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Well Child Visit At 4 Months
A well child visit
is when your child sees a healthcare provider to prevent health problems. It is a different type of visit than when your child sees a healthcare provider because he is sick. Well child visits are used to track your child's growth and development. It is also a time for you to ask questions and to get information on how to keep your child safe. Write down your questions so you remember to ask them. Your child should have regular well child visits from birth to 17 years.
Development milestones your baby may reach at 4 months:
Each baby develops at his own pace. Your baby might have already reached the following milestones, or he may reach them later:
- Smile and laugh
- Coo in response to someone cooing at him
- Bring his hands together in front of him
- Reach for objects and grasp them, and then let them go
- Bring toys to his mouth
- Control his head when he is placed in a seated position
- Hold his head and chest up and support himself on his arms when he is placed on his tummy
- Roll from front to back
What you can do when your baby cries:
Your baby may cry because he is hungry. He may have a wet diaper, or be hot or cold. He may cry for no reason you can find. Your baby may cry more often in the evening or late afternoon. It can be hard to listen to your baby cry and not be able to calm him down. Ask for help and take a break if you feel stressed or overwhelmed. Never shake your baby to try to stop his crying. This can cause blindness or brain damage. The following may help comfort him:
- Hold your baby skin to skin and rock him, or swaddle him in a soft blanket.
- Gently pat your baby's back or chest. Stroke or rub his head.
- Quietly sing or talk to your baby, or play soft, soothing music.
- Put your baby in his car seat and take him for a drive, or go for a stroller ride.
- Burp your baby to get rid of extra gas.
- Give your baby a soothing, warm bath.
What you can do to keep your baby safe in the car:
- Always place your baby in a rear-facing car seat. Choose a seat that meets the Federal Motor Vehicle Safety Standard 213. Make sure the child safety seat has a harness and clip. Also make sure that the harness and clips fit snugly against your baby. There should be no more than a finger width of space between the strap and your baby's chest. Ask your healthcare provider for more information on car safety seats.
- Always put your baby's car seat in the back seat. Never put your baby's car seat in the front. This will help prevent him from being injured if you get into an accident.
Keep your baby safe at home:
- Do not give your baby medicine unless directed by his healthcare provider. Ask for directions if you do not know how to give the medicine. If your baby misses a dose, do not double the next dose. Ask how to make up the missed dose. Do not give aspirin to children under 18 years of age. Your child could develop Reye syndrome if he takes aspirin. Reye syndrome can cause life-threatening brain and liver damage. Check your child's medicine labels for aspirin, salicylates, or oil of wintergreen.
- Do not leave your baby on a changing table, couch, bed, or infant seat alone. Your baby could roll or push himself off. Keep one hand on your baby as you change his diaper or his clothes.
- Never leave your baby alone in the bathtub or sink. A baby can drown in less than 1 inch of water.
- Always test the water temperature before you give your baby a bath. Test the water on your wrist before putting your baby in the bath to make sure it is not too hot. If you have a bath thermometer, the water temperature should be 90°F to 100°F (32.3°C to 37.8°C). Keep your faucet water temperature lower than 120°F. Adjust your water heater temperature if it is higher than 120°F.
- Never leave your baby in a playpen or crib with the drop-side down. Your baby could fall and be injured. Make sure that the drop-side is locked in place.
- Do not let your baby use a walker. Walkers are not safe for your baby. Walkers do not help your baby learn to walk. Your baby can roll down the stairs. Walkers also allow your baby to reach higher. They can reach for hot drinks, grab pot handles off the stove, or reach for medicines or other unsafe items.
How to lay your baby down to sleep:
It is very important to lay your baby down to sleep in safe surroundings. This can greatly reduce his risk for SIDS. Tell grandparents, babysitters, and anyone else who cares for your baby the following rules:
- Put your baby on his back to sleep. Do this every time he sleeps (naps and at night). Do this even if he sleeps more soundly on his stomach or on his side. Your baby is less likely to choke on spit-up or vomit if he sleeps on his back.
- Put your baby on a firm, flat surface to sleep. Your baby should sleep in a crib, bassinet, or cradle that meets the safety standards of the Consumer Product Safety Commission (CPSC). Do not let him sleep on pillows, waterbeds, soft mattresses, quilts, beanbags, or other soft surfaces. Move him to his bed if he falls asleep in a car seat, stroller, or swing. He may change positions in a sitting device and not be able to breathe well.
- Put your baby to sleep in a crib or bassinet that has firm sides. The rails around your baby's crib should not be more than 2⅜ inches apart. A mesh crib should have small openings less than ¼ of an inch.
- Put your baby in his own bed. A crib or bassinet in your room, near your bed, is the safest place for your baby to sleep. Never let him sleep in bed with you. Never let him sleep on a couch or recliner.
