Routine Well Visit: 4 Months

Development

By 4 months, your baby should

• Show increased muscle tone and will also be able to hold their head steady without support
• Might roll from tummy to back (particularly if they are used to tummy-time by now)
• Can hold and shake a toy, will bat at dangling toys
• Reaches for objects and tries to put objects in their mouth
• When lying on stomach, raises head and pushes up to elbows
• Vision is improved, and baby will be enthralled by bright colors
• Babbles, squeals, laughs, blows raspberries and may mimic sounds. They are
• learning to communicate with you

Nutrition

Continue breast milk or formula on demand.
Babies do not require any additional water –they get all the fluids they need from breast
milk and/or formula.

Now is about the time you may have a well-meaning grandmother or older adult ask about adding cereal to the bottle. The answer is No, it does not help them sleep longer, and can possibly lead to choking.

You can introduce a tiny amount of peanut butter – try a pea-sized amount or less, mixed with formula to make it liquid. Recent studies have shown that peanut products introduced early (between 4 and 6 months result in a lower likelihood of allergies later.

Sleep

Back to Sleep should still be the mantra at this point, but once baby learns to roll over, it is safe to allow him/her to sleep in whichever position they wish. They should have established some routine for nap/sleep schedule. Put baby in their crib when they are starting to tire and allow them some time to fuss and self-soothe before sleep. Wake the baby if he/she is sleeping more than 3 hours during the day so the longer sleep patterns are at night when you need some sleep!

Safety

Babies learn about their environment through their senses. This means everything will go into their mouths! Expect that they will grab and bat everything (including your coffee, so don’t even try a sip while holding them). The house definitely needs to be child-proofed by now - careful of loose cords from electrical outlets and from window blinds. Diaper changes should be on a low flat surface to prevent falls.

Relationships

Babies learn through play and interaction. Peek-a boo, tactile and brightly colored toys that are safe for chewing are all appropriate. Continue singing, playing, and reading to baby. Your baby had 9 months in the womb to listen to your voice, nothing sounds sweeter to them!

The 4 month office visit

We follow the American Academy of Pediatrics and CDC schedule for well visits and vaccines. In addition to discussing your baby’s growth and development, they will receive dose #2 of the vaccines they received at the 2 month visit. For information about these vaccines, please visit www.immunize.org/vis