4-Year-Old Vaccines & Care Instructions

Vaccines:
Your child is due for the last major vaccine set before age 11, which includes:

• DTaP: Protects against tetanus, pertussis (whooping cough), and diphtheria
• IPV: Polio vaccine
• MMR: Measles, mumps, rubella
• Varicella: Chickenpox

Common Side Effects:

• Fever (usually <102°F)
• Soreness and mild redness at the injection site
• Firmness in the muscle where vaccinated
• Rash in up to 15% of children (red spots locally or all over, possibly up to 2 weeks after vaccination)

Uncommon Side Effects:

• Body aches and pains
• Rare platelet problems (usually self-limited but should be reported to your doctor)

Fever or Pain Management:
For 2–3 days after vaccination, give:

• Children’s Ibuprofen (100 mg/5 mL): dose by weight every 6 hours as needed
• Children’s Acetaminophen (160 mg/5 mL): dose by weight every 6 hours as needed

Well-Child Care

1. Promote Growth:
   Offer a variety of foods even if your child is picky. Include at least one favorite food plus several balanced options at every meal.
   Talk about the food groups and their benefits while trying all the foods together.
2. Promote Development:
   Read daily with your child.
   Limit screen time to less than 1 hour per day, ideally engaging together.
   Keep screen use before 6 pm to avoid sleep interference.
3. Promote Social Skills:
   Provide chances to play with children of the same age through preschool, pre-K, or playgroups.
   Spend daily playtime with your child.
   Good toys include building blocks, crayons, toy animals, dolls, safe musical instruments, balls, swimming, and bike riding.
4. Ensure Safety:
   Use a self-locking gate between the pool and house to prevent unsupervised pool access.
   Continue using a high-back car seat in the back seat.
   Enroll your child in swim lessons.
   Limit internet access and securely lock away household cleaners, especially detergent pods.
5. Bedtime Routine:
   Teach your child to stay in their own bed.
   If afraid of the dark, use a dim nightlight or flashlight.
   Soft music can create a calming bedtime atmosphere.
6. Nighttime Dryness:
   Most girls are dry through the night by age 6. Most boys are dry at night by age 9.
   To begin nighttime potty training:

• Limit fluids 2 hours before bedtime (e.g., no drinks after 6 pm for an 8 pm bedtime).
• Wake your child once at night around 10–11 pm for a bathroom visit.
  If dryness isn’t achieved by age 9, consider a bedwetting alarm (available online).

When should you call for help?

Contact your doctor if:

• You are concerned your child is not growing or learning normally.
• You are worried about your child's behavior.
• You have questions or need more information about your child's care.

Where can you learn more?

Go to http://www.nurturepediatric.com/

Care instructions adapted under license by Nurture Pediatrics. This information is for use with your licensed healthcare professional. If you have questions about a medical condition or these instructions, always ask your healthcare professional.