Well Child Care at 4 Months

Feeding

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

If you are breast-feeding your baby, it’s a good idea to sometimes feed your baby with pumped breast milk in a bottle. This helps your baby learn another way to drink milk and allows other people to feed your baby.

Your baby is ready for cereal when she is able to hold her head up well, likes having food in her mouth, and can swallow it easily. Use a spoon to give 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 a thin mix of rice cereal and breast milk or formula. You can thicken it after a few days as your baby gets used to eating cereal.

You can also start pureed fruits, vegetables, and meats between 4 and 6 months. Wait at least 2 days before you start each new food or juice so you have time to make sure your baby is not allergic to the new food. Diarrhea, rash, or vomiting are signs of a possible food allergy.

Don't give your baby a bottle just to quiet her. Don’t put your baby to bed with a bottle. Babies who spend too much time with a bottle in their mouth use the bottle as a security object. This makes it harder for them to give up the bottle and start eating solid food. Babies who spend too much time with a bottle in their mouth are also more likely to have ear infections and tooth decay problems. Find another security object like a stuffed animal or a blanket.

Development

Your baby is starting to roll over from her stomach to her back. Babies at this age enjoy toys that make noise when shaken.

It’s normal for babies to cry. To calm your baby, talk to her with a gentle, soothing voice, hold her, or try rocking, dancing, or humming. Sometimes a ride in the car can be soothing for your baby.

Many babies sleep through the night by 4 months of age and will also nap 4 to 6 hours during the day. If your baby's sleeping patterns are different from this, you may want to ask your healthcare provider for ideas about ways to keep your baby more alert and awake during the day and asleep at night.

Reading and Technology

As your baby gets older, read to her every day. Choose cloth or board books with bright colors and large simple pictures.

Limit how much time your child spends with technology. Play games, read, or watch TV with your child and communicate with your child while you do. Children this age need to be active because it helps their brains and bodies to develop. Play and interact with your child, and be a role model by limiting your own use of technology.

Dental Care

Your baby may start teething and may drool and chew a lot. It may help to massage your baby's swollen gums with your finger. A teething ring may be useful. As your baby’s teeth start coming in, you can clean them by wiping them with a damp washcloth.

Never let your child go to sleep with a bottle. Babies can get tooth decay from having the sugar from milk or juice sit in their mouths for long periods of time.

Safety Tips

If you find yourself getting annoyed or angry with your baby, or if your baby is crying too much and you cannot cope with it, call a friend or relative for help. NEVER shake a baby.

Choking and Suffocation

• Place your baby in bed on her back. Sleeping on the back lowers the risk of sudden infant death syndrome (SIDS). SIDS is the sudden, unexplained death of a healthy baby. The cause of SIDS is not known.
• Keep soft objects, toys, and loose bedding out of your baby's crib. Also keep plastic bags, balloons, baby powder, and small hard objects out of reach.
• Keep cords, ropes, or strings away from your baby, especially near the crib. Remove hanging mobiles or toys before your baby can reach them. Ropes and strings around your baby's neck can choke her.
• Use only unbreakable toys that don’t have any sharp edges or small parts that can come loose.
• Don’t let your baby sleep in a bed or on a couch, and don’t sleep with your baby.

Falls

• Never leave your baby on a high place, like a changing table, bed, or couch. Your baby should never be left alone except in a bassinet or crib with the crib sides up.
• Keep mesh netting of playpens in the upright position. The mesh should have openings of less than 1/4 inch.
• Always buckle the safety belts or straps when your baby is in an infant carrier or shopping cart.
• Do not put your baby in a walker. Baby walkers are unsafe and can delay learning to walk.

Car Safety

• Car seats are the safest way for babies to travel in cars and are required by law. Place infant car seats in the back seat with your baby facing toward the back of the car. If you are not sure how to install the seat in your car, contact your local fire department.
• Never leave children alone in a parked car, even for a few minutes. Children are at risk for heat illness and injury when left alone. Always check to make sure your child is not still in the car when you leave your car.

Fires and Burns

• Check formula to make sure that it is warm, not hot.
• Never eat, drink, or carry anything hot while you are holding your baby or near your baby.
• Turn down your water heater to 120°F (49°C) or lower.
• Install smoke detectors. Check your smoke detectors as often as recommended by the manufacturer or at least once a month to make sure they work. For all detectors that use batteries, replace batteries at least once a year or when they are low.
• Keep a fire extinguisher in or near the kitchen.

Smoking

• Children who live in a house where someone smokes have more respiratory infections, like colds, flu, and throat 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. Ask your healthcare provider for help in quitting. If you cannot quit, do NOT smoke in the house or car or near children.

Immunizations

Immunizations protect your child against several serious, life-threatening diseases. At the 4-month visit, your baby should have:

• Diphtheria, tetanus, and pertussis (DTaP) shot
• Haemophilus influenza type B (Hib) shot
• Polio shot
• Pneumococcal (PCV13) shot
• Rotavirus (RV) oral vaccine

Some babies also get another hepatitis B (hep B) shot at this age.

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

Your baby may have a fever and be irritable for a few days after getting shots. Your baby may also have some soreness, redness, and swelling where the shots were given. Ask your healthcare provider what symptoms or problems you should watch for and what to do if your child has them.

Bring your child's shot record to all visits with your child’s healthcare provider.

Next Visit

Your baby's next routine visit should be at the age of 6 months.