4 Month Well Child Visit

• Feeding: Some babies are ready to start solid foods by 4-6 months of age. Indicators that your baby may be ready are breast-feeding more than 8-10 times per day or drinking more than 32 ounces of formula per day. We recommend that when your baby is ready to begin solids, you start with cereals – rice, barley or oatmeal. Please refer to the “Feeding Your Baby” handout for more details.
• Elimination: With the introduction of solid foods, you can expect your baby’s bowel movements to change in both color and consistency. Some foods, including cereals (especially rice), applesauce and bananas can be constipating. Please talk to your pediatrician if your baby’s stools become hard, small pellets.
• Sleep: Naps may continue to be irregular, but many infants have begun to sleep through the night by 4 months of age. Developing a comfortable bedtime routine can make bedtime easier for the entire family. Your child should begin to develop the ability to comfort herself, and putting her to bed when sleepy but still awake can encourage this. Using a soft toy, sometimes called a “transition object” because it eases the transition from wakefulness to sleep, can help. Do not put your baby to bed with a bottle as this have been shown to increase the incidence of ear infection and can cause significant dental problems later on.

Development:

• Motor Skills: Your baby will soon be able to roll over from stomach to back and back to stomach. She can grasp toys with her whole hand and can hold her hands together. She will begin to transfer objects from one hand to the other. She is now able to hold her head without support and will follow bright objects 180 degrees.
• Communication/Socialization: Your baby will begin to initiate social contact. Smiling, laughing, squealing and a social cough are common. She now will respond to her name and can begin to distinguish your emotions by the tone of your voice. Before your next visit, she may develop some anxiety or awareness of strangers. Having others involved in her care will help her overcome some of those fears.

Safety:

• Continue to use a rear facing car seat in the back seat of your car until your baby is 12 months old and 20 pounds.
• Put gates on stairs.
• Never leave the baby unattended on a bed, countertop or table.
• Keep powders, baby cleaners, household cleaners, and small objects out of baby’s reach at all times.
• Continue to check toys for sharp edges and small or loose parts that can be pulled off and swallowed.
• Infant walkers have been found to be very dangerous, and we discourage their use.
• Eliminate baby’s exposure to tobacco smoke as it has been strongly implicated in childhood illnesses including ear infections, colds, asthma, and sudden infant death syndrome (SIDS). As a parent, you have both the right and the responsibility to protect your child when visitors come to your home.
• Never leave your baby alone in the bathtub, even for a minute.

Parenting: This is a common time for sibling rivalry to surface, as the baby is becoming more responsive and interactive. Spending some quality time alone with each of the baby’s siblings is very important. Involve your other children in caring for the baby, but remember to use caution and observe the interaction closely. Continue to interact with your baby by talking to her and encouraging her vocalizations. Encourage play in her playpen or safe area where she can roll around and enjoy some free motor play.

Play: At this stage babies begin to enjoy books made with boards, cloth or vinyl pages. Rings, rattles, blocks, stuffed toys, plastic keys and “banging toys” such as pots and pans are great fun. Seeking and finding partially hidden toys is a great activity.

Next visit is at 6 months of age.