2025 – PAGE 194 – DEVELOPMENTAL MILESTONES & ANTICIPATORY GUIDANCE
SURVEILLANCE MILESTONES – 4 YEARS OF AGE
| AGE | LANGUAGE &
COMMUNICATION |
MOVEMENT & PHYSICAL | COGNITIVE | SOCIAL &
EMOTIONAL |
| 4 yo
“lamb” |
³ 4-word sentences; remembers some lines from song lyrics, nursery rhymes, or stories; can name at least one thing they did that day; can answer simple questions like asking what an item is for | Able to catch a a large ball; can serve their own food or pour their own drink while supervised; can undo buttons; can hold writing instruments correctly between their thumb and fingers | Recognizes some colors; can anticipate what happens next in a story; can draw 3 body parts for a person | Participates in pretend role play; asks to play with friends; comforts somebody if they notice they are hurt or feeling sad; avoids dangerous actions; likes to help others; adjusts their behavior depending on the environmental context (e.g., being quiet in a library) |
MNEMONICS: At lease FOUR-word sentences at FOUR years of age.
MNEMONIC STORY: The words “MARY” and “LAMB” have FOUR letters, so let’s talk about MARY and her little LAMB. You may be thinking, “I CAN ANTICIPATE WHAT HAPPENS NEXT IN THIS STORY!” but you’d be wrong if you anticipated a lamb with a fleece as white as snow. In fact, this sheep’s fleece had MULTIPLE COLORS, like blue, yellow, and green that made him special. One day, Mary had to go to school and leave her multicolored lamb alone. The lamb asked Mary why she goes to school, and Mary ANSWERED HIS SIMPLE QUESTION with a simple answer: “I go to school to learn.” Mary’s lamb was understanding, but LOOKED SAD, SO SHE COMFORTED HIM. She HELPED her lamb get a delicious snack, and she POURED HER OWN CUP OF WATER too before heading off to school. At school, she UNBUTTONED her jacket, sat at her desk, and HELD HER PENCIL PERFECTLY as she started to DRAW A PERSON with several body parts (a head, arms, and legs). She then started to PRETEND ROLE PLAY with her stick figure drawing until she got bored. She then ASKED HER TEACHER IF SHE CAN PLAY WITH HER FRIENDS outside and the teacher said, “Yes, but AVOID THE DANGERS of traffic and strangers. Mary was calm and collected in class, but she ADJUSTED HER BEHAVIOR once outside to be loud and energetic. Her friend THREW A LARGE BALL AT HER AND SHE CAUGHT IT! The school bell rang, and Mary became so excited to go home and TELL HER LAMB AT LEAST ONE EXCITING THING SHE DID THAT DAY.
4-YEAR-OLD MILESTONES TO KEEP ON YOUR RADAR
| AGE | LANGUAGE | GROSS MOTOR | FINE MOTOR | COGNITIVE | SOCIAL | RED FLAGS |
| 4 yo | Uses past tense; speech is 100% intelligible | Balances on one foot for 4 seconds; goes up AND down stairs easily and with alternating feet; uses handrails on the way down | Draws a plus sign (+) or cross; brushes teeth without help | Reads a tumbling E chart (4–5 yo); tries to bargain and change game rules; knows age/city; knows opposites | Prefers peer play; separates briefly from parents and doesn’t cry; plays dress-up; shares when asked to do so; plays hide and seek; plays tag | No peer play; trouble using stairs
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