Well-Baby Checkup: 4 Months
At the 4-month checkup, the healthcare provider will examine the baby and ask how things are going at home. This sheet describes some of what you can expect.
Always put your baby to sleep on her back.
Development and Milestones
The healthcare provider will ask questions about your baby. And he or she will observe the baby to get an idea of the infant’s development. By this visit, your baby is likely doing some of the following:
Holding up his or her head
Reaching for and grabbing at nearby items
Squealing and laughing
Rolling to one side (not all the way over)
Acting like he or she hears and sees you
Sucking on his or her hands and drooling (this is not a sign of teething)
Feeding Tips
Keep feeding your baby with breast milk and/or formula. To help your baby eat well:
During the day, feed at least every 2-3 hours. At night, feed when the baby wakes, often every 3-4 hours.
Breastfeeding sessions should last around 10-15 minutes. With breast milk or formula from a bottle, give the baby 4-6 ounces at each feeding.
If you’re concerned about the amount or how often your baby eats, discuss this with the healthcare provider.
Ask the healthcare provider if your baby should take vitamin D.
Ask when you should to start feeding the baby solid foods (“solids”).
Be aware that many babies of 4 months continue to spit up after feeding. In most cases, this is normal. Talk to the healthcare provider if you notice a sudden change in your baby’s feeding habits.
Hygiene Tips
Some babies poop (stool) a few times a day. Others poop as little as once every 2-3 days. Anything in this range is normal.
It’s fine if your baby poops even less often than every 2-3 days if the baby is otherwise healthy. But if the baby also becomes fussy, spits up more than normal, eats less than normal, or has very hard stool, tell the healthcare provider. The baby may be constipated (backed up).
The baby’s stool may range in color from mustard yellow to pale yellow to green. If it’s another color, tell the healthcare provider.
Bathe the baby at least once a week.
Sleeping Tips
At 4 months, most babies sleep around 15-18 hours each day. It’s common to sleep for short spurts throughout the day, rather than for hours at a time. This will likely improve over the next few months as your baby settles into regular naptimes. Also, it’s normal for the baby to be fussy before going to bed for the night (around 6:00 PM to 9:00 PM). To help your baby sleep safely and soundly:
Always put the baby down to sleep on his or her back. This helps prevent SIDS (sudden infant death syndrome).
Ask the healthcare provider if you should let your baby sleep with a pacifier.
Don’t put a pillow, heavy blankets, or stuffed animals in the crib. These could suffocate the baby.
Swaddling (wrapping the baby tightly in a blanket) can help the baby feel safe and fall asleep.
This is a good age to start a bedtime routine. By doing the same things each night before bed, the baby learns when it’s time to go to sleep. For example, your bedtime routine could be a bath, followed by a feeding, followed by being put down to sleep.
It’s okay to let your baby cry in bed. This can help your baby learn to sleep through the night. Talk to the healthcare provider about how long to let the crying continue before you go in.
If you have trouble getting your baby to sleep, ask the healthcare provider for tips.
Safety Tips
By this age, babies begin putting things in their mouths. Don’t let your baby have access to anything small enough to choke on. As a rule, an item small enough to fit inside a toilet paper tube can cause a child to choke.
When you take the baby outside, avoid staying too long in direct sunlight. Keep the baby covered or seek out the shade. Ask your baby’s healthcare provider if it’s okay to apply sunscreen to your baby’s skin.
In the car, always put the baby in a rear-facing car seat. This should be secured in the back seat according to the car seat’s directions. Never leave the baby alone in the car.
Don’t leave the baby on a high surface such as a table, bed, or couch. He or she could fall and get hurt. Also, don’t place the baby in a bouncy seat on a high surface.
Walkers with wheels are not recommended. Stationary (not moving) activity stations are safer. Talk to the healthcare provider if you have questions about which toys and equipment are safe for your baby.
Older siblings can hold and play with the baby as long as an adult supervises.
Call the doctor right away if the baby has a rectal temperature over 100.4°F.
Vaccinations
Based on recommendations from the American Association of Pediatrics, at this visit your baby may receive the following vaccinations:
Diphtheria, tetanus, and pertussis
Haemophilus influenzae type b
Pneumococcal
Polio
Rotavirus
Going Back to Work
You may have already returned to work. Or you may be preparing to soon. Either way, it’s normal to feel anxious or guilty about leaving your baby in someone else’s care. These tips may help with the process:
Share your concerns with your partner. Work together to form a schedule that balances jobs and childcare.
Ask friends or relatives with kids to recommend a caregiver or daycare center.
Before leaving the baby with someone, choose carefully. Watch how caregivers interact with your baby. Ask questions and check references. Get to know your baby’s caregivers so you can develop a trusting relationship.
Always say good-bye to your baby, and say that you will return at a certain time. Even a child this young will understand your reassuring tone.
If you’re breastfeeding, talk to your baby’s healthcare provider or a lactation consultant about how to keep doing so. Many hospitals offer return-to-work classes and support groups for breastfeeding moms.
Next checkup at: _______________________________
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