4 Months

Feeding and Elimination

  • The baby is usually eating between 4-8 ounces every 3-4 hours. Breast fed babies are usually feeding every 3-4 hours. The actual amount the baby is eating will depend on their weight so there is no “right number of ounces.”
  • Stool patterns may vary but should still be semi-soft and passed easily.
  • Solid foods for babies are not really solid at all. The first solid food is usually semi-liquid ground for rice cereal. Start with infant rice cereal. Mix ½ to 1 tbsp. of cereal with formula or water. Offer this once a day for 3-5 days, slowly increasing the amount as tolerable. Then introduce barley, oat, wheat and lastly, mixed cereal. Allow 3-5 days between introductions of each new food. This allows time to observe for any allergic reactions like hives, trouble breathing, vomiting, or diarrhea.
  • Research does not support introducing solid food to promote longer periods of sleep. Your baby will be able to sleep for extended periods only when he has reached the right level of developmental maturity and is capable of comforting himself when awake and not hungry.
  • No solids in bottles – Don’t let well-intentioned advice lead you astray.
  • Start the meal with solids – save the bottle until your baby has finished eating the solids. They will be hungriest at the start of the meal and more willing to try new foods. Remember, in the beginning, solid foods are an addition to – not a replacement for – breast milk or formula.
  • American Academy of Pediatrics recommends that honey not be given to infants younger than 12 months. Honey has been associated with infant botulism, an illness that can be fatal.

General Care and Concerns

  • Before a child is mobile is a great time to start baby-proofing the house. Consider plugging outlets, locking up cleaning supplies, medications, weapons or objects of safety concerns. Obtain a fire extinguisher, and check all fire and carbon monoxide alarms.
  • Your baby is more active, so be extra careful with hot foods and drinks when your baby is in your lap. They are often stronger than they look. They also love putting everything in their mouth, so it is important to keep small items like marbles, coins, and batteries out of their reach.
  • Start a bedtime routine with your baby (i.e. bath time, reading books, lullabies), and put your baby in the crib when they are almost asleep. This will help your baby learn how to self soothe and fall asleep on their own.

Development

  • The baby is probably cooing, smiling, and laughing. They like to hold and regard their own hands. During tummy time, they like to raise their upper body using their arms and roll over from stomach to back.
  • Games like pat-a-cake and peek-a-boo are a great way to enforce object permanence and teach the baby beginner social skills.
  • Facial expressions and voice intonations you use when you are playing with them teach them the normal flow and rhythm of language. Talk to the baby as much as possible. Telling them seemingly mundane things like “I am changing your diaper now” are important to their language development.
  • Your child may do the following:
    • Move head forward to reach spoon when hungry
    • Swipe food toward the mouth when hungry
    • Turn head away from spoon when full
    • Get distracted or notice surroundings more when full
    • Sit with help or support
    • Push food out of mouth with tongue, which gradually decreases with age
    • Move pureed food forward and backward in mouth with tongue to swallow
    • Recognizes spoon and holds mouth open as spoon approaches
    • On tummy, pushes up on arms with straight elbows

Immunizations

  • Immunizations are a critical part of the baby’s well-being. Immunizations protect us from illnesses that have historically caused significant illness and death in children. Multiple studies are completed on the importance and safety of vaccines before they are added to the state’s mandatory list. Particular information on each vaccine is available on our website. The vaccines that are administered at the 4 month visit are the following:
    • Pentacel – vaccinates against diphtheria, pertussis, tetanus, haemophilus influenza type B, and polio
    • These bacteria and viruses can cause severe respiratory infections, meningitis, epiglottitis, some ear infections, lockjaw, and paralysis
    • PCV13 – vaccinates against the pneumococcal bacteria) the bacteria can cause meningitis, pneumonia, and some ear infections)
    • Rotateq – oral live vaccine that vaccinates against bacteria that can cause severe diarrhea
  • You may give a dose of Tylenol to alleviate any discomfort from the shot administration – this can be given to the baby before you come in for the visit. Common side effects from these vaccines include fussiness, fever (usually less than 102 degrees), mild redness or swelling at the injection site. Use of Tylenol for greater than 72 hours to control fever or fever greater than 102 with increased irritability warrants a call to the office.