This book constitutes the proceedings of the 4th International Conference on Serious Games, JCSG 2018, held in Darmstadt, Germany, in November 2018. The 15 full and 12 short papers presented in this volume were carefully reviewed and selected from 40 submissions. They were organized in topical sections named: serious games studies; game-based learning and teaching; game development - serious games design, models, tools and emerging technologies; and serious games for health.