using the latest versions of any of the following browsers: Edge, Firefox, Chrome, Opera, or Safari . You can find the latest versions of these browsers at https://browsehappy.com

• Publications
• HealthyChildren.org

Shopping cart

Order Subtotal

Your cart is empty.

Looks like you haven't added anything to your cart.

• Career Resources
• Philanthropy
• About the AAP
• The Pediatrician's Role in Preventing Child Maltreatment
• AAP Report: Pediatric Practices Play Vital Role in Preventing Child Maltreatment
• Child Abuse and Neglect: What Parents Should Know
• AAP - Child Maltreatment can be Prevented
• News Releases
• Policy Collections
• The State of Children in 2020
• Healthy Children
• Secure Families
• Strong Communities
• A Leading Nation for Youth
• Transition Plan: Advancing Child Health in the Biden-Harris Administration
• Health Care Access & Coverage
• Immigrant Child Health
• Gun Violence Prevention
• Tobacco & E-Cigarettes
• Child Nutrition
• Assault Weapons Bans
• Childhood Immunizations
• E-Cigarette and Tobacco Products
• Children’s Health Care Coverage Fact Sheets
• Opioid Fact Sheets
• Advocacy Training Modules
• Subspecialty Advocacy Report
• AAP Washington Office Internship
• Online Courses
• Live and Virtual Activities
• National Conference and Exhibition
• Prep®- Pediatric Review and Education Programs
• Journals and Publications
• NRP LMS Login
• Patient Care
• Practice Management
• AAP Committees
• AAP Councils
• AAP Sections
• Volunteer Network
• Join a Chapter
• Chapter Websites
• Chapter Executive Directors
• District Map
• Create Account

• Materials & Tools
• Clinical Practice
• States & Communities
• Quality Improvement
• Implementation Stories

Bright Futures Resources for Families

The resources below can help you protect and promote your child's health by increasing your knowledge of children's health issues, providing assistance on partnering with health care providers, and linking you to helpful organizations and tools. ​

The Well-Child Visit: Why Go and What to Expect  

Consistent with the Bright Futures Guidelines, tips written in plain language for parents of children and teens of all ages to help prepare them for their well-child visits. This tip sheet is available in English and Spanish .

• HealthyChildren.org is the official American Academy of Pediatrics Web site for parents. Backed by 66,000 pediatricians, HealthyChildren.org offers general information about children's health as well as specific guidance on parenting issues. Parents can find information on their child's ages and stages, healthy living, safety and prevention, family life, and health issues, as well as newsletters and interactive tools like the KidsDoc Symptom Checker ​, Ask the Pediatrician , and the Physical Developmental Delays: What to Look For Too​l ​​​​.
• The Screening Technical Assistance & Resource (STAR) Center is part of the Screening in Practices Initiative that envisions a system of care in which every child receives the screening, referral, and follow-up needed to foster healthy development. A family video was recently produced to highlight the positive impact that screening, referral, and follow-up can have on a family in need.
• The National Center for Family/Professional Partnerships offers information on how to connect with the Family-to-Family Health Information Center (F2F HIC) in your state. These family-staffed organizations provide support, information, resources, and training to families of children and youth with special health care n​eeds. For example, F2F HICs provide assistance to families and professionals in navigating health care systems; guidance on health programs and policy; and collaboration with other F2F HICs, family groups, and professionals.
• The Well-Visit Planner creates a personalized visit guide for parents or guardians of children ages 4 months to 3 years old who are scheduled to have a well-child visit. Families answer questions about their children's health and pick what they want to talk about at their next visit. The Planner then makes a printable guide that families can bring to the visit and use with the doctor. The tool was developed by the Child and Adolescent Health Measurement Initiative and is based on Bright Futures Guidelines, with support from the Maternal and Child Health Bureau, Health Resources and Services Administration.
• Bright Futures Activity Book, 2nd Edition ​ provides a fun, informative, and interactive overview of the 12 Bright Futures themes that can be explored together by children and their parents. It is in English and Spanish.
• Bright Futures at Georgetown *​ offers family and professional tools and materials including:
• Information on what to expect and when to seek help
• Health record forms
• Nutrition fact sheets​ *Many of these resources are available in both English and Spanish
• Milestone Tracker Mobile App - Track your child’s milestones from age 2 months to 5 years. Share your child’s summary with your pediatrician, get tips for encouraging your child’s development, and find out what to do if you ever become concerned about how your child is developing.​
• Milestones in Action - Check out photos and videos demonstrating milestones from 2 months to 5 years of age. This library was created by CDC to help parents learn about typical developmental milestones.​
• Milestone checklist ​ - You can celebrate your child’s milestones by tracking them with a free milestone checklist and sharing it with your child’s doctor.
• How to Help Your Child/How to Talk to the Doctor
• Learn the Signs. Act Early.​​​​​
• Developmental Milestones​
• Essentials ​for Parenting Toddlers and Preschoolers​
• Positive Parenting Tips
• The Medical Home and Head Start Working Together
• Caring Connections Podcast
• Early Childhood Health and Wellness​​​
• Engaging Fathers ​
• Family Support & Well-being​
• Parenting Your Child
• Health Tips for Families​​​​
• Parents as Teachers is an evidence-based home visiting model that promotes the optimal early development, learning, and health of children by supporting and engaging parents and caregivers. As part of their resources, Parents as Teachers produced a podcast series called Intentional Partnerships where each episode offers a real-world perspective from people exploring shared values around family engagement
• The QuestionBuilder App from the Agency for Healthcare Research and Quality (AHRQ) helps parents and caregivers prepare for medical appointments and maximize time during the visit. The app is available at no cost through the Appl​e App store and Google Play . Access a one-page handout about the QuestionBuilder App.

