Your Child’s 4-Year Well Visit: What to Expect
Congratulations and welcome to the preschool years. Hopefully the toddler years were full of fun and joy, and your child is ready to move on to the next stage of her development. That is one of the things we will check and discuss with you today.
You will get a reminder and request from Phreesia to confirm your visit. Please be sure to confirm. If you do not confirm your visit, we may have to reschedule your well visit.
Be sure to complete your registration paperwork on Phreesia BEFORE your visit.. You will get an email or text message. If you do not do them before the visit, please arrive at your visit 15 minutes early.
Checklist for today’s visit
Hearing Screen
Vision Screen
preschool vaccines (see below)
Free book!
These are the vaccines we usually give at this visit. Your child’s schedule may differ from the usual schedule. You can view your child’s vaccine record on the portal and compare it with the standard schedule.
Today’s vaccines are all booster doses of the vaccines given during the infant and toddler years. They can be given any time between ages four and six years old. It is usually easier on children to get them all at age four so that they don’t need any at age five. Georgia requires them by five years old for school or daycare.
Vaccines are among the most researched and safest treatments for children (and adults). They are highly effective at preventing severe illness and death and save hundreds of thousands of children’s lives every year. For centuries, these diseases were the most common cause of death in children, and all of them are still present and a threat to the health and lives of infants and children. Visit our Vaccine Center for more information.
Vaccines usually given at this visit
The DTaP vaccine protects against three diseases: diphtheria, tetanus, and pertussis (whooping cough). These germs infect infants and often cause severe illness or death. Infants in our area are at risk; tetanus lives in the dirt and is always around. Diphtheria outbreaks occur in other countries and may travel here. We still see cases of whooping cough in our area. Children should not delay getting this vaccine.
Children usually receive five doses of DTaP, usually at the following ages:
- Two months
- Four months
- Six months
- 15–18 months
- 4–6 years
More information
The IPV (polio) vaccine protects against the poliovirus, which can cause paralysis. It can occur at any age. The paralysis can be permanent and affect only the arms or legs affect the chest, causing breathing difficulty. These patients have to live inside an iron lung for the rest of their lives.
More information
The MMR vaccine protects against three diseases: measles, mumps, and rubella (German measles). There are still numerous measles outbreaks in England, Europe, and the United States due to increased numbers of unvaccinated children. Measles can be severe or deadly in children, and mumps can cause sterility in males. Rubella can infect babies in their mother’s womb and cause hearing loss and other birth defects.
More information
The varicella vaccine protects against chickenpox, which is caused by the varicella virus. While many considered chickenpox a relatively harmless childhood rite of passage, several hundred children in the US every year had severe and sometimes fatal infections before the vaccine was developed.
More information
The influenza (flu) vaccine is recommended during flu season for all children. Children less than nine years old need two doses this year if they have not had at least two doses before. The vaccine is usually given between October and March each year.
More information
Giving medication for fever or pain before the vaccines is not recommended, and it is not needed for fever after the vaccines either. Fever will not harm your child, and it helps the vaccines work. You only need to treat discomfort. If your child is cranky, fussy, or uncomfortable, give some pain medication (acetaminophen or ibuprofen). See After Vaccine Care for more information.
You can learn more about each vaccine from the CDC Vaccine Information Statements (VIS). There is a link above for each vaccine and a copy in a notebook in your exam room. You can also ask for a paper copy at your child’s visit.
Vision screening
Your child’s vision is critical during the younger years because a proper “image” from the eyes is necessary for the brain to develop correctly. If it doesn’t, lifelong vision loss will occur because the brain never developed correctly. We will check your child’s vision today using a standard vision chart as a screening tool. Normal vision at this age is at least 20/40 in each eye. If your child’s vision is worse than 20/40 on this screening test, she will need to see an optometrist or ophthalmologist. We have a list of recommended specialists. Learn more about vision screening in children.
Hearing Screening
Your child’s hearing is important for learning speech and language development during the younger years. Hearing loss is often not noticed until significant loss has occurred. Young children often cannot tell that they have a hearing problem; it sounds normal to them. Hearing problems starting later in childhood can cause learning, social, and emotional difficulties. Learn more about hearing screening.
Your child’s medical home
As your child’s medical home, we want to know about any new developments since the last visit, including
- any emergency department or urgent care visits and hospitalizations
- visits to any specialists, therapists, or any other health care providers
- changes in family health history
- recent illnesses or injuries
- changes or challenges at home, family, and living situation
We track and manage all your child’s health information in one place!
Learn more about what it means to be your child’s medical home.
Free book!
We are a Reach Out and Read site. That means that your child will receive a brand-new book at every well-child visit from 6 months to 5 years old! Partnering with Reach Out and Read is part of our early literacy and school readiness initiatives. Learn more about our partnership with this amazing program.
Treating other problems today
Well-child visits include advice and guidelines on caring for your child and updating all of your child’s medical information. Sometimes we may treat new or existing medical problems during a well-child visit, saving you an extra trip to our office. Your insurance company may view this as a separate “visit” and charge you a co-pay or apply it to your deductible. Sometimes this can cause confusion or frustration for parents. You can learn more about it here.
Next visit
- Your child’s next well visit is at five years old. Learn more about what to expect at that visit.
- You can schedule that visit today at checkout.
References
- Hagan JF, Shaw JS, Duncan PM, eds. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, 4th ed. Elk Grove Village, IL: American Academy of Pediatrics, 2017. Bright Futures website
- American Academy of Pediatrics Periodicity Schedule