Mt. Ascutney Hospital and Health Center

4 month WCC

Your Baby

PROFILE:  Your 4 month old baby has really become a member of the family.  He has a definite personality.  He is more active and better coordinated, he can see better, and he pays more attention to what goes on around him.  He looks forward to special events like feedings and playtime.  He laughs, cries, and otherwise lets you know whether he’s happy or not.  Now is a good time to try him with a sitter because he is good-natured, flexible, and not yet afraid of strange people or places.
 

FEEDING:  Continue breast milk or formula with iron.  Unless your doctor tells you otherwise, let your baby take as much as he wants.  Let him hold his bottle if he wants, but don’t lay him down with it or let him go to sleep with a bottle.  It can cause ear infections, early tooth decay, and is a very hard habit to break!

Sometime between 4 and 6 months you may introduce baby food.  Many babies do well on breast milk or formula alone until 6 months, so there is no hurry to start.  Talk with your provider about the best time to start solid foods for your baby.

Babies do not need juice at this age.  Juice has very limited nutritional value and many doctors recommend avoiding juice until the third year of life.

Start the baby on the cup as soon as he starts to show interest.  He won’t do well with it at first, but he’ll learn fast.
 

TEETHING:  A lot of babies cut their first tooth between  4 and 6 months of age, but some perfectly normal babies don’t cut a tooth until they’re over a year old.  Babies this age do drool a lot, whether they’re teething or not.  If your baby is teething and it seems to hurt, let him chew on a cold teething ring or toy (keep a couple in the refrigerator).  We think it’s better to use acetaminophen (Tylenol or other brands) than medicines you rub on the gums.  Use the same dose as for fever.

Don’t blame fever, diarrhea, or other illnesses on teething.  Teething can cause your child to be irritable and may be associated with low grade temperatures (less than 101 F).  If your baby has a problem for which you would normally call us, please do- even if he is teething.  We don’t want to miss a real illness.
 

SLEEP:  Life will be easier in the long run if you let your baby learn to go to sleep on her own, without nursing or taking a bottle to bed.  Spend some quiet time with the baby at bedtime, give her a feeding, but put her down before she dozes off.  Let her learn to find ways to settle herself to sleep.  If she wakes up at night and continues to fuss, go to her every 15 minutes or so.  Change her if she needs it and feed her if you think she’s hungry, but keep the interactions to a minimum.  Feed her, burp her and put her down!  If you don’t think she’s hungry, just talk quietly, pat her, hold her for a minute or so, then put her down and leave.  Stay long enough to let her know you are around – she needs that – but don’t stay long enough to encourage her to fuss the next time she wakes at night.  Continue to put her to sleep on her back or side.
 

ACTIVITY/TOYS:  Toys to hold, feel, shake and bite are good at this age – colored rattles, rubber squeeze things, balls, and soft snuggly stuffed animals.  A toy is not safe if it is small enough to fit completely into his mouth or if small pieces might come off (for example, a squeaky toy is not safe if the squeaker comes out).  Babies at this age should not watch television or videos.

A 4 month old baby is very active.  Around this age she’ll notice that she can make certain things happen, such as making noise by hitting a pan with a spoon – and she’ll want to do it over and over.  She can sit for a while propped up, but is probably happiest when she’s able to wave her arms and legs and wiggle.  Let her move around in a safe playroom, in a playpen, or on a blanket on the floor if you’re where you can watch her.  Be sure to let her exercise on her tummy as well as her back.  Walkers with wheels are not a good idea.  Talking starts with cooing and babbling sounds.  Babies this age jabber a lot to themselves.  You should talk to your baby a lot – even though it will be a long time before she says any real words, she is learning about words by hearing other people talk.
 

SAFETY:  Some things are especially important for safety when there’s a baby in the house.  If you haven’t already done these, consider doing them now:

*Set the hot water heater in your home to 120-125 degrees F (low setting).

*Have working smoke and carbon monoxide alarms in your home.  Check the batteries monthly.

*Make sure crib rails are no more than 2 2/3 inches apart.

*Place emergency phone numbers by the telephone.

*Always stay right with your baby whenever he is in or near water.

*Always use a rear-facing car safety seat!
 

ANTICIPATE NEW SKILLS AND BE SAFE!

*Soon she will roll:  Make sure the rails are up whenever she is in the crib and don’t leave her on the changing table, bed or cough alone!

*Plan ahead for increased mobility – creeping and crawling.  Put gate guards in front of steps.  Do not use a walker with wheels.  Get her used to spending some time in a playpen or high chair.

*She can put things in her mouth.  Keep her away from objects small enough to fit in her mouth, and also plastic bags.  If you do not know CPR, sign up for a course!!!
 

FAMILY ISSUES:  How well are you balancing your own needs, those of others, and the new baby?  This is a good time to take stock and make changes if necessary.  Parents need to have personal time to take care of their own needs (sleep, exercise, relax, time with friends).  Couples need to spend time together, sometimes without the kids.  Older siblings need one-on-one time with parents.  Working parents need to share household duties and/or find extra help.  Dads need time alone with their child(ren).  If your family is having trouble adjusting, ask for advice from trusted friends, counselors or our staff.  Your family’s health is important to us.
 

IMMUNIZATIONS:  The second Pentacel (Dtap/IPV/Hib), HepB, and pneumococcal conjugate vaccines are usually given at this visit.  We recommend acetaminophen (Tylenol or other brands) every 4 hours for the next 24 hours to help prevent pain and fever.  Use a cold compress at the injection sites for pain and swelling if necessary.

FOLLOW-UP:  Your baby’s next visit is at 6 months of age.