Last Updated

American Academy of Pediatrics

Ages & Stages

Your checkup checklist: 4 years old.

​​​​​​​​​A 4-year-old engages the world with endless curiosity. Then, they may tell you a story all about it or ask a zillion questions. This is the age of why, what, when and how?

At 4 years old, your child feels "grown up." They typically can get dressed and undressed and go to the bathroom (though they still may not have control at night). They are curious about their bodies and start to want some privacy.

Most kids this age can identify emotions, even nuanced feelings like anxiety and joy, in themselves and others. They comfort others who look sad and like to be helpers. They may respond well to praise and clearly stated rules. But they're also eager to explore boundaries. How far can they walk away from a caregiver before being chased? How many toys can they get away with taking from a sibling ?

Your 4-year-old needs to use up energy by running, climbing, swinging and jumping. But they also need time to rest, play quietly and use their imaginations . Make-believe and dress-up are important for this age. Media and technology have strong appeal and should be used wisely .

What to expect at the 4-year well-child visit

Your 4-year-old will probably participate more in this check-up visit than in the past. The pediatrician will ask them more questions directly. This helps gain your child's cooperation and shows that they've reached some milestones. They may ask if your child brushes their teeth , or what they like to draw or about a favorite story. The doctor will also focus on helping you provide your child a safe, secure ​environment. In addition, they may talk with you about school readiness ,  healthy nutrition and habits,  screen time  and injury prevention .

Here's what else to expect at this visit:

✅ immunizations.

Between the ages of four and six, your child will need several booster shots. They will receive the fifth dose of the DTaP (diphtheria, tetanus, and acellular pertussis), fourth dose of the polio , second dose of the MMR (measles, mumps, and rubella)​ and second dose of the varicella (chickenpox) vaccines.

Your pediatrician will recommend the influenza (flu) vaccine during flu season, and talk about the latest COVID-19 guidelines. You can use these tips​  to make getting a shot less stressful. See " Vaccines Your Child Needs by Age 6 ."

✅ Health Screenings

A full physical exam will be performed along with hearing , vision  and oral health screenings. The vision screening likely will involve an eye chart. The pediatrician also will assess fine and gross motor skills , and observe your child's speech for any difficulties. If a patient is at risk for things like lead exposure or other conditions, your child will be screened for those.

As in last year's visit, pediatricians may take time to address possible needs like having adequate food and being around safe people.​If needed, your doctor can provide community resources offering housing, food and social support.

Questions your pediatrician may ask

Has your child received any specialty or emergency care since the last visit? Or, has your child or anyone in the family developed a new health condition?

