Well Child Visits
4 Month Visit
At this visit, your doctor will …
- Check baby’s weight, length and head circumference.
- Do a physical exam with your baby undressed while you are present.
- Discuss baby’s development.
- Address any concerns/questions you may have.
- Immunizations: 4 Month scheduled vaccines ( see Immunization Schedule)(consider giving baby Tylenol just before this check up – see Medication Dosing Chart)
- For babies at 4 months of age, breast milk or formula is generally still the best food.
- Typically, you should not introduce solid foods, juice or water until about 6 months. Be sure to talk with baby’s doctor before starting baby on any solids.
- Babies this age should have several wet diapers a day and regular bowel movements. Some may poop every day; others may poop every few days. This is normal as long as stools are soft. Let your doctor know if they become hard, dry, or difficult to pass.
- If still breastfeeding, that’s great! Begin to plan for pumping and storage of breast milk.
- If formula feeding, safely prepare, heat and store formula. Hold baby while feeding, and avoid propping the bottle. Do not put baby to bed with a bottle.
- At this age, babies sleep about 12 to 16 hours a day, with two or three daytime naps. Most babies have a stretch of sleep for 5 or 6 hours at night. Some infants, particularly those who are breastfed, may wake more often.
- Now is a good time to lower baby’s mattress.
(guidelines for reducing the risk of SIDS, Sudden Infant Death Syndrome)
- Always place baby to sleep on his/her back
- In your room in a bassinet or crib not in your bed
- In crib which meets current safety standards: Bars should be no more than 2 3/8 inches apart. Allow no more than a width of 2 adult fingers between the crib mattress and frame. For full crib safety and standards visit www.cpsc.gov
- Use a firm mattress without any bumpers, blankets, quilts, pillows, plush toys, ribbons or ties
- Avoid overheating by keeping the room temperature comfortable
- Consider putting your baby to sleep sucking on a pacifier
Routine Baby Care
- Notice what helps to calm your baby: patting, rocking, talking, going for walks, sucking fingers or pacifier, etc.
- Continue routines for feeding, sleeping, bathing and playing daily.
- Keep baby out of the sun (sunscreen is not recommended before 6 months old).
- Some babies begin teething when they’re around 4 months old. If your baby has pain, use a cold teething ring. Talk to your doctor before giving acetaminophen for pain.
- Make sure you are getting appropriate dental care twice per year. If your teeth are
unhealthy, you could pass bacteria on to baby and possibly cause tooth decay.
- Do not share cups or spoons with your baby, or use your mouth to clean baby’s pacifier.
- Clean baby’s gums and teeth as soon as you see the first tooth. Use a soft cloth or toothbrush with a small smear (size of a grain of rice) of fluoride toothpaste.
Tips for mom
Take care of yourself:
- Take time for yourself.
- Spend time socially with your partner, family and friends.
- Choose a mature, responsible caregiver or babysitter.
- Be sure to let your doctor and/or baby’s doctor know if you are feeling anxious or overwhelmed.
- Interact with your baby! Singing, talking, and reading to your baby are great ways to help him/her learn.
- Encourage active play: Offer child-safe mirror, floor gyms and colorful age-appropriate toys.
- Learn what your baby likes and does not like.
- Give your baby supervised “tummy time” when awake, and be ready to help if he or she gets tired or frustrated in this position.
- Limit the amount of time your baby spends in an infant seat, bouncer, or swing.
- Limit screen time for your baby. TV, videos, etc. aren’t recommended for babies this young.
By 4 months, it’s common for many babies to:
- turn when they hear voices
- smile, laugh, and squeal
- “coo” in response to your “coos”
- bring hands together in front of chest
- reach for and grasp objects
- have good head control when sitting
- hold up head and chest, supporting themselves on arms, while on tummy
- Roll from front to back
* All babies develop at different rates, and meet developmental milestones differently.
- Visit healthychildren.org for complete car seat guidelines provided by the American Academy of Pediatrics (AAP).
- Make sure car seat is installed correctly (the Fire Department will check car seats for correct installation)
- Make sure seat is rear-facing in the back seat, and never in the front seat with a passenger side airbag
- Never leave baby alone in the car
- Always wear a seat belt, and do not drive under the influence of alcohol or drugs
Child Safety Seat Inspection:
1-866-SEATCHECK (732-2432) or www.seatcheck.org
- Do not smoke/vape or allow others to smoke/vape around baby
- Do not leave baby unattended
- Never leave a baby alone with siblings or pets, in the bath, on a changing table, or any other raised surface.
- Make sure your home’s water temperature is set to below 120º F
- Do not carry or drink hot liquids while holding baby
- Test baby’s formula temperature with your wrist
- Keep small objects such as balloons, bags, toys from other children away from baby.
- Never feed baby hard pieces of food such as raw carrots, hot dogs, grapes, apples, peanuts, and popcorn.
- Do not use a baby walker as they are more likely to cause accidents.
- The kitchen is a dangerous place. Avoid letting baby crawl in kitchen by using a playpen or high chair.
When to Call
- Fever: Rectal temperature below 96.8º or above 100.4º
- If you suspect baby is not acting normal for any reason