4-year-old milestones: the CDC checklist

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

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)

This checklist is not a screening test, and it does not grade your child. It helps you notice and remember what to ask.

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.

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, a list for the doctor that prints without an email step, and nothing kept anywhere.

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. Not medical advice.