Clinical Reference Systems: Pediatric Advisor 10.0
Well Child Care at 4 Months
Your baby should still be taking breast milk or infant
formula. Most babies now take about 6 ounces every 4 to 5
hours. Some doctors recommend waiting to give a baby juice
until he can hold a cup. Others advise that you can start
juice at the age of 4 to 6 months but should limit it to a
few ounces each day.
Some babies are now ready to start cereal. A baby is ready
for cereal when he is able to hold his head up enough to eat
from a spoon. Cereal should not be given from a bottle or
infant feeder. When you start cereal, start with rice
cereal mixed with breast milk or formula. You may want to
start with a thin mix of cereal and then thicken it
gradually. Pureed fruits and vegetables can also be started
between 4 and 6 months. Start a new food or juice no more
often than every 5 days to make sure your baby is not
allergic to the new food.
Never leave the baby in bed with a bottle because it can
lead to tooth decay. Also, your child may start using the
bottle as a security device. It may also cause ear
Babies are starting to roll over from stomach to back. Your
baby's voice may become louder; squealing when happy or
crying when he wants food or to be held. In both cases,
gentle, soothing voices are the best way to calm your baby.
Toys that make noise when shaken are enjoyed.
It is normal for babies to cry. At this age you can't spoil
a baby. Meeting your baby's needs quickly is still a good
For more information see: Normal Development: 4 Months
Most babies are sleeping through the night by 4 months of
age and will also nap 4 to 6 hours during the daytime. If
your baby's sleeping patterns are different than this you
may want to ask your doctor for ideas about ways to keep
your baby alert and awake during the day and sound asleep at
night. Remember to place your baby in bed on her back.
Your baby may begin teething. While getting teeth, your
baby will drool a lot and chew on almost anything. A
teething ring is very useful.
For more information see: Teething
Avoid Suffocation and Choking
- Remove hanging mobiles or toys before the baby can
- Keep cords, ropes, or strings away from your baby,
especially near the top of the crib. Ropes and strings
around the baby's neck can choke him.
- Keep plastic bags and balloons out of reach.
- Use only unbreakable toys without sharp edges or small
parts that can come loose.
Avoid Fires and Burns
- Never eat, drink, or carry anything hot near the baby
or while you are holding the baby.
- Turn down your water heater to 120 degrees F (50
- Check smoke detectors to make sure they work.
- If your child does get burned, rinse the burned area
immediately with cold water, then call your doctor.
- Check formula temperature carefully. Formula should be
warm or cool to the touch.
- Don't smoke near the baby.
- Wear your safety belt.
- Use an approved infant car seat correctly in the back
- Never leave the baby alone on a high place.
- Keep crib and playpen sides up.
- Do not put your baby in a walker.
At the 4-month visit, your baby should have a:
- DPT (diphtheria, pertussis, tetanus) shot
- Hib (Haemophilus influenza type B) shot
- a polio vaccine (given either by a shot or by mouth).
Your baby may run a fever and be irritable for about 1 day
after the shots. Your baby may also have some soreness,
redness, and swelling where the shots were given.
Acetaminophen drops (1/2 dropperful, or 0.4 ml, every 4 to 6
hours) may help to prevent the fever and irritability. For
swelling or soreness, put a wet, warm washcloth on the area
of the shots as often and as long as needed for comfort.
Call your child's physician if:
- Your child has a rash or any other reaction besides fever
and mild irritability.
- Your child has a fever that lasts more than 36 hours.
Your baby's next routine visit should be at the age of 6
months. At this time your child will get the next set of
immunizations. Please bring the shot card to each visit.