Four Month Visit

General

• Stay in touch with friends and family members.  This is a time of major change for your family and conflicts may arise.  Talk through those with your partner and family.  

• Make sure you attend to your own needs.  Take some time for yourself and your partner. Encourage your partner to participate in the baby’s care.

• Spend time with your other children.  Help them enjoy the baby by asking them to bring you supplies or to hold the baby’s hand.

• You will begin to understand and recognize your infant’s personality and are beginning to know how to adjust your responses to meet her needs.  

Caring for Your Baby

• You can use gentle massage to help your baby calm and sleep.

• If you are returning to work, this may be the time you are worried about separation.  Talk about your feelings.  Choose babysitters and caregivers who are mature and responsible and are recommended by people you trust.  

• An established routine for feedings, naps and bedtime is a good idea.  Your baby may not be sleeping all night quite yet, but a routine will help to promote longer sleeping stretches at night.  Routines also help to promote feelings of security for your baby.

• Sleeping patterns often raise concerns for parents.  It is important to help your baby learn to put himself to sleep by placing him in his crib when he is drowsy.  Talk gently to him and gently patting can help babies learn to sleep on their own.  

• Your baby should still be put to sleep on her back to reduce the risk of SIDS.  Remind your relatives and other caregivers.  Do not use loose pillows, soft bedding, pillows or soft toys in the baby’s bed.  

• You may want to lower the crib mattress now to the lowest position so you have that done before the baby can sit up by himself.

• Never leave your baby alone with a crib or playpen with the drop side down.  Your baby will be rolling over soon.

• At four months a baby’s favorite thing is interacting with her parents. This means you will need to be sure to balance dedicated play time

with your other responsibilities.  If you feel overwhelmed, just focus on one thing at a time.  

• Playing with your baby involves both quiet activities such as reading, singing or sitting together and more active playtime.  For activity give your baby age appropriate toys such as a floor play gym, a safety mirror he can look in while playing on his tummy, or toys he can reach for.  

• Make sure the play environment is safe for your baby.  Make sure the baby can’t pull things over onto himself, and that pets can be trusted or put away.

• If your baby is fussy and you know that he is fed, clean, safe and well, it is okay to put the baby in his bed and give yourself a short break to avoid feelings of frustration.  Babies sometimes cry a lot at this age; it decreases as they get older.  If crying is consistent, call your pediatrician for advice.

 Nutrition

• Breastfeeding is ideal for the first 4-6 months.  If you have questions about breast or bottle feeding please discuss your concerns with your pediatrician.  It is not unusual for babies to go through growth spurts during the first year of life and when this occurs your baby may want to feed more often, even going back to more night feedings.

• A healthy infant may appear chubby even when her growth is normal.  Look at the growth chart when you visit your pediatrician to see how the baby is growing.

• Adding solid foods is highly individualized.  Between 4-6 months of age your baby will be ready to begin eating solids.  Signs that your baby is ready are a decreased tongue thrust (not pushing every thing out) and opening her mouth and leaning forward in anticipation of a spoon coming her way.  At this stage your baby should be able to sit with the support of your arm and have good head and neck control.  

• Baby cereal is the first food to introduce.  Never introduce foods associated with lifelong sensitization (nuts or products containing nuts, fish or shellfish) during the first year of life.

• Always tell your pediatrician if you are using any form of dietary supplements.

Oral Health

• Never prop a bottle.  For the baby’s safety and to prevent future problems with dental caries, always feed your baby in an upright or partially upright position.

• Don’t share spoons or pacifiers with your baby.

• If your baby is teething, he may drool, become fussy, or try to put things in his mouth.  A cold teething ring may help.

Safety

• Continue to use a rear facing car seat in the back seat of the vehicle.

• Always use a safety belt and never drive when impaired by drugs or alcohol.  

• Never leave a baby alone in a tub, sink or any elevated surface such as a changing table, bed or sofa.  Always keep one hand on the baby when on elevated surfaces.  Don’t use walkers.

• Make sure your water heater temperature is set under 120 degrees.

• Do not drink hot liquids, cook or iron while holding the baby, 

• Keep small objects and plastic bags away from the baby.

• Consider your home and car smoke free zones.  Never smoke, or allow others to smoke around your baby.  If you want to quit, please talk to your physician about resources to help you.