Four months is a fun age. Your baby is becoming more and more interactive. He or she may make squealing noises and even laugh at you (or should I say with you J). If you’re lucky, your baby may even start sleeping through the night consistently by 4 months of age. Most babies do that blessed maneuver somewhere between 4 and 6 months of age.

Safety

  • Car: Continue to use an infant seat, in the back seat of the vehicle, rear facing (I like the 5 point harness style that allows you to pull the straps tight against the infant’s chest)
  • Sleep: A baby’s risk of SIDS peaks at around 4 months of age, (it is hypothesized that this increase corresponds to when a baby is just learning to roll, but is not yet good at moving his/her head to clear his/her airway). This makes the parent’s roll of providing a safe sleeping environment more important.
    • The crib is the safest place, slats <2 3/8 in. apart
    • On your baby’s back
    • No extra soft bedding (quilts, comforters), pillows, toys, positioners, or bumpers (these are also suffocation hazards)
  • Water heater less than 120 degree F (prevent scalding)
  • Keep home and car smoke free
  • Do not leave the baby on a high surface where he or she could roll off (e.g., changing table, couch, or bed).
  • Limit sun exposure
  • Childproof your home. A child who can roll can also move across a room and reach a surprising number of things
    • Safety gates over stairs
    • Locks on cabinets
    • Outlet plug covers
    • Hooks for blind cords

 Nutrition

  • Milk. Your baby’s nutritional needs are met at this age by milk, either breast milk or iron-fortified infant formula. Do not introduce cow’s milk until 12 months.
  • If breastfeeding, your baby should be feeding approximately 5-6 feedings in a 24 hour period. However, some babies may feed more frequently during the day if they are sleeping through the night.
  • If formula feeding, your baby should be taking 28-34 ounces in a 24 hour period. Make sure the formula is iron fortified. As for which formula, nearly all infants can tolerate a cows milk based formula without problem. There are very few medical indications for hydrolyzed formulas. The latest and greatest in formulas is trying to imitate breast milk, and this contains the ingredient DHEA (claiming it is better for your baby’s brain).
  • Supplements: If breastfeeding (exclusively), Vitamin D 400 IU per day for baby (to prevent Ricketts)
  • Introducing solids. While many parents are very eager to try feeding their baby solid foods, their baby is often not quite developmentally ready yet. By about 5-6 months your baby should be able to hold her neck steady, sit with support, and draw in her lower lip as a spoon is removed from her mouth. This will help indicate she is ready. If tried too early, the tongue thrust reflex will cause her spit out the food and not be able to handle the spoon appropriately. Cereal is the first semi-solid food I usually recommend. It is easily digested, not likely to cause allergies, and a good source of iron. Try a rice or barley cereal and mix it with formula or breast milk. Start with a tablespoon and gradually increase to 3-4 tablespoons per day. Stick with the same kind of cereal for a number of days before changing to check for allergic symptoms (e.g., rash, diarrhea, coughing). FYI: Some of the latest scientific literature is suggesting that waiting until a child is older (i.e., 6 mo.) decreases the child’s risk of allergies–more food for thought.

Oral Health

  • Do not put your baby to bed with a bottle. It establishes bad habits, causes bottle rot (have you seen the children with rotten teeth or capped teeth?), and is a choking hazard.
  • Discuss with your pediatrician whether your infant needs supplemental fluoride (this depends on your city’s water supply).

Milestones

  • Babbles, coos
  • Is starting to roll (may only do it one direction–front to back most common)
  • Grasps a rattle
  • Recognizes parents voice/touch
  • Controls head well
  • Laughs/squeals
  • Opens hands
  • Puts everything in mouth