Milestones at 4 years
The 4-year list is the longest, with six social items: pretend play, asking to play with other children, comforting a friend and changing behaviour to suit a place. Four-word sentences and talking about something from the day are listed for language, and drawing a person with three or more body parts for thinking.
CDC's 4-year checklist lists 17 milestones: 6 social and emotional, 4 language and communication, 3 cognitive and 4 movement and physical development. The largest group at this age is social and emotional, with 6 items. Each one is something most children (75% or more) can do by age 4, so many children do it earlier.
No standardized screening is routinely scheduled at the 4-year visit, but you can ask for one at any visit if you have a concern. The checkpoint before this one is 3 years, with 12 milestones. The next is 5 years, with 15.
No standardized screening is routinely scheduled at 4 years; ask for one if you have a concern. Next checkpoint: 5 years.
Screening ages: AAP, via CDCSocial and emotional6 items
“Pretends to be something else during play (teacher, superhero, dog)”
Most children (75%+) by 4 years · many earlier · Source: CDC“Asks to go play with children if none are around, like “Can I play with Alex?””
Most children (75%+) by 4 years · many earlier · Source: CDC“Comforts others who are hurt or sad, like hugging a crying friend”
Most children (75%+) by 4 years · many earlier · Source: CDC“Avoids danger, like not jumping from tall heights at the playground”
Most children (75%+) by 4 years · many earlier · Source: CDC“Likes to be a “helper””
Most children (75%+) by 4 years · many earlier · Source: CDC“Changes behavior based on where she is (place of worship, library, playground)”
Most children (75%+) by 4 years · many earlier · Source: CDC
Language and communication4 items
“Says sentences with four or more words”
Most children (75%+) by 4 years · many earlier · Source: CDC“Says some words from a song, story, or nursery rhyme”
Most children (75%+) by 4 years · many earlier · Source: CDC“Talks about at least one thing that happened during her day, like “I played soccer.””
Most children (75%+) by 4 years · many earlier · Source: CDC“Answers simple questions like “What is a coat for?” or “What is a crayon for?””
Most children (75%+) by 4 years · many earlier · Source: CDC
Cognitive (learning, thinking, problem-solving)3 items
“Names a few colors of items”
Most children (75%+) by 4 years · many earlier · Source: CDC“Tells what comes next in a well-known story”
Most children (75%+) by 4 years · many earlier · Source: CDC“Draws a person with three or more body parts”
Most children (75%+) by 4 years · many earlier · Source: CDC
Movement and physical development4 items
“Catches a large ball most of the time”
Most children (75%+) by 4 years · many earlier · Source: CDC“Serves herself food or pours water, with adult supervision”
Most children (75%+) by 4 years · many earlier · Source: CDC“Unbuttons some buttons”
Most children (75%+) by 4 years · many earlier · Source: CDC“Holds crayon or pencil between fingers and thumb (not a fist)”
Most children (75%+) by 4 years · many earlier · Source: CDC
Checklist items quoted from CDC’s “Learn the Signs. Act Early.” milestones for 4 years (Source: CDC). “Learn the Signs. Act Early.” materials are not a substitute for standardized, validated developmental screening tools.
If something is “not yet”
“You know your child best. Don’t wait. If your child is not meeting one or more milestones, has lost skills he or she once had, or you have other concerns, act early. Talk with your child’s doctor, share your concerns, and ask about developmental screening.”
Source: CDC, milestone checklist for 4 years
- Write down the items you answered “Not yet” or “Not sure”, with an example of what you see at home.
- Bring the list to your child’s doctor and ask whether a developmental screening is a good next step.
- Under 3? Call your state’s early intervention program and ask for a free evaluation. You don’t need a referral.
- 3 or older? Call your local public elementary school and ask for a preschool special education evaluation.