Violence has become common in people's lives; do you feel safe in your home?

Can your child go to the bathroom by themselves? Are there any issues around pooping ?

What are your child's likes and dislikes?

Are you concerned about anyone in your home smoking , drinking or using drugs?

✅Developmental Screenings

Your child's play , speech, learning, and movement all are expressions of their growing developmental skills . Most 4-year-olds pretend to be someone or something else, like a teacher or a dog, during play . They can repeat parts of a story or song, and tell you what comes next if they've heard it often. They can answer questions that explain something, like: What is a coat for?

As language skills continue to develop, speech challenges like repetitions of whole words, false starts and stuttering are normal. Never hurry a child to respond because it can increase stuttering. Most  ​outgrow these patterns , but if a child stutters for more than six months, they should be taken for an evaluation.

Children this age can have big feelings , which make them sensitive. They can be easily encouraged or hurt by what others say and do. You can teach your child coping skills by modeling behaviors like apologizing and being respectful of others. Know that nightmares and night terrors are common at this age.

To explore developmental milestones ,  use our motor skills tool . Be sure to share any concerns with your pediatrician. They can offer next steps like a possible referral for further evaluations or an early intervention program.

Does your child understand concepts like "same" and "different?" Can they follow 2- to 3-step instructions?

What do you do when your child is upset?

Can your child get dressed and undressed?

Can they serve themselves food and water?

How is preschool? What does your child like to do there?

Does your child draw a person with three body parts? Can they  ​hold a crayon or pencil ​using fingers and thumb, rather than a fist?

Does your family have a  media use plan ?

Questions you may have

What can I do with my child at this age ?

My child isn't toilet trained . Is that normal ? How about wetting the bed ?

Should I limit screen time ?

What can I do to help calm my child when they're sad or upset?

Is my child ready for school ? Is my child ready to read ?

My child has nightmares . What can I do?

Does my child still need a nap ?

My child is stuttering . Do they need to be evaluated?

✅Feeding & Healthy Nutrition

Like last year, 4-year-olds often have a reduced appetite. That's because they have a slower growth rate at this age. If your child refuses food, they likely aren't hungry. In fact, encouraging a child to eat often means extra unneeded calories. Provide healthy options , especially fruits and vegetables, in appropriate amounts at regular times through the day. Then, let your child decide how much to eat. Minimize foods and drinks high in added sugars​ and saturated fat and low in nutrients. Also, don't prepare substitute foods to entice them to eat because that encourages picky eating .

What did you have for dinner last night?

What snacks do you offer your child?

What does your child drink each day? How much water and milk ?

What should my child be eating ?

My child refuses to drink milk . Does that matter?

What should my child drink ?

My child is picky . What can I do?

The 4-year-old child feels more independent but still needs supervision . They are not ready to cross the street alone, must be watched during outside play, and watched around water. Parents should constantly evaluate the safety of their child's environment. Children should continue to use car seats, using a 5-point harness as long as possible. Most 4-year-olds aren't yet big enough for a booster seat.

Is your community safe for outdoor play?

Do you have a plan for how often your child can use media?

Who watches your child when you cannot?

Is there a firearm in your home or the homes of others where your child might play?

How are you practicing pool and water safety?

When will my child be ready for a booster seat ?

How should I teach my child to safely be around dogs ?

What do I do in a dental emergency ?

✅ Communication Tips

Your pediatrician's top priority is to attend to your concerns. They may refer you to care elsewhere if it is after hours or if a specialist is needed. Pediatricians also can refer you to resources available in your community.

More information

• Safety for Your Child: 2 to 4 Years
• Social Development in Preschoolers
• Creating Positive Experiences With Your Preschooler
• How to Shape & Manage Your Young Child's Behavior
• CDC 4-year-old Milestone Checklist ​

An official website of the United States government Here’s how you know

Official websites use .gov A .gov website belongs to an official government organization in the United States.

Secure .gov websites use HTTPS A lock ( Lock A locked padlock ) or https:// means you’ve safely connected to the .gov website. Share sensitive information only on official, secure websites.

Well-Child Care

Improving infant well-child visits.

