4 Month Visit

Four months have gone by so fast! Your baby is increasingly interacting with you, and you’re seeing 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 changed quickly, hang on because more will be changing soon!

What most babies do by this age:

Social/Emotional Milestones

  • 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

Language/Communication Milestones

  • Makes sounds like “oooo” and “aah” (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

Babies are working on increasing core strength and balance for the next couple of months. By six months, 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 some support with your hands. This can be in your lap, next to you on the couch, or a play mat. Have fun practicing this often!

Playing together

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) 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 require their use.


Most babies at this age eat around 30-32 ounces of breastmilk or formula daily. Their daily milk volume typically stays about the same from this point to 12 months. It will be time to start some food soon, and it is good to start talking about that at this age.

The medical literature shows different guidance on when to start foods between 4 and 6 months. Ultimately, it is best to begin sometime between these two ages. To let you know that your baby is ready, some signs to watch for include how well she is sitting with support and how much she is jealously watching you eat.

There is no best way to start food, but many websites and publications claim to be the best. “Baby-led weaning” has become very popular recently, but it is still OK to start with purees. Many of our families end up doing a bit of both.

When you start food, it is a good idea to stick to a single food for the first couple of weeks and add variety slowly later.

Starting some of the more allergenic foods earlier rather than later is recommended. For most babies, this means at six 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 it 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 typical 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 four-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 low-grade fever, but not over 100.4 degrees.  If your baby has a fever, consider the 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 three immunizations: Vaxelis, Vaxneuvanse, and oral Rotavirus.


  • Vaxelis is a combination vaccine containing DTaP, IPV, HIB, and Hepatitis B. This vaccine protects against diphtheria (a severe throat infection), tetanus (lock-jaw), pertussis (whooping cough), polio (paralysis), HIB (a bacteria that causes meningitis and severe respiratory infections), and hepatitis B (a liver infection).
  • Vaxneuvanse is a vaccine against Pneumococcus, a bacteria that causes ear infections, meningitis, sepsis (blood infections), and 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. Ensure that cords or other items that can be pulled are out of your baby’s reach. Remember, anything your baby plays with will probably go into his mouth. Ensure that these items don’t have small parts, which could break off and cause a choking hazard.

    Please be careful with hot water, and set your water heater below 120 degrees to prevent burns.

    Your baby should remain rear-facing in the car seat until he is two years old and 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 unavailable, parents can apply minimal 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.

    The next visit is at 6 months of age and should be at least 8 weeks from now. See you then!