Well Check-Up / 4 Months
FEEDING
Babies at this age still receive complete nutrition from formula or breastmilk with additional Vitamin D. But after 4 months, it can be acceptable to introduce solids into your baby’s diet, if he or she seems ready and interested. Options for first foods include infant cereal or pureed vegetables or fruits. Always feed your baby solids with a spoon (not with a bottle or feeder), and start with a small amount and go slowly. If your baby pushes the foods out of her mouth with her tongue, wait a few days and try again. Introduce one new food at a time and wait at least 1-2 days before starting another one to watch for any kind of reaction, including vomiting, diarrhea, or rash. If you or your baby is not interested in solids yet, breastmilk or formula still can provide complete nutrition for your baby until 6 months of age.
SLEEPING
At 4 months your baby should be sleeping through at least one nighttime feeding and maybe even through the night. If your baby has trouble winding down at bedtime, try to establish a consistent bedtime ritual, such as a bath, a story, and rocking quietly. Keeping it dark and quiet at night will help your baby learn the difference between night and day. Try to put your baby into her crib before she falls asleep, so she can learn to fall asleep on her own. Most babies at 4 months still take at least 2 naps each day.
FEVER/ILLNESS
After 2 months of age, fever is defined as a temperature greater than 101. 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. Cold viruses usually cause nasal congestion, runny nose, cough, decreased appetite, and often fever. Most cold viruses last up to 10 days, but the fever should not last more than 3-5 days. If your baby has cold symptoms that last longer than 10 days, fever that lasts longer than 3 days, or fever associated with not drinking or not sleeping or extreme fussiness, please call the office. 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 and should not be used. 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. Babies love to look at colors, shapes, and movement, and their ability to follow moving objects is fairly well-developed by this age. By now, your baby should smile when you interact with her and make lots of cooing and babbling noises. Most babies at this age are very fascinated by a mirror and love to watch their reflections. Many babies will learn to sit up alone between 6-7 months.
SAFETY
Babies at this age still need to sleep on their backs to minimize the chance of SIDS (Sudden Infant Death Syndrome). Be particularly careful not to 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 until 2 years of age. Check smoke detectors regularly to assure they are working. Avoid direct sunlight and protect baby with loose layers, hats, and canopies when outdoors on a sunny day.