Well-Child Visit: 4 Months

What to Expect During This Visit

Your doctor and/or nurse will probably:

1. Check your baby's weight, length, and head circumference and plot the measurements on a growth chart.

2. Ask questions, address concerns, and offer advice about how your baby is:

Feeding. Breast milk or formula is still all your baby needs. You can give iron-fortified cereal or puréed meats when your baby is ready for solid foods at about 6 months of age. Talk with your doctor before starting any solids.

Peeing and pooping. 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 the poop is soft. Let your doctor know if it gets hard, dry, or difficult to pass.

Sleeping. At this age, babies sleep about 12–16 hours a day, including 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.

Developing. By 4 months, most babies:

• turn their head to the sound of your voice
• make sounds like "oooo" and "aahh" (cooing)
• make sounds back to you when you talk
• smile and chuckle (not yet a full laugh)
• look at you, move, or make sounds to get or keep your attention
• look at their hands with interest
• hold a toy when placed in their hand
• hold head steady when held
• push up onto their elbows/forearms while on their tummy
• use their arms to bat at toys

Talk to your doctor if your baby is not meeting one or more milestones, or you notice that your baby had skills but has lost them.

3. Do an exam with your baby undressed while you are present. This will include an eye exam, listening to your baby's heart and feeling pulses, checking hips, and paying attention to your baby's movements.

4. Update vaccines.Vaccines can protect infants from serious childhood illnesses, so it's important that your baby get them on time. Vaccine schedules can vary from office to office, so talk to your doctor about what to expect.

5. Because postpartum depression is common, your baby’s doctor may ask you to fill out a depression screening questionnaire.

Looking Ahead

Here are some things to keep in mind until your baby's next routine checkup at 6 months:

Feeding

• Breast milk or formula is still all your baby needs.
• Most babies are ready to eat solid foods at about 6 months, though some babies may be ready sooner. If your doctor recommends introducing solids:
  • Share your family history of any food allergies.
  • Start with a small amount of iron-fortified single-grain cereal mixed with breast milk or formula. You can also start with a puréed meat, another iron-rich food.
  • Use an infant spoon — do not put cereal in your baby's bottle.
  • If your baby is pushing a lot out with the tongue, they may not be ready for solids yet. Wait a week or so before trying again.
  • Wait until your baby successfully eats cereal from the spoon before trying other solids. Introduce one new food at a time and wait several days to watch for a possible allergic reaction before introducing another.
• If breastfeeding, continue to give vitamin D supplements. Breastfed babies may need iron supplements until they get enough iron from the foods they eat.
• Pay attention to signs that your baby is hungry or full.
• Do not give juice until after 12 months.
• Do not prop bottles or put your baby to bed with a bottle.

Routine Care

• Many babies begin teething when they're around 4 months old. To help ease pain or discomfort, offer a clean wet washcloth or a teether. Talk to your doctor about giving acetaminophen for pain.
• Clean your baby's gums with a wet, clean washcloth or soft toothbrush.
• Sing, talk, read, and play with your baby. Babies learn best by interacting with people.
• TV, videos, and other types of screen time aren't recommended for babies this young. Video chatting is OK.
• Continue to give your baby plenty of supervised "tummy time" when awake. Create a safe play space for your child to explore.
• Limit the amount of time your baby spends in an infant seat, bouncer, or swing.
• It's common for new moms to feel tired and overwhelmed at times. But if these feelings are intense, or you feel sad, moody, or anxious, call your doctor.
• Talk to your doctor if you're concerned about your living situation. Do you have the things that you need to take care of your baby? Do you have enough food, a safe place to live, and health insurance? Your doctor can tell you about community resources or refer you to a social worker.

Safety

• To reduce the risk of sudden infant death syndrome (SIDS):
  • Always place your baby to sleep on a firm, flat mattress on their back, and not on the stomach or side, in a crib or bassinet without any crib bumpers, blankets, quilts, pillows, or plush toys.
  • Breastfeed your baby, if possible.
  • Let your baby sleep in your room in a bassinet or crib next to the bed until your baby's first birthday, or for at least 6 months, when the risk of SIDS is highest.
  • Avoid overheating by keeping the room temperature comfortable. Dress your baby for the room temperature and don't overbundle. Don't cover your baby's head while they're sleeping. Watch for signs of overheating, such as sweating or feeling hot to the touch.
  • Consider putting your baby to sleep sucking on a pacifier. If your baby rejects the pacifier, don't force it. If the pacifier falls out during sleep, you don't have to replace it. If you're breastfeeding, wait until breastfeeding is established before introducing the pacifier.
  • Don’t let your baby fall asleep on a product that isn’t specifically designed for sleeping babies, such as a sitting device (like a car seat), a feeding pillow (like the Boppy pillow), or an infant lounger (like the Dock-a-Tot, Podster, and Bummzie).
  • Don’t use products or devices that claim to lower the risk of SIDS, such as sleep positioners (like wedges or incliners) or monitors that can detect a baby’s heart rate and breathing pattern. No known products can actually do this.
  • Make sure that all sleep surfaces and products you use to help your baby sleep have been approved by the U.S. Consumer Product Safety Commission (CPSC) and meet federal safety standards.
• Don't use an infant walker. They're dangerous and can cause serious injuries. Walkers also do not encourage walking and may actually hinder it.
• Soon, your baby will be reaching, grasping, and moving things to his or her mouth, so keep small objects and harmful substancesout of reach. Keep your baby away from cords, wires, and toys with loops or strings.
• While your baby is awake, don't leave your little one unattended, especially on high surfaces or in the bath.
• Never shakeyour baby — it can cause bleeding in the brain and even death. If you are ever worried that you will hurt your baby, put your baby in the crib or bassinet for a few minutes. Call a friend, relative, or your health care provider for help.
• Always put your baby in a rear-facing car seat in the back seat. Never leave your baby alone in the car.
• Don't smoke or use e-cigarettes. Don't let anyone else smoke or vape around your baby.
• Avoid sun exposure by keeping your baby covered and in the shade when possible. Sunscreens are not recommended for infants younger than 6 months. However, you may use a small amount of sunscreen on an infant younger than 6 months if shade and clothing don't offer enough protection.

These checkup sheets are consistent with the American Academy of Pediatrics (AAP)/Bright Futures guidelines.