Four Month Visit

Development

Babies at this age are outgoing and social. They smile, coo, giggle and squeal. They recognize parents and will reach out for them to be held.

Babies can sit steadily if supported. They have no head lag when pulled to a sitting position and they begin to support their weight on their legs when held.

At this age your baby should grasp and reach for objects and explore objects with his/her mouth.

Activities

- Give your baby toys and textures to grab. Once your baby can easily put toys in his/her mouth substitute chew toys for the pacifier.
- Encourage tummy-time when awake.
- Interact with your baby: talk, sing, read aloud.
- Babies enjoy outings at this age: go for walks, trips to parks, museums or the zoo.

Sleep

Place in crib sleepy but awake; establish a nighttime routine which everyone enjoys.

At 4 months of age your child will hopefully soon be sleeping at least one 5-7 hour stretch at night. If your child falls asleep independently at the beginning of the night, it will be easier for your baby to go back to sleep in the middle of the night without your help.

Keep middle of night feeding brief and boring to encourage sleep.

Some babies have transitional objects (comfort objects) as early as four months.

Your infant should sleep only on his/her back.

There is no need to change the diaper of a sleeping baby.

Safety

Use a properly fitting rear-facing car seat. The center rear seat is the safest position.

Never leave a baby unattended on surfaces above the floor. This is the age when babies can roll off the bed or changing table or wiggle out of the car seat or stroller if they are not strapped in place.

Never hold a baby while drinking a hot beverage or smoking.

Check your smoke detectors and fire extinguishers on a regular basis. Have a family fire exit plan with ladders in upstairs bedrooms.

Avoid direct sunlight; sunburns happen easily. Use light cotton clothing. If direct sunlight is unavoidable use a baby sunscreen.

Check toys carefully for breakage, sharp or small parts as everything goes in the mouth!

Secondhand smoke is harmful. A new baby in the family is excellent motivation to stop smoking. Visit www.quitline.com or talk to your own physician about smoking cessation resources.

Do not use walkers with wheels. They are associated with serious injury. Stationary devices such as Exersaucers or Johnny Jump Up exercisers are good substitutes.

Parenting

Have you gone out on a date since becoming parents? Start a babysitter list and information sheet to leave with caretakers. Include home address, home phone number, cell phone or other contact information, poison control, 911 and medical insurance information.

Take time for yourself and to be alone with other family members. Try to get back to an exercise program for your own mental and physical health.

Nutrition

Solid foods can be introduced between 4 to 6 months of age. Watch your child for signs of interest in food when you are eating. Families with a history of allergies, asthma and eczema should delay the introduction of solid foods until six months.

Start with plain rice cereal with iron mixed with formula, breast milk or water to a very liquid consistency.

Begin introducing pureed vegetables and fruit baby food when your baby has mastered the art of swallowing. By introducing new foods every 3-5 days it will help to note if your baby has intolerance or allergies to certain foods, although allergies are rare.

Children do not need juice. If you decide to give juice, put it in a cup, not a bottle, and limit it to less than 4 oz 100% fruit juice a day.

To prevent vitamin D deficiency, the American Academy of Pediatrics recommends that all breastfed infants take 0.5ml Tri-Vi-Sol daily unless they are drinking at least 16 oz daily of formula.

Hold your baby during feedings. Do not put your baby to bed with a bottle.

Immunizations Today

Your baby will receive the same vaccines he/she received at the 2-month visit. Most babies will have no reaction or are somewhat sleepier following their immunizations. Your baby may develop a fever and/or be fussy for 24-48 hours. Some tenderness or redness at injection site may occur. Acetaminophen (Tylenol) may be given if any of these symptoms are present.

Next Visit

Please schedule your next visit for when your child is 6 months of age as you leave today.

Books/Resources

- Your Baby's First Year by the American Academy of Pediatrics
- Caring for Your Baby and Young Child: Birth to Age 5 by the American Academy of Pediatrics
- Healthy Sleep Habits, Happy Child by Marc Weissbluth MD
- Solve Your Child's Sleep Problems by Richard Ferber, MD
- Sleeping Through the Night, Revised Edition: How Infants, Toddlers and Their Parents Can Get a Good Night's Sleep by Jodi A. Mindell PhD
- The No-Cry Sleep Solution: Gentle Ways to Help Your Baby Sleep Through the Night by Elizabeth Pantley
- www.vaccine.chop.edu- great site for vaccine information