Well Child Care at 4 Months

Feeding

Your baby should still be taking breast milk or infant formula. Most babies now take about 6 to 7 ounces every 4 to 5 hours. You can start juice at the age of 4 to 6 months but should limit it to a few ounces each day.

If you 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 well, likes having food in his mouth, and can swallow easily. Use a spoon to feed your baby cereal, not a bottle or an infant feeder. Sitting up while eating helps your baby learn good eating habits. 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, vegetables, and meats 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.

Babies will respond gleefully when they see a bottle, but 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. They are also more likely to have ear infections and tooth decay problems. 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.

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.

Reading and Electronic Media

As the baby gets older, read to her every day. Choose books that are durable (cloth or board books). Pick books with bright colors and large simple pictures. Never prop your baby in front of a television.

Teething

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

Safety Tips

Choking and Suffocation

• 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.

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.

Falls

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

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.

Smoking

• Children who live in a house where someone smokes have more respiratory infections. Their symptoms are also more severe and last longer than those of children who live in a smoke-free home.
• If you smoke, set a quit date and stop. Set a good example for your child. If you cannot quit, do NOT smoke in the house or near children.

Immunizations

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

• DTaP (diphtheria, acellular pertussis, tetanus) shot
• Hib (Haemophilus influenza type B) shot
• polio shot
• pneumococcal (PCV13) shot
• rotavirus oral vaccine.

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

Some vaccines can be combined to reduce the total number of shots for your baby.

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.

You may give acetaminophen drops in the appropriate dose 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 healthcare provider if:

• Your child has a rash or any reaction other than 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. Bring your child's shot card to all visits.