High-quality well-child visits can improve children’s health, support caregivers’ behaviors to promote their children’s health, and prevent injury and harm. The American Academy of Pediatrics and Bright Futures recommend nine well-care visits by the time children turn 15 months of age. These visits should include a family-centered health history, physical examination, immunizations, vision and hearing screening, developmental and behavioral assessment, an oral health risk assessment, a social assessment, maternal depression screening, parenting education on a wide range of topics, and care coordination as needed. i  When children receive the recommended number of high-quality visits, they are more likely to be up-to-date on immunizations, have developmental concerns recognized early, and are less likely to visit the emergency department. ii , iii , iv , v , vi , vii  However, many infants do not receive the recommended number of infant well-child visits. 

The Centers for Medicare & Medicaid Services (CMS) offers quality improvement (QI) technical assistance (TA) to help states increase the attendance and quality of well-child visits for Medicaid and Children’s Health Insurance Program (CHIP) beneficiaries ages 0 to 15 months.

QI TA resources , to help state Medicaid and CHIP staff and their QI partners get started improving the use of infant well-child visits for their beneficiaries

Improving Infant Well-Child Visit learning collaborative resources , to share different approaches to improving well-child visit care and state examples

For more information on these materials and other QI TA, please email [email protected] .

QI TA Resources

These resources can help states get started in developing their own infant well-child QI projects:

Getting Started on Quality Improvement Video . This video provides an overview of how Medicaid and CHIP agencies can start a QI project to improve the use of infant well-child visits. The Model for Improvement begins with small tests of change, enabling state teams to “learn their way” toward strong programs and policies.

Driver Diagram and Change Idea Table . A driver diagram is a visual display of what “drives” or contributes to improvements in infant well-child visits. This example of a driver diagram shows the relationship between the primary drivers (the high-level elements, processes, structures, or norms in the system that must change to use and quality of infant well-child visits) and the secondary drivers (the places, steps in a process, time-bound moments, or norms in which changes are made to spur improvement). The document also includes change idea tables, which contain examples of evidence-based or evidence-informed QI interventions to improve the use of infant well-child care. The change ideas were tailored for Medicaid and CHIP.

Measurement Strategy . This document provides examples of measures that can be used to monitor infant well-child care QI projects.

Improving Infant Well-Child Visits: Learning Collaborative Resources

Beginning in 2021, CMS facilitated the two year Infant Well-Child Visit learning collaborative to support state Medicaid and CHIP agencies’ efforts to improve the use of infant well-child visits from 0-15 months of age. The learning collaborative included a webinar series and an affinity group to support state Medicaid and agencies’ quality improvement efforts. The webinars, listed and linked to below, described approaches that states can use to improve attendance and quality of infant well-child visits.

California, Missouri, North Carolina, South Carolina, Texas and Virginia participated in the action-oriented affinity group where teams designed and implemented an infant well-child quality improvement (QI) project in their state with tailored TA from CMS. Learnings from participating states can be found in the state highlights brief.

Learning Collaborative Webinar Series

State Spotlights Webinar on Improving Infant-Well Child Care ( Video ) ( Transcript ). This 2024 webinar spotlighted several state QI projects from the affinity group, highlighting their strategies, partnerships, and lessons learned.

Using Payment, Policy and Partnerships to Improve Infant Well-Child Care ( Audio )( Transcript ). This August 2021 webinar focused on Medicaid and CHIP payment incentives, managed care contracts, and other strategies that can increase the use and quality of infant well-child visits and advance equity. Speakers from the CMS and Mathematica introduced CMS’ Maternal and Infant Health Initiative and shared the importance of high-quality well-child visits and the opportunities within Medicaid and CHIP to impact infant health. Speakers from Pennsylvania and Texas’ Medicaid and CHIP agencies described their efforts to expand and incentivize participation in infant well-child visits, such as through value-based purchasing, performance improvement projects, CHIP Health Services Initiatives (HSIs), and partnerships with aligned service providers like the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). State presenters offered insights into ways to incentivize efforts to close gaps in care, engage families, and improve performance on quality measures. During the Q&A session, presenters discussed the impact of the COVID-19 pandemic on well-child care, the potential of using telehealth or hybrid visits to increase access, and incentives for managed care entities, and addressing the social determinants of health in value-based payment strategies.

