Well Child Care at 4 Months

Feeding

Your baby should still be taking breast milk or infant formula. Most babies now take about 6 ounces every 4 to 5 hours. Some doctors recommend waiting to give a baby juice until he can hold a cup. Others advise that you can start juice at the age of 4 to 6 months but should limit it to a few ounces each day.

Even if you only give your baby breast milk, it is a good idea to sometimes feed your baby with pumped milk that you put in a bottle. Then your baby will learn another way to drink milk and other people can enjoy feeding your baby.

Some babies are now ready to start cereal. A baby is ready for cereal when he is able to hold his head up enough to eat from a spoon. Cereal should not be given from a bottle or infant feeder. When you start cereal, start with rice cereal mixed with breast milk or formula. You may want to start with a thin mix of cereal and then thicken it gradually. Pureed fruits and vegetables can also be started between 4 and 6 months. Start a new food or juice no more often than every 5 days to make sure your baby is not allergic to the new food.

Never leave the baby in bed with a bottle because it can lead to tooth decay. Don't give your baby a bottle just to quiet him when he really isn't hungry. Babies who spend too much time with a bottle in their mouth start to use the bottle as a security object, which makes weaning more difficult. Ear infections and tooth decay can also result. Find another security object like a stuffed animal or a blanket.

Development

Babies are starting to roll over from stomach to back. Your baby's voice may become louder. He may squeal when happy or cry when he wants food or to be held. In both cases, gentle, soothing voices are the best way to calm your baby. Babies at this age enjoy toys that make noise when shaken.

It is normal for babies to cry. At this age you can't spoil a baby. Meeting your baby's needs quickly is still a good idea.

Normal Development: 4 Months

Sleep

Many babies are sleeping through the night by 4 months of age and will also nap 4 to 6 hours during the daytime. If your baby's sleeping patterns are different than this you may want to ask your doctor for ideas about ways to keep your baby alert and awake during the day and sound asleep at night. Remember to place your baby in bed on her back.

Teething

Your baby may begin teething. While getting teeth, your baby may drool and chew a lot. A teething ring is very useful.

Safety Tips

Avoid Suffocation and Choking

• Remove hanging mobiles or toys before the baby can reach them.
• Keep cords, ropes, or strings away from your baby, especially near the crib. Ropes and strings around the baby's neck can choke him.
• Keep plastic bags and balloons out of reach.
• Use only unbreakable toys without sharp edges or small parts that can come loose.

Avoid Fires and Burns

• Never eat, drink, or carry anything hot near the baby or while you are holding the baby.
• Turn down your water heater to 120°F (50°C).
• Check your smoke detectors to make sure they work.
• Check formula temperature carefully. Formula should be warm or cool to the touch.
• Don't smoke in the house or near the baby.

Car Safety

• Use an approved infant car seat correctly in the back seat.
• Never leave your baby alone in a car.
• Wear your safety belt.

Avoid Falls

• Never leave the baby alone on a high place.
• Keep crib and playpen sides up.
• Do not put your baby in a walker.

Immunizations

At the 4-month visit, your baby should have a:

• DPT (diphtheria, pertussis, tetanus) shot
• Hib (Haemophilus influenza type B) shot
• polio shot
• pneumococcal (PCV7) shot.

Some babies also receive a hepatitis B shot at this age.

Your baby may run a fever and be irritable for about 1 day after the shots. Your baby may also have some soreness, redness, and swelling where the shots were given. Acetaminophen drops (1/2 dropperful, or 0.4 ml, every 4 to 6 hours) may help to prevent the fever and irritability. For swelling or soreness, put a wet, warm washcloth on the area of the shots as often and as long as needed for comfort.

Call your child's physician if:

• Your child has a rash or any other than reaction besides fever and mild irritability.
• Your child has a fever that lasts more than 36 hours.

Next Visit

Your baby's next routine visit should be at the age of 6 months. At this time your child will get the next set of immunizations. Please bring the shot card to each visit.