Your Child’s Checkup: 4 Months

What to Expect During This Visit

Your doctor and/or nurse will probably:

1. Check your baby’s weight, length, and head circumference and plot the measurements on the growth charts.

2. Ask questions, address concerns, and offer advice about how your baby is:

Feeding. Breast milk or formula is all a baby needs for the first 4–6 months. Iron-fortified cereal or puréed meats can be introduced between 4 and 6 months of age. Talk with your doctor before starting any solids.

Peeing and pooping. Babies this age should have several wet diapers a day and regular bowel movements. Some may poop every day; others may poop every few days. This is normal as long as stools are soft. Let your doctor know if they become hard, dry, or difficult to pass.

Sleeping. At this age, babies sleep about 14 hours a day, with two or three daytime naps. Most babies “sleep through the night” with a stretch of 5 or 6 hours of sleep. Some infants, particularly those who are breastfed, may still wake at night. But most no longer need a middle-of-the-night feeding.

Developing. By 4 months, it’s common for many babies to:

• smile, laugh, and squeal
• “coo” in response to your “coos”
• bring hands together in front of chest
• reach for and grasp objects
• bring toys to the mouth
• have good head control when sitting
• hold up head and chest, supporting themselves on arms, while on tummy
• possibly roll from front to back

There’s a wide range of normal and children develop at different rates. Talk to your doctor if you’re concerned about your child’s development.

3. Perform a physical exam with your baby undressed while you are present. This will include an eye exam, listening to your baby’s heart and feeling pulses, checking hips, and paying attention to your baby’s movements.

4. Update immunizations. Immunizations can protect infants from serious childhood illnesses, so it’s important that your baby receive them on time. Immunization schedules can vary from office to office, so talk to your doctor about what to expect.

Looking Ahead

Here are some things to keep in mind until your next routine visit at 6 months:

Feeding

1. Breast milk or formula is still all your baby needs.
2. If your doctor recommends introducing solids:
   • Share your family history of any food allergies.
   • Start with a small amount of iron-fortified single-grain cereal mixed with breast milk or formula. You can also start with a pureed meat, another iron-rich food.
   • Use an infant spoon — do not put cereal in your baby’s bottle.
   • If your baby is pushing a lot out with the tongue, he or she may not be ready for solids yet. Wait a week or so before trying again.
   • Wait until your baby successfully eats cereal from the spoon before trying other solids. Introduce one new food at a time and wait several days to a week to watch for a possible allergic reaction before introducing another.
3. Pay attention to signs that your baby is hungry or full.
4. Do not give juice until after 6 months.
5. Do not prop bottles or put your baby to bed with a bottle.

Routine Care/Safety

1. Many babies begin teething when they’re around 4 months old. To help ease pain or discomfort, offer a clean wet washcloth or a teether. Talk to your doctor about giving acetaminophen for pain.
2. Babies begin rolling over at around 4–6 months. Keep placing your baby to sleep on his or her back on a firm mattress in a crib without any crib bumpers, blankets, pillows, or plush toys. But it’s OK if your little one rolls over while sleeping.
3. Remove mobiles when your baby starts to push to his or her hands and knees or when your baby turns 5 months old, whichever comes first.
4. Continue to give your baby plenty of supervised “tummy time” when awake. Create a childproof play space for him or her to explore.
5. Limit the amount of time your baby spends in an infant seat, bouncer, or swing.
6. Don’t use a walker. They’re dangerous and can cause serious injuries. Walkers also do not encourage walking and may actually hinder it.
7. While your baby is awake, don’t leave your little one unattended, especially on high surfaces or in the bath.
8. Keep small objects and harmful substances out of reach.
9. Always put your baby in a rear-facing car seat in the back seat.
10. Avoid sun exposure by keeping your baby covered and in the shade when possible. Sunscreens are not recommended for infants younger than 6 months. However, you may use a small amount of sunscreen on an infant younger than 6 months if shade and clothing don’t offer enough protection.
11. TV viewing (or other screen time, including computers) can interfere with the brain development of young children. Therefore, TV is not recommended for those under 2 years old.
12. If you haven’t already, start childproofing your home. Get down on your hands and knees to look for potential dangers. Keep choking hazards, toxic substances (medicines, cleaning supplies, etc.), and hot or sharp items out of reach.
13. Limit your child’s exposure to secondhand smoke, which increases the risk of heart and lung disease.

These checkup sheets are consistent with the American Academy of Pediatrics (AAP)/Bright Futures guidelines.