4 Month Old Checkup

(Children 4 -6 Months Old)

Feeding: At four months old, babies still only need breastmilk or formula as their primary food/nutrition. However, some can digest the larger sugars that are in solid foods, and they enjoy exploring the world with their mouth. Sometime between now and 6 months, you can begin feeding your child iron fortified cereal with a spoon, if you choose. The foods will not replace the breast or bottle feedings at this point.  All babies are different, so we do not have a set regimen or schedule for each individual infant. However, you should start with a baby cereal and may add vegetables and fruits shortly after.  Babies often get rashes and minor illnesses which are sometimes blamed on the introduction of a new food. Wait 3-4 days between introducing new foods and if a rash or other symptoms occur, you can stop the food. You can reintroduce the food in a few weeks and if the symptom does not return, it probably was not the food causing the symptom. Don’t be afraid to try a food again if your baby did not like it initially. He/she will often change his/her mind. Every baby is different. Some eat one time a day at this age. Others may have solid foods three times a day. Hold off on meats and table foods until 6-9 months. Babies at this age are too young for whole milk and should be kept on formula or breastmilk until 12 months of age. Again, breastmilk or formula is still the primary source of nutrition for a baby this age.

Sleeping and Napping: Establishing a bedtime routine at this age can help prevent a lot of bedtime troubles later on. Try to establish a set bedtime for your child, and develop a routine that starts 20 minutes before bedtime to help your child wind down. You may read or sing to your baby before sleep. It is best to place your baby in his/her own bed drowsy, but not fully asleep. Remember, it may be necessary with some babies to allow them to fuss a little to establish a bedtime schedule. If you have not moved your baby to another room yet, now may be a good time to do so.

Development: Below are things some 4-month old children can do:

•   Watches his/her face in a mirror
•   Holds objects
•   Puts things in the mouth and drools a lot
•   Begins to coo more, and may laugh, varies tone and volume of his/her voice
•   May soon begin to roll from tummy to back and/or back to tummy
•   Responds to voices
•   Lifts head and chest off the table when lying on stomach

Different babies have different temperaments, and this becomes more evident over time. Just because your baby seems to fuss more than other babies the same age does not mean you have done anything wrong. Some babies clearly fuss more than others…independent of what their parents do. Fussy babies often do not deal well with a lot of new sights, sounds and tastes introduced all at once. It is often best with babies that tend to fuss a lot to keep schedules and stimulation fairly consistent, to introduce new foods, objects and sounds one at a time.

Teething: Baby’s first teeth usually come in between 6-7 months. Gums may swell a little and baby may drool. Teething does not cause a fever (temperature of 100.4°F or higher). Babies at this age love to chew on everything and cold teething rings (from the refrigerator, not the freezer) may feel good to baby’s gums.

Illness: Your baby may become sick occasionally, as he/she gets older. This may happen more if your child is in daycare or if there are older children in the home. Colds and diarrhea are common. Fever is only one sign of infection. Many illnesses at this age are caused by viruses, which may not need an antibiotic. Call the doctor or nurse to see if your baby needs to be seen. Never give an antibiotic unless it is prescribed for your baby. You may give Tylenol if the fever is high or your baby is fussy. Cold medicines are not safe to use in babies this age and don’t work very well. It is not unusual for healthy babies in daycare to get sick about once a month.

Immunizations: Your baby will get mostly the same vaccines again today as he/she got at 2 months old. You may give your baby Tylenol every 4-6 hours if he/she seems fussy or runs a fever. Your baby will get vaccines again at 6 months old.

Health and safety:

• Make sure the car seat is placed in the car correctly and always in the back seat.
• Your baby may roll over. Don’t leave them alone on bed, couch, or other high surface.
• Keep putting your baby on their back at sleep time.
• Don’t eat, drink, or carry hot things near your baby.
• Keep your baby out of the sun as much as possible.
• Keep your baby away from cigarette smoke.
• Make sure all your smoke detectors work.

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A good website for other general questions: www.healthychildren.org  – This is the American Academy of Pediatrics Website for parents.

Your next appointment will be at 6 months old.