4-Month-Old Well Child Check

Your baby smiles spontaneously, laughs and gets excited.

She also spends time looking at her hands and is reaching for objects.

Nutrition

Feedings

Both human milk and/or commercially prepared formula is still required. Cow's milk is not recommended until after one year of age. Thirty-two ounces per day is usually the maximum amount recommended, and should be divided into four to five feedings per day.

Solids are not required for adequate nutrition, but depending on your baby's individual needs, may be introduced between four to six months of life. Start with single foods given once a day. Feed with a spoon. Do not put solids in a bottle or infant feeder.

Please see our page on feeding for more thorough information.

Vitamins

The American Academy of Pediatrics recommends supplementing exclusively breastfed babies with vitamin D. One such supplement, D-vi-sol, can be purchased over the counter; give one dropper daily. Nursing mothers should continue their prenatal vitamins. Formula fed infants receive adequate vitamin supplement from commercially prepared formula.

Development

At this age most babies:

  • Smile spontaneously, laugh and get excited
  • Start to reach for objects
  • Roll over
  • Respond and turn to sound
  • Hold their head up steady when being held in a sitting position
  • Spend time looking at and touching their own hands

Indicators for concern:

  • Does not watch moving objects
  • No startle to sound
  • Does not move extremities equally

Vaccinations

At this visit, your child is scheduled to receive the DTaP, Hib, IPV, Pneumococcal Conjugate, and Rotavirus immunizations.

Common Issues And Concerns

Medications

To see information on Acetaminophen (Infant Tylenol) dosage, click here. Remember to always dose based on the weight of your child.

Sleep

(Helpful hints for preventing problems)

  • Establish a bedtime routine and put the baby to bed while he is awake.
  • Discontinue the 2:00 a.m. feeding before it becomes a habit. Your baby does not need to be fed more than five times per day.
  • If your baby cries for more than five minutes during the night, do not feed her, just comfort her with a back rub or a few soothing words. Do not turn on the light or lift her out of the crib.
  • Make middle-of-the-night contacts brief and boring. Minimize interactions with your child between 10:00 p.m. and 6:00 a.m.
  • If the crying continues, you can recheck your baby every 20 minutes. Remember that all children have four to five partial awakenings a night.
Recommendations
  • Remember the baby should always be buckled into his car seat when traveling; children cannot be placed in the front seat if the car has airbags. Your baby may be outgrowing his infant seat. Follow the manufacturer's recommendations and replace with a larger seat when your baby reaches the maximum weight allowed.
  • Do not string toys or mobiles across the crib. Once the child can raise his head, he could get caught and strangle.
  • Keep dangerous objects out of reach.
  • Stimulate your baby verbally and tactically.
  • Offer safe, colorful toys.
  • Begin getting your house ready for a crawling baby by using safety locks on cabinets and by covering electrical outlets.
  • Games your infant may enjoy playing include pat-a-cake and peek-a-boo. They also love to have you talk and sing to them.
  • Your baby will not be able to tell you when he doesn't feel well; watch for signs of illness such as fever, poor appetite, being less active/more fussy; have a thermometer at home and learn how to take your baby's temperature.
  • Baby teeth may start to come in as early as six months and this may make your baby irritable or restless; a cool teething ring or clean wash cloth to chew on may make sore gums feel better. 
  • Do not leave an iron or curling iron in baby's reach.
Depression During and After Pregnancy

Depression during and after pregnancy is common and treatable. Having a baby is challenging and every woman deserves support. We will screen for caregiver depression at your child's well-child visits through the first year. Talk to your child's healthcare provider or your healthcare provider if you are experiencing symptoms. Please review this information from the CDC regarding postpartum depression. There are also resources available. Contact the Postpartum Support International Warmline and a trained helpline volunteer will call/text you back to identify a local coordinator and resources in your area:

  • Call 1-800-944-4773, #1 en Espanol or #2 English
  • Text 503-894-9453

Next Well Child Visit

Your child's next well child visit will be at six months of age.