  Improving Quality and Utilization of Infant Well-Child Visits ( Audio )( Transcript ). This September 2021 webinar focused on the characteristics of a high-performing system of well-child health care. CMS and Mathematica presenters shared the Maternal and Infant Health Initiative’s Theory of Change. Speakers from Washington and Arkansas Medicaid and CHIP agencies discussed how their states have achieved high rates of participation in infant well-child visits and how they use data to monitor performance and disparities and ensure access to services. Washington shared insights on leveraging collaborative performance improvement projects to identify and address barriers to care. Arkansas discussed the state’s per member per month incentives for performance and minimum performance measures for infant well-child visit rates. During the Q&A session, presenters highlighted efforts to improve health equity, engage parents and providers, and leverage performance measures and quality tools to improve attendance at infant well-child visits.

Models of Care that Drive Improvement in Infant Well-Child Visits ( Audio )( Transcript ). In this September 2021 webinar, three states—Oregon, Michigan, and North Carolina—shared approaches to designing and implementing models of care associated with improved infant well-child visit participation, including patient-centered medical homes (PCMHs) and home visiting. States offered insights on the importance of strategic alignment of policies, processes, and partnerships. Oregon discussed its home visiting program and quality incentive strategy for its coordinated care organizations. The state incentivizes progress on the HEDIS measures and other measures designed by the state’s Pediatric Improvement Partnership, including a measure of social-emotional health service capacity and access for infants and children. Michigan discussed how they requires MCOs to identify and publish disparities in well-child visit rates and how they encourage plans to reduce disparities. The state also uses an algorithm that automatically assigns members to MCOs based on MCOs’ performance and reimburses for maternal-infant health home visiting. North Carolina shared its Keeping Kids Well program, which aims to increase well-child visit and immunization rates and reduce disparities in those rates. The program offers coaches to practices to support their improvements, established an advisory board of key interested parties, and provides customized vaccination notices for practices to distribute to beneficiaries, in partnership with health systems and pharmaceutical companies. The state also used the Healthy Opportunities payment to incentivize the identification and redress of health-related social needs and provided the Health Equity Payment to providers serving areas with high poverty rates. 

i 3 Hagan, J.F., J.S. Shaw, and P.M. Duncan (eds.). Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents. 4th ed. Elk Grove Village, IL: American Academy of Pediatrics, 2017.

ii Gill, J.M., A. Saldarriaga, A.G. Mainous, and D. Unger. “Does Continuity Between Prenatal and Well-Child Care Improve Childhood Immunizations?” Family Medicine, vol. 34, no. 4, April 2002, pp. 274–280.

iii Buchholz, M., and A. Talmi. “What We Talked About at the Pediatrician’s Office: Exploring Differences Between Healthy Steps and Traditional Pediatric Primary Care Visits.” Infant Mental Health Journal, vol. 33, no. 4, 2012, pp. 430–436.

iv DeVoe, J.E., M. Hoopes, C.A. Nelson, et al. “Electronic Health Record Tools to Assist with Children’s Insurance Coverage: A Mixed Methods Study.” BMC Health Services Research, vol.18, no. 1, May 2018, p. 354–360.

v Coker, T.R., S. Chacon, M.N. Elliott, et al. “A Parent Coach Model for Well-Child Care Among Low-Income Children: A Randomized Controlled Trial.” Pediatrics, vol. 137, no. 3, March 2016, p. e20153013.

vi Flores, G., H. Lin, C. Walker, M. Lee, J. Currie, R. Allgeyer, M. Fierro, M. Henry, A. Portillo, and K. Massey. “Parent Mentoring Program Increases Coverage Rates for Uninsured Latino Children.” Health Affairs, vol. 37, no. 3, 2018, pp. 403–412.

vii Hakim, R.B., and D.S. Ronsaville. “Effect of Compliance with Health Supervision Guidelines Among US Infants on Emergency Department Visits.” Archives of Pediatrics & Adolescent Medicine, vol. 156, no. 10, October 2002, pp. 1015–1020.