Well Check-Up / 4 Months
FEEDING
Babies at this age still require formula or breastmilk as their primary nutrition. Breastfed babies should continue to receive addition additional Vitamin D, and it’s recommended breastfed babies also receive extra iron after 4 months. Options for iron supplementation include drops and iron-fortified infant foods. (Poly-vi-sol with iron is a drop for babies with both Vit D and iron.) It is also acceptable to introduce solids into your baby’s diet, if he or she seems ready and interested, but this is not necessary until 6 months of age. Options for first foods include iron-fortified infant cereal or soft vegetables or fruits. If your baby pushes food out of her mouth with her tongue, wait a few days and try again. Babies still do not need anything else to drink at this age. To decrease the risk of peanut allergy later in life, all babies should try peanut products by 6 months. Ground peanuts or unsweetened peanut butter or baby food with peanuts are easy ways to do this.
SLEEPING
Keep baby’s room dark and quiet at night to help her learn the difference between day and night. Starting to establish good bedtime routines includes reading or rocking before bed and putting babies in their beds when they are sleepy but before they are all the way asleep and allowing them to soothe themselves.
FEVER/ILLNESS
If your baby is going to be in daycare or around large groups of children, we expect that he or she will get as many as 1-2 colds or viral illnesses each month. Most cold viruses last up to 10 days, but any fever should not last more than 3-5 days. If your baby has cold symptoms that last longer than 10 days, fever for more than 3 days, trouble taking fluids or difficulty breathing, call the office right away. Good handwashing is still the best way to prevent the spread of germs.
TEETHING
Sometime between 4 and 7 months most babies will start getting their first teeth. All babies will begin drooling and chewing on things by 4 months, even if teeth do not come in right away. Usually, one of the bottom or top front teeth appears first. Sometimes teething will cause mild fussiness, crying, excessive drooling, low grade fever (never more than 101 degrees), and increased desire to chew on something. You may gently massage your baby’s swollen gums with your finger or give her a teething ring made of hard rubber or a cold teether. Teething tablets and gels are not considered safe for babies. Also, amber teething necklaces are dangerous and create a choking and strangulation risk. If your baby seems overly irritable or has a fever more than 101 degrees, it is probably not due to teething alone and you should call the office. Once teeth have arrived, it is good to gently clean them with a wet washcloth during bath time or before bed at night.
DEVELOPMENT
At this age, most babies will be able to push up on their arms when on their tummies. A few will have already rolled over, usually first from tummy to back. At this age, your baby should also be able to bring interesting objects to her mouth. By now, your baby should smile and make lots of cooing and babbling noises. Many babies will learn to sit up alone between 6-7 months.
SAFETY
Babies this age still need to sleep on their backs to minimize the chance of Sleep Related Infant Death (previously known as SIDS). The safest place for babies to sleep is in a separate bed in the same room as their parents. Babies should always sleep on a bed that is meant for babies and never on an adult mattress or in an adult bed or on a couch. Their arms must be free and not swaddled, although they can still wear a sleepsack or swaddle blanket with the arms out. Do not leave your baby unattended on an elevated surface, as she may wiggle and squirm and roll off. Your baby still needs to face backwards in the infant car seat. Check smoke detectors regularly to assure they are working, and be careful with the temperature of bath water, as babies’ skin can easily burn. Protect your baby from the sun by staying out of direct sunlight or using sunscreen when needed.