4-year-old milestones: the CDC checklist

Wording from the CDC.

Most children (75 in 100) do these things by 4 years; mark what your child does and take the list to your child’s doctor.

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Children born early usually use their actual age from age 2.

Social/Emotional Milestones

Pretends to be something else during play (teacher, superhero, dog)
Asks to go play with children if none are around, like “Can I play with Alex?”
Comforts others who are hurt or sad, like hugging a crying friend
Avoids danger, like not jumping from tall heights at the playground
Likes to be a “helper”
Changes behavior based on where she is (place of worship, library, playground)

Language/Communication Milestones

Says sentences with four or more words
Says some words from a song, story, or nursery rhyme
Talks about at least one thing that happened during her day, like “I played soccer.”
Answers simple questions like “What is a coat for?” or “What is a crayon for?”

Cognitive Milestones (learning, thinking, problem-solving)

Names a few colors of items
Tells what comes next in a well-known story
Draws a person with three or more body parts

Movement/Physical Development Milestones

Catches a large ball most of the time
Serves herself food or pours water, with adult supervision
Unbuttons some buttons
Holds crayon or pencil between fingers and thumb (not a fist)

Other important things to share with the doctor

CDC suggests these questions; the wording is CDC’s.

  1. What are some things you and your child do together?
  2. What are some things your child likes to do?
  3. Is there anything your child does or does not do that concerns you?
  4. Has your child lost any skills he/she once had?
  5. Does your child have any special healthcare needs or was he/she born prematurely?

What to ask the doctor

Talk with your child’s doctor. You know your child best. If you have a concern, don’t wait for the next visit: call your child’s doctor, share it, and ask about developmental screening.

Screenings at checkups. Doctors are advised to screen every child’s development with a standard questionnaire at the 9-, 18- and 30-month visits, and to screen for autism at the 18- and 24-month visits. You can ask for a screening at any visit.

If your child loses a skill. If your child stops doing something they used to do, at any age, call the doctor. Losing a skill is always worth a call.

You don’t need a referral. If your child is under 3, you can contact your state’s early intervention program yourself. From age 3, contact your local public school district, even if your child doesn’t go there. Find early intervention (CDC)

If you have concerns, talk to your child's doctor.

Sources: Zubler et al. 2022, Pediatrics 149(3) (the 2022 checklists); Lipkin and Macias 2020, Pediatrics 145(1) (the screening schedule); CDC’s early intervention pages.

Act early

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.

If you or the doctor are still concerned

  • Ask for a referral to a specialist who can evaluate your child more; and
  • Call your state or territory's early intervention program to find out if your child can get services to help. Learn more and find the number at cdc.gov/FindEI.

From CDC’s “Learn the Signs. Act Early.” page for this age.

Questions parents ask at 4 years

Answered from CDC’s 2022 checklists, quoting CDC’s wording exactly.

How long should a 4-year-old’s sentences be?

CDC’s 4-year list says “Says sentences with four or more words” and “Talks about at least one thing that happened during her day, like “I played soccer.”” At 3 years it listed “Talks with you in conversation using at least two back-and-forth exchanges”. CDC’s advice is to act early: if you have a concern, don’t wait, and talk with your child’s doctor.

Should my 4-year-old be writing letters?

Writing is not on CDC’s 4-year list. It lists “Holds crayon or pencil between fingers and thumb (not a fist)” and “Draws a person with three or more body parts”. CDC lists “Writes some letters in her name” at 5 years. If you have a question about it, talk with your child’s doctor.

Does a 4-year-old play pretend?

CDC’s 4-year list includes “Pretends to be something else during play (teacher, superhero, dog)” and “Asks to go play with children if none are around, like “Can I play with Alex?”” Pretend play starts earlier in CDC’s lists: at 30 months, “Uses things to pretend, like feeding a block to a doll as if it were food”. If you have a question about play, talk with your child’s doctor.

What comes before and after 4 years

Show CDC’s 3-year and 5-year lists

CDC’s checklists for the checkpoints on either side of 4 years, word for word, by area of development. They are here to compare; the checklist to mark is the 4-year one above.

Social/Emotional Milestones

At 3 years

  • Calms down within 10 minutes after you leave her, like at a childcare drop off
  • Notices other children and joins them to play

At 5 years

  • Follows rules or takes turns when playing games with other children
  • Sings, dances, or acts for you
  • Does simple chores at home, like matching socks or clearing the table after eating

Language/Communication Milestones

At 3 years

  • Talks with you in conversation using at least two back-and-forth exchanges
  • Asks “who,” “what,” “where,” or “why” questions, like “Where is mommy/daddy?”
  • Says what action is happening in a picture or book when asked, like “running,” “eating,” or “playing”
  • Says first name, when asked
  • Talks well enough for others to understand, most of the time

At 5 years

  • Tells a story she heard or made up with at least two events. For example, a cat was stuck in a tree and a firefighter saved it
  • Answers simple questions about a book or story after you read or tell it to him
  • Keeps a conversation going with more than three back-and-forth exchanges
  • Uses or recognizes simple rhymes (bat-cat, ball-tall)

Cognitive Milestones (learning, thinking, problem-solving)

At 3 years

  • Draws a circle, when you show him how
  • Avoids touching hot objects, like a stove, when you warn her

