4 Month Visit
Four months have gone by so fast! Your baby is starting to interact with you more and more and you’re starting to see a glimpse of their personality. By this age, babies usually enjoy being entertained by their parents, and maybe even more so by their older siblings. If you feel that everything has been changing quickly, hang on because lot’s more will be changing very soon!
What most babies do by this age:
- Smiles on his own to get your attention
- Chuckles (not yet a full laugh) when you try to make her laugh
- Looks at you, moves, or makes sounds to get or keep your attention
- Makes sounds like “oooo”, “aahh” (cooing)
- Makes sounds back when you talk to him
- Turns head towards the sound of your voice
Cognitive Milestones (learning, thinking, problem-solving)
- If hungry, opens mouth when she sees breast or bottle
- Looks at his hands with interest
Movement/Physical Development Milestones
- Holds head steady without support when you are holding her
- Holds a toy when you put it in his hand
- Uses her arm to swing at toys
- Brings hands to mouth
- Pushes up onto elbows/forearms when on tummy
Source: CDC – Learn the Signs, Act Early
Next, work on…
Sitting – first supported then alone
For the next couple of months, babies are working on increasing core strength and balance. By 6 months of age they should be able to sit for a few seconds with little support. You can help by putting your baby in a sitting posture and giving a bit of support with your hands. This can be in your lap, next to you on the couch or on a play mat. Have fun practicing this often!
Since babies of this age have more ability to reach for toys, they enjoy games involving handing things back and forth with you. They also like laughing, learning to blow ‘raspberries’, and having you play ‘peek a boo’. Of course reading together is another great activity!
Sadly, sickness will happen.
Babies at this age commonly have upper respiratory infections (colds) which are caused by viruses. If your baby becomes sick, he should be examined to determine the cause of the illness. Upper respiratory infections do not need to be treated with antibiotics, but sometimes another infection (such as an ear infection) may occur which does require their use.
Most babies at this age are eating around 30-32 ounces of breastmilk or formula daily. Typically, their daily milk volume stays about the same from this point all the way to 12 months. It will be time to start some food soon, and it is good to start talking about that at this age.
Guidance on when to start foods varies between 4 and 6 months in the medical literature. Ultimately, it is probably best to start sometime between these two ages. Some signs to watch for to let you know that your baby is ready include how well she is doing sitting with support and how much she is jealously watching you eat.
There is really no best way to start food but there are many websites and publications that claim to be best. “Baby Led Weaning” has become very popular recently, but it is still fine to start with purees. Many of our families end up doing a bit of both.
Whenever you do start food, it may be a good idea to stick to a single first food for the first couple of weeks and add variety slowly later.
It is now recommended to start some of the more allergenic foods earlier rather than later. For most babies, this means at 6 months so you don’t have to focus on that yet.
Some babies will “sleep through the night” at this point. Others may still awaken to eat, but should be easy to get back to sleep. Most babies take 2-3 naps during the day at this age, and should be developing a more regular nap schedule.
- This is a common age for “teething symptoms”, some of which may precede the actual cutting of teeth by months. Most babies will not have any teeth come in for several months. Drooling and putting the hand in the mouth are common for all 4 month old babies and probably don’t mean that teeth are coming soon.
- Usually the bottom central incisors are the first teeth to come in so that’s the area to keep an eye on.
- Teething may cause a very low grade fever, but not over 100.4 degrees. If your baby has fever, think about illness first and have us check them.
- If teeth are starting to come in, cold teething rings, or an occasional dose of tylenol may help with the discomfort.
Today your child will receive four separate immunizations: Pediarix, Hib, Prevnar and oral Rotavirus. This group of vaccines is the same as at the 2 month visit.
- Pediarix is a combination vaccine containing DTaP, IPV and Hepatitis B. This vaccine protects against diphtheria (a severe throat infection), tetanus (lock- jaw), pertussis (whooping cough), polio (paralysis), and hepatitis B (a liver infection).
- Hib is a vaccine against Haemophilus influenza type B, a bacteria which causes meningitis (infection of the spinal cord and/or brain) and severe respiratory infections.
- Prevnar is a vaccine against Pneumococccus, a bacteria which causes ear infections, meningitis, sepsis (blood infections) as well as pneumonia.
- Rotavirus is a vaccine against a virus that causes severe diarrhea and dehydration.
Now is the time to start thinking about “baby proofing” your home. Make sure that cords or other items that can be pulled are out of your baby’s reach. Remember, anything that your baby plays with will probably go into his mouth. Make sure that these items don’t have small parts, which could break off and cause a choking hazard.
Be careful with hot water and set your hot water heater below 120 degrees to prevent burns.
Your baby should remain rear-facing in the car seat until he is 2 years old and should be placed in the center of the back seat if possible.
To prevent sunburn, avoid sun exposure and dress infants in lightweight long pants, long-sleeved shirts, and brimmed hats that shade the neck. However, when adequate clothing and shade are not available, parents can apply a minimal amount of sunscreen with at least SPF 30 to small areas, such as the infant’s face and the back of the hands. If an infant gets sunburned, apply cold compresses to the affected area.