4 Months Checkup

Height: ____  Weight ____  Head Circ: ____

FEEDING: Your baby will grow well on breast milk or formula. You may start juices at this time (except citrus), but it is now recommended to limit such to one serving (2-4 ounces) per day. You may notice that your baby has become interested in noises and may jerk away from the breast or bottle in order to locate the sound. He may cry or be easily distracted at the slightest interruption. When this occurs, going to a quieter room to decrease distractions may help.

If your baby is requiring more than 32 ounces of formula per day to be satisfied, you can begin spoon feeding rice cereal. We recommend the dry cereal that you mix with water, juice, formula or breast milk. Start with one teaspoon and work up to 1- 2 Tablespoons, 2-3 times per day.

ELIMINATION: Stools may vary greatly (several per day to one every 2-4 days), but as long as they are not hard and are easily passed, this is okay. Contact us before attempting treatment for hard stools. Most babies strain and grunt when passing even soft stool, and this is not an indication of difficulty or pain. Avoid using suppositories unless directed by a physician. Keep in mind, addition of cereal to the diet will cause more formed stools.

SLEEP: Sleep requirements vary. Put baby to bed at a regular time each night. While some are sleeping through the night by now, some may not. Don’t awaken baby for a night feeding … let him wake you. Your baby should sleep in his own bed, preferably out of the parent’s room. This will avert many problems in the long run. Most still take a morning and afternoon nap.

Still place your baby on her back to sleep to start out, but if she rolls to her belly on her own, that is okay.

DEVELOPMENT:

• Coos, giggles aloud, interacts vocally with caregiver
• Holds head up in sitting position with mild head lag when pulled from lying to sitting
• Plays with hands and clothes, moves arms and legs vigorously
• Locates sound by turning head side to side and looking in same direction
• Rolls back to side, completely over by 20 weeks
• Begins to bear weight on legs (this will NOT make your baby bowlegged)

PLAY:

• Your baby will enjoy: rattles, crib gyms, soft squeeze toys of various textures. Talk to your baby, repeat sounds he makes. Call him by name, laugh with him.
• Use a swing or stroller
• Support him in a sitting position and let him lean forward to balance himself

SAFETY:

• Protect from falls, do not leave unattended on any raised surface.
• Never leave your baby in the sun, or unattended in your car.
• Do not tie pacifier or anything else around baby’s neck.
• Use pacifier with one-piece construction and loop handle
• Protect from burns, check bathwater, set water heater at 120 degrees or less.
• Install smoke detectors
• Use an approved car seat
• Do NOT use walkers (“Exer-saucers” are fine)
• Avoid using high chair until your child is old enough to sit well.

SMOKING: Do not smoke around your baby, or even in the house or the car. Exposure to cigarette smoke has been linked to numerous illnesses: crib death, ear infections, pneumonia, bronchitis, allergies, and growth retardation. Keep in mind, too, that you are your child’s most trusted role model. Do you really want your child to smoke?

TEETHING: The first tooth may erupt at 3-6 months of age, or later. Usually the bottom center teeth emerge first. For pain relief try a cold wash cloth to chew on, or teething rings. Tylenol may help, especially at night. Generally teething is NOT associated with a true fever (above 100.4 degrees rectally), and if he shows signs of ear pulling, vomiting or diarrhea, he should be examined.