Well Child: 4th Month Checklist

FEEDING YOUR BABY: Continue to feed your baby breast milk or iron-fortified formula. Bottle-fed babies take approximately 4-8 oz/feeding and a total of 24-32 oz/day. Periods of high demand may indicate a growth spurt. You may begin to feed your baby solid food between four and six months of age. Some signs your baby is ready include seemingly constant hunger, opens mouth for spoon, sits with support, has good head and neck control, and shows interest in foods you eat. If you have a strong family history of food allergies or asthma, it may be better to delay starting solids until six months of age. For exclusively breast fed infants, iron should be added to the baby’s diet at this age by starting iron-fortified cereal or by using Poly-vi-sol® with iron 1ml by mouth daily.

When starting solids, start with 3 tablespoons of rice cereal or oatmeal mixed with breast milk or formula twice daily, then progress through yellow vegetables and fruits. Introduce one new food at a time and wait a couple of days before adding another new food to see if any reactions occur. Breast milk or formula is still the most important food for your baby. Solids should not reduce milk intake. If your baby does not seem to like a food, do not force the food and try it again in a month. A baby’s appetite and acceptance of new foods will vary. Remember these instructions are guidelines, not rigid rules.

SAFETY: As babies begin to roll over, they are at increased risk for falling off elevated surfaces. Never leave your baby unattended on the changing table or in the bath. As your baby starts teething, he will enjoy grabbing and chewing on toys so make sure the toys do not have sharp edges or small removable parts. If you have not already, take a CPR course at Children’s Healthcare of Atlanta or Northside Hospital. Keep an emergency contact list by your phone.

DEVELOPMENT: At this age, most babies sit with support, grasp an object, coo, laugh, squeal, and smile. Many babies are rolling over, but some are not. First teeth generally erupt between 4 and 9 months of age, but may appear at any time. You may notice your baby drooling and chewing on objects at the start of teething.

SLEEP: At four months, most babies will take 2-3 naps per day and sleep through the night with possibly one feeding, especially in exclusively breast fed. If necessary, you may need to allow your baby to cry for a short time to see if he can comfort himself instead of rushing to feed him during the night. Up to 16 hours of sleep per day is normal.

IMMUNIZATIONS: Pentacel, Hepatitis B, Prevnar 13, and Rotateq vaccines will be given today. These are the same immunizations given to your baby at the two month visit. All immunizations may cause mild discomfort, fussiness, irritability, or mild fever. You may also notice small knots in your baby’s thighs at the injection sites. There is no need to worry when this happens, and the appropriate dose of infant acetaminophen suspension (Tylenol®) may be given every 4-6 hours as needed. Do not give your baby ibuprofen (Motrin®) until 6 months of age.

RETURN TO OUR OFFICE AT 6 MONTHS FOR YOUR CHILD’S NEXT VISIT
(Click Here for 6 Month Checklist)

• Click here for a downloadable version for printing: (Downloadable PDF Link)