Well Child Care, 4 Months

PHYSICAL DEVELOPMENT

The 4-month-old is beginning to roll from front-to-back. When on the stomach, your baby can hold his or her head upright and lift his or her chest off of the floor or mattress. Your baby can hold a rattle in the hand and reach for a toy. Your baby may begin teething, with drooling and gnawing, several months before the first tooth erupts.

EMOTIONAL DEVELOPMENT

At 4 months, babies can recognize parents and learn to self soothe.

SOCIAL DEVELOPMENT

Your baby can smile socially and laugh spontaneously.

MENTAL DEVELOPMENT

At 4 months, your baby coos.

RECOMMENDED IMMUNIZATIONS

  • Hepatitis B vaccine. (Doses should be obtained only if needed to catch up on missed doses in the past.)

  • Rotavirus vaccine. (The second dose of a 2-dose or 3-dose series should be obtained. The second dose should be obtained no earlier than 4 weeks after the first dose. The final dose in a 2-dose or 3-dose series has to be obtained before 8 months of age. Immunization should not be started for infants aged 15 weeks and older.)

  • Diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccine. (The second dose of a 5-dose series should be obtained. The second dose should be obtained no earlier than 4 weeks after the first dose.)

  • Haemophilus influenzae type b (Hib) vaccine. (The second dose of a 2-dose series and booster dose or 3-dose series and booster dose should be obtained. The second dose should be obtained no earlier than 4 weeks after the first dose.)

  • Pneumococcal conjugate (PCV13) vaccine. (The second dose of a 4-dose series should be obtained no earlier than 4 weeks after the first dose.)

  • Inactivated poliovirus vaccine. (The second dose of a 4-dose series should be obtained.)

  • Meningococcal conjugate vaccine. (Infants who have certain high-risk conditions, are present during an outbreak, or are traveling to a country with a high rate of meningitis should obtain the vaccine.)

TESTING

Your baby may be screened for anemia, if there are risk factors.

NUTRITION AND ORAL HEALTH

  • The 4-month-old should continue breastfeeding or receive iron-fortified infant formula as primary nutrition.

  • Most 4-month-olds feed every 4–5 hours during the day.

  • Babies who take less than 16 ounces (480 mL) of formula each day require a vitamin D supplement.

  • Juice is not recommended for babies less than 6 months of age.

  • The baby receives adequate water from breast milk or formula, so no additional water is recommended.

  • In general, babies receive adequate nutrition from breast milk or infant formula and do not require solids until about 6 months.

  • When ready for solid foods, babies should be able to sit with minimal support, have good head control, be able to turn the head away when full, and be able to move a small amount of pureed food from the front of his mouth to the back, without spitting it back out.

  • If your health care provider recommends introduction of solids before the 6 month visit, you may use commercial baby foods or home prepared pureed meats, vegetables, and fruits.

  • Iron-fortified infant cereals may be provided once or twice a day.

  • Serving sizes for babies are ½–1 tablespoons of solids. When first introduced, the baby may only take 1–2 spoonfuls.

  • Introduce only one new food at a time. Use only single ingredient foods to be able to determine if the baby is having an allergic reaction to any food.

  • Teeth should be brushed after meals and before bedtime.

  • Continue fluoride supplements if recommended by your health care provider.

DEVELOPMENT

  • Read books daily to your baby. Allow your baby to touch, mouth, and point to objects. Choose books with interesting pictures, colors, and textures.

  • Recite nursery rhymes and sing songs to your baby. Avoid using "baby talk."

SLEEP

  • Place your baby to sleep on his or her back to reduce the change of SIDS, or crib death.

  • Do not place your baby in a bed with pillows, loose blankets, or stuffed toys.

  • Use consistent nap and bedtime routines. Place your baby to sleep when drowsy, but not fully asleep.

  • Your baby should sleep in his or her own crib or sleep space.

PARENTING TIPS

  • Babies this age cannot be spoiled. They depend upon frequent holding, cuddling, and interaction to develop social skills and emotional attachment to their parents and caregivers.

  • Place your baby on his or her tummy for supervised periods during the day to prevent your baby from developing a flat spot on the back of the head due to sleeping on the back. This also helps muscle development.

  • Only give over-the-counter or prescription medicines for pain, discomfort, or fever as directed by your baby's caregiver.

  • Call your baby's health care provider if the baby shows any signs of illness or has a fever over 100.4° F (38° C).

SAFETY

  • Make sure that your home is a safe environment for your child. Keep home water heater set at 120° F (49° C).

  • Avoid dangling electrical cords, window blind cords, or phone cords.

  • Provide a tobacco-free and drug-free environment for your baby.

  • Use gates at the top of stairs to help prevent falls. Use fences with self-latching gates around pools.

  • Do not use infant walkers which allow children to access safety hazards and may cause falls. Walkers do not promote earlier walking and may interfere with motor skills needed for walking. Stationary chairs (saucers) may be used for brief periods.

  • Your baby should always be restrained in an appropriate child safety seat in the middle of the back seat of your vehicle. Your baby should be positioned to face backward until he or she is at least 2 years old or until he or she is heavier or taller than the maximum weight or height recommended in the safety seat instructions. The car seat should never be placed in the front seat of a vehicle with front-seat air bags.

  • Equip your home with smoke detectors and change batteries regularly.

  • Keep medications and poisons capped and out of reach. Keep all chemicals and cleaning products out of the reach of your child.

  • If firearms are kept in the home, both guns and ammunition should be locked separately.

  • Be careful with hot liquids. Knives, heavy objects, and all cleaning supplies should be kept out of reach of children.

  • Always provide direct supervision of your child at all times, including bath time. Do not expect older children to supervise the baby.

  • Babies should be protected from sun exposure. You can protect them by dressing them in clothing, hats, and other coverings. Avoid taking your baby outdoors during peak sun hours. Sunburns can lead to more serious skin trouble later in life.

  • Know the number for poison control in your area and keep it by the phone or on your refrigerator.

WHAT'S NEXT?

Your next visit should be when your child is 6 months old.