Bright Futures Parent Handout: 4 Year Visit


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Here are some suggestions from Bright Futures experts that may be of value to your family.

How Your Family is Doing

  • Stay involved in your community. Join activities when you can.

  • If you are worried about your living or food situation, talk with us. Community agencies and programs such as WIC and SNAP can also provide information and assistance.

  • Don't smoke or use e-cigarettes. Keep your home and car smoke-free. Tobacco-free spaces keep children healthy.

  • Don't use alcohol or drugs.

  • If you feel unsafe in your home or have been hurt by someone, let us know. Hotlines and community agencies can also provide confidential help.

  • Teach your child about how to be safe in the community.

    • Use correct terms for all body parts as your child becomes interested in how boys and girls differ.

    • No adult should ask a child to keep secrets from parents.

    • No adult should ask to see a child's private parts.

    • No adult should ask a child for help with the adult's own private parts.

Getting Ready aor School

  • Give your child plenty of time to finish sentences.

  • Read books together each day and ask your child questions about the stories.

  • Take your child to the library and let him choose books.

  • Listen to and treat your child with respect. Insist that others do so as well.

  • Model saying you're sorry and help your child to do so if he hurts someone's feelings.

  • Praise your child for being kind to others.

  • Help your child express his feelings.

  • Give your child the chance to play with others often.

  • Visit your child's preschool or child care program. Get involved.

  • Ask your child to tell you about his day, friends, and activities.

Healthy Habits

  • Give your child 16 to 24 oz of milk every day.

  • Limit juice. It is not necessary. If you choose to serve juice, give no more than 4 oz a day of 100% juice and always serve it with a meal.

  • Let your child have cool water when she is thirsty.

  • Offer a variety of healthy foods and snacks, especially vegetables, fruits, and lean protein.

  • Let your child decide how much to eat.

  • Have relaxed family meals without TV.

  • Create a calm bedtime routine.

  • Have your child brush her teeth twice each day. Use a pea-sized amount of toothpaste with fluoride.

TV and Media

  • Be active together as a family often.

  • Limit TV, tablet, or smartphone use to no more than 1 hour of high-quality programs each day.

  • Discuss the programs you watch together as a family.

  • Consider making a family media plan. It helps you make rules for media use and balance screen time with other activities, including exercise.

  • Don't put a TV, computer, tablet, or smartphone in your child's bedroom.

  • Create opportunities for daily play.

  • Praise your child for being active.


  • Use a forward-facing car safety seat or switch to a belt-positioning booster seat when your child reaches the weight or height limit for her car safety seat, her shoulders are above the top harness slots, or her ears come to the top of the car safety seat.

  • The back seat is the safest place for children to ride until they are 13 years old.

  • Make sure your child learns to swim and always wears a life jacket. Be sure swimming pools are fenced.

  • When you go out, put a hat on your child, have her wear sun protection clothing, and apply sunscreen with SPF of 15 or higher on her exposed skin. Limit time outside when the sun is strongest (11:00 am–3:00 pm).

  • If it is necessary to keep a gun in your home, store it unloaded and locked with the ammunition locked separately.

  • Ask if there are guns in homes where your child plays. If so, make sure they are stored safely.

What to Expect at Your Child's 5 and 6 Year Visit

We will talk about

  • Taking care of your child, your family, and yourself

  • Creating family routines and dealing with anger and feelings

  • Preparing for school

  • Keeping your child's teeth healthy, eating healthy foods, and staying active

  • Keeping your child safe at home, outside, and in the car

The information contained in this handout should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances. Original handout included as part of the Bright Futures Tool and Resource Kit, 2nd Edition.

Listing of resources does not imply an endorsement by the American Academy of Pediatrics (AAP). The AAP is not responsible for the content of external resources. Information was current at the time of publication.

The American Academy of Pediatrics (AAP) does not review or endorse any modifications made to this handout and in no event shall the AAP be liable for any such changes.

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