- Do not leave soft objects or loose bedding in his crib. His bed should contain only a mattress covered with a fitted bottom sheet. Use a sheet that is made for the mattress. Do not put pillows, bumpers, comforters, or stuffed animals in his bed. Dress your baby in a sleep sack or other sleep clothing before you put him down to sleep. Avoid loose blankets. If you must use a blanket, tuck it around the mattress.
- Do not let your baby get too hot. Keep the room at a temperature that is comfortable for an adult. Never dress him in more than 1 layer more than you would wear. Do not cover his face or head while he sleeps. Your baby is too hot if he is sweating or his chest feels hot.
- Do not raise the head of his bed. Your baby could slide or roll into a position that makes it hard for him to breathe.
What you need to know about feeding your baby:
Breast milk or iron-fortified formula is the only food your baby needs for the first 4 to 6 months of life.
- Breast milk gives your baby the best nutrition. It also has antibodies and other substances that help protect your baby's immune system. Babies should breastfeed for about 10 to 20 minutes or longer on each breast. Your baby will need 8 to 12 feedings every 24 hours. If he sleeps for more than 4 hours at one time, wake him up to eat.
- Iron-fortified formula also provides all the nutrients your baby needs. Formula is available in a concentrated liquid or powder form. You need to add water to these formulas. Follow the directions when you mix the formula so your baby gets the right amount of nutrients. There is also a ready-to-feed formula that does not need to be mixed with water. Ask the healthcare provider which formula is right for your baby. As your baby gets older, he will drink between 26 to 36 ounces each day. When he starts to sleep for longer periods, he will still need to feed 6 to 8 times in 24 hours.
- Burp your baby during the middle of his feeding or after he is done with his feeding. Hold your baby against your shoulder. Put one of your hands under your baby's bottom. Gently rub or pat his back with your other hand. You can also sit your baby on your lap with his head leaning forward. Support his chest and head with your hand. Gently rub or pat his back with your other hand. Your baby's neck may not be strong enough to hold his head up. Until his neck gets stronger, you must always support his head while you hold him. If your baby's head falls backward, he may get a neck injury.
- Do not prop a bottle in your baby's mouth or let him lie flat during a feeding because he can choke. If he lies down during a feeding, the milk may flow into his middle ear and cause an infection.
- Ask your baby's healthcare provider when you can offer iron-fortified infant cereal to your baby. He may suggest that you give your baby iron-fortified infant cereal with a spoon 2 or 3 times each day. Mix a single grain cereal (such as rice cereal) with breast milk or formula. Offer him 1 to 3 teaspoons of infant cereal during each feeding. Sit your baby in a high chair to eat solid foods.
Help your baby get physical activity:
Your baby needs physical activity so his muscles can develop. Encourage your baby to be active through play. The following are some ways that you can encourage your baby to be active:
- Hang a mobile over his crib to motivate him to reach for it.
- Gently turn, roll, bounce, and sway your baby to help increase his muscle strength. Place your baby on your lap, facing you. Hold your baby's hands and help him stand. Be sure to support his head if he cannot hold it steady.
- Play with your baby on the floor. Place your baby on his tummy. Tummy time helps your baby learn to hold his head up. Put a toy just out of his reach. This may motivate him to roll over as he tries to reach it.
Other ways you can support your baby:
- Help your baby develop a healthy sleep-wake cycle. Your baby needs sleep to help him stay healthy and grow. Create a routine for bedtime. Bathe and feed your baby right before you put him to bed. This will help him relax and get to sleep easier. Put your baby in his crib when he is awake but sleepy.
- Relieve your baby's teething discomfort with a cold teething ring. Ask your healthcare provider about other ways that you can relieve your baby's teething discomfort. Your baby's first tooth may appear between 4 and 8 months of age. Some symptoms of teething include drooling, irritability, fussiness, ear rubbing, and sore, tender gums.
- Read to your baby. This will comfort your baby and help his brain develop. Point to pictures as you read. This will help your baby make connections between pictures and words. Have other family members or caregivers read to your baby.
- Do not smoke near your baby. Do not let anyone else smoke near your baby. Do not smoke in your home or vehicle. Smoke from cigarettes or cigars can cause asthma or breathing problems in your baby.
- Take an infant CPR and first aid class. These classes will help teach you how to care for your baby in an emergency. Ask your baby's healthcare provider where you can take these classes.
What you need to know about your baby's next well child visit:
Your baby's healthcare provider will tell you when to bring your baby in again. The next well child visit is usually at 6 months. Contact your child's healthcare provider if you have questions or concerns about his health or care before the next visit. Your baby may need the following vaccines at his next visit: hepatitis B, rotavirus, diphtheria, DTaP, HiB, pneumococcal, and polio.
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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.