Age: 4 Months

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. If you’re lucky, your baby may even start sleeping through the night by 4 months of age. Most babies do that blessed maneuver somewhere between 4 and 6 months of age.

SAFETY

1. 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)

   1. For help securing the seat make an appointment with a Nationally Certified Child Passenger Safety Technician (to find a location nearest you visit https://highwaysafety.utah.gov/seat-belts-and-car-seats/car-seat-safety/)

2. 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.

3. 1. The crib is the safest place, slats

   2. On your baby’s back

   3. No extra soft bedding (quilts, comforters), pillows, toys, positioners, or bumpers (these are also suffocation hazards)

4. Water: heater less than 120 degree F (prevent scalding)

5. Smoke: Keep home and car smoke free

6. Falling: Do not leave the baby on a high surface where he or she could roll off (e.g., changing table, couch, or bed).

7. Sun: Limit sun exposure, wear sun protective clothing, no sunscreen until 6 months Childproof: 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 Consider what a child could pull down on him/herself (anything with a dangling cord)

NUTRITION

1. 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.

2. 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.

3. If formula feeding, your baby should be taking 28-34 ounces in a 24 hour period (typically 5-6 oz bottles every 3-4 hours). Make sure the formula is iron fortified. As for which formula, nearly all infants can tolerate a cow’s milk based formula without problem. There are very few medical indications for hydrolyzed formulas. Feel free to use a generic formula if cost is a factor.

4. Supplements: If breastfeeding (exclusively), Start Poly-vi-sol with iron—1 ml once a day (this is in place of the Vit D). If formula feeding, there are no need for supplements.

5. 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 his/her neck steady, sit with support, and draw in his/her lower lip as a spoon is removed from her mouth. This will help indicate he/she is ready. If tried too early, the tongue thrust reflex will cause him/her spit out the food and not be able to handle the spoon appropriately. Cereal is the first semi-solid food I usually recommend (for ease, not due to some official recommendation). It is easily digested, not likely to cause allergies, and a good source of iron. Try a rice, barley, or oat 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). 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.

SLEEP

1. Should be giving you a 5-6 hour stretch of sleep at night before waking to feed

2. Starting to fall into a more predictable schedule: typically taking 3 naps a day (a shorter morning, longer afternoon nap, and a third evening cat nap).

3. If your baby has been in a bassinet, this is a good age to consider transitioning to the crib (more space, decrease risk of SIDS)

4. If you have been swaddling your baby, this is a good age to start gradually transitioning out of the swaddle

5. Total sleep is 12-16 hours (including naps) in a 24 hour period

MILESTONES

1. Babbles, coos

2. Is starting to roll (may only do it one direction–front to back most common)

3. Grasps a rattle

4. Recognizes parents voice/touch

5. Controls head well

6. Laughs/squeals

7. Opens hands

8. Puts everything in mouth (drooling is common and not necessarily a sign of teething)

9. Coos and makes sounds in response to parent

ORAL HEALTH

1. 1. 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.

   2. Discuss with your pediatrician whether your infant needs supplemental fluoride (this depends on your city’s water supply).

ILLNESS

At this age you may treat fever and minor illnesses at home as long as your baby looks and acts ok. Bring your baby to the doctor if: symptoms are severe or prolonged (>5 days), your infant isn’t eating well, your infant is particularly fussy, or you are concerned.

YOUR NEXT VISIT

Your baby’s next well child check is at 6 months of age. The vaccines at that visit are: DtaP (diphtheria, tetanus, pertussis), IPV (inactivated polio), Hib (Haemophilus influenza type b), PCV-13 (prevnar-for pneumococcal disease), Hepatits B, and Rotavirus. Depending on the time of year, your infant may qualify for a flu shot. Remember, the first time your infant gets a flu shot, he or she will require a booster dose 30+ days later.

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