At 5 years

  • Counts to 10
  • Names some numbers between 1 and 5 when you point to them
  • Uses words about time, like “yesterday,” “tomorrow,” “morning,” or “night”
  • Pays attention for 5 to 10 minutes during activities. For example, during story time or making arts and crafts (screen time does not count)
  • Writes some letters in her name
  • Names some letters when you point to them

Movement/Physical Development Milestones

At 3 years

  • Strings items together, like large beads or macaroni
  • Puts on some clothes by himself, like loose pants or a jacket
  • Uses a fork

At 5 years

  • Buttons some buttons
  • Hops on one foot

Tips and activities for 4 years

From CDC’s “Learn the Signs. Act Early.” program. The tips and activities below are CDC’s, word for word. CDC’s page for this age

What You Can Do for Your 4-year-old

As your child's first teacher, you can help his or her learning and brain development. Try these simple tips and activities in a safe way. Talk with your child's doctor and teachers if you have questions or for more ideas on how to help your child's development.

  • Help your child be ready for new places and meeting new people. For example, you can read stories or role play (pretend play) to help him be comfortable.
  • Read with your child. Ask him what's happening in the story and what he thinks might happen next.
  • Help your child learn about colors, shapes, and sizes. For example, ask the color, shapes, and size of things she sees during the day.
More Parenting Tips and Activities (25)
  • Encourage your child to use "his words" to ask for things and solve problems but show him how. He may not know the words he needs. For example, help your child say, "Can I have a turn?" instead of taking something from someone.
  • Help your child learn about others' feelings, and about positive ways to react. For example, when he sees a child who is sad, say "He looks sad. Let's bring him a teddy."
  • Use positive words and give attention to behaviors you want to see ("wanted behaviors"). For example, say "You're sharing that toy so nicely!" Give less attention to those you don't want to see.
  • Tell your child in a simple way why she can't do something you don't want her to do ("unwanted behavior"). Give her a choice of what she can do instead. For example, "You can't jump on the bed. Do you want to go outside and play or put on some music and dance?"
  • Let your child play with other children, such as at a park or library. Ask about local play groups and pre-school programs. Playing with others helps you child learn the value of sharing and friendship.
  • Eat meals with your child when possible. Let her see you enjoying healthy foods, such as fruits, vegetables, and whole grains, and drinking milk or water.
  • Create a calm, quiet bedtime routine. Avoid any screen time (TV, phone, tablet, etc.) for 1 to 2 hours before bed and don't put any screens in your child's bedroom. Children this age need 10 to 13 hours of sleep a day (including naps). Consistent sleep times make it easier!
  • Give your child toys or things that encourage his imagination, such as dress-up clothes, pots and pans to pretend cook, or blocks to build with. Join him in pretend play, such as eating the pretend food he cooks.
  • Take time to answer your child's "why" questions. If you don't know the answer, say "I don't know," or help your child find the answer in a book, on the Internet, or from another adult.
  • Count simple things, such as fingers, toys, or bananas. This will help your child learn about numbers and counting.
  • Give your child choices that are simple and healthy. Let her choose what to wear, play, or eat for a snack. Limit choices to 2 or 3.
  • Continue to teach your child skills to play with others, such as using words, sharing toys, and taking turns.
  • Teach your child to play outdoor games with friends, such as tag, follow the leader, and hide and seek.
  • Spend time speaking to your child in complete sentences, using "grown-up" words. This will help her learn better speaking skills and helps with future reading and writing skills.
  • Let your child help with simple chores, such as bringing in the mail, feeding a pet, or wiping down tables. This helps build independence.
  • Teach your child to stop and wait when excited by playing red light, green light, or freeze dance (play music, turn it off, and have everyone freeze when it stops).
  • Play your child's favorite songs and dance with your child. Take turns copying each other's moves.
  • Give your child time to solve her own problems with friends. For example, if they are arguing over who gets to be which superhero, let them work it out. Stay nearby to help if needed. If they can't work it out, use questions to help them think of other solutions.
  • Use words, such as "first," "second," and "finally." When playing, telling stories, or doing chores, ask your child what comes next. This will help your child learn about the order of events.
  • Comfort your child if he is afraid and talk about his fears. For example, "Monsters can feel scary even though they are not real and can't hurt you." Help your child learn things he can do when he is afraid, such as hugging a stuffed animal.
  • Play simple games, such as Tic-Tac-Toe or matching games.
  • Try to make time for active play each day. Your child will have more fun if she can choose the activity. For example, give her choices, such as playing music and dancing together, playing outside, or taking a walk together.
  • Help your child notice when he hurts someone's feelings by describing what you see. Encourage him to say sorry and help him find a way to make the person feel better.
  • Take trips to the library to let your child pick out books.
  • Limit screen time (TV, tablets, phones, etc.) to no more than 1 hour per day of a children's program with an adult present. Don't put any screens in your child's bedroom. Children learn by talking, playing, and interacting with others.

On CDC’s site

The checklist on this page is CDC’s, word for word. CDC’s site already has an online checklist for each age. What this page adds: a corrected-age calculator and a list for the doctor that prints without an email step.

More for parents

Milestone checklist: Centers for Disease Control and Prevention (CDC), “Learn the Signs. Act Early.”, 2022 revision. Source: CDC. Read this checklist on cdc.gov

Use of CDC material on this page does not imply endorsement by CDC, ATSDR, HHS or the United States Government.

Prepared by MyTestAtlas from CDC materials.