Well Child Care, 4 Months

PHYSICAL DEVELOPMENT

The 4 month old is beginning to roll from front-to-back. When on the stomach, the baby can hold his head upright and lift his chest off of the floor or mattress. The baby can hold a rattle in the hand and reach for a toy. The 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

The child can smile socially and laughs spontaneously.

MENTAL DEVELOPMENT

At 4 months, the child coos.

IMMUNIZATIONS

At the 4 month visit, the health care provider may give the 2nd dose of DTaP (diphtheria, tetanus, and pertussis-whooping cough); a 2nd dose of Haemophilus influenzae type b (HIB); a 2nd dose of pneumococcal vaccine; a 2nd dose of the inactivated polio virus (IPV); and a 2nd dose of Hepatitis B. Some of these shots may be given in the form of combination vaccines. In addition, a 2nd dose of oral Rotavirus vaccine may be given.

TESTING

The 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 of formula per 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 to 1 tablespoon of solids. When first introduced, the baby may only take one or two 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.

  • Brushing teeth after meals and before bedtime should be encouraged.

  • If toothpaste is used, it should not contain fluoride.

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

DEVELOPMENT

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

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

SLEEP

  • Place babies to sleep on the back to reduce the change of SIDS, or crib death.

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

  • Use consistent nap-time and bed-time routines. Place the baby to sleep when drowsy, but not fully asleep.

  • Encourage children to sleep in their own crib or sleep space.

PARENTING TIPS

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

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

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

  • Call your health care provider if the baby shows any signs of illness or has a fever over 100.4° F (38° C). Take temperatures rectally if the baby is ill or feels hot. Do not use ear thermometers until the baby is 6 months old.

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. Crawl around your home and look for safety hazards at your baby's eye level.

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

  • 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 playtime for short periods of time.

  • The child should always be restrained in an appropriate child safety seat in the middle of the back seat of the vehicle, facing backward until the child is at least one year old and weighs 20 lbs/9.1 kgs or more. The car seat should never be placed in the front seat with 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.

  • Make sure that your child always wears sunscreen which protects against UV-A and UV-B and is at least sun protection factor of 15 (SPF-15) or higher when out in the sun to minimize early sun burning. This can lead to more serious skin trouble later in life. Avoid going outdoors during peak sun hours.

  • 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.