Four-Month Checkup

Date ______________________________________

A.  MEASUREMENTS                   

Length _________________ in     (         %tile) 

Weight ___________ lb ___ oz    (          %tile) 

Head Size ______________ cm    (         % tile)

B.  IMMUNIZATIONS

Your child will receive the following:                               

 Although most infants do fine with these immunizations, some may experience fever or fussiness.  This should subside within 48 hours.  You can give acetaminophen if your child develops a fever.

C.  LABORATORY STUDIES AND PROCEDURES

 No routine tests are performed today.

D.  FEEDING

Your baby should continue to take breast milk or infant formula until he is one year old.  Do not let him lie down with a bottle because this can lead to tooth decay or ear infections.  Remember to check with us before switching formulas.  If your baby is breastfed primarily, continue to give him vitamins containing ADC, such as Vidaylin or Trivisol.

Feeding solids to infants younger than six months of age may increase the risk of food allergies as well as the risk of development of diabetes later in life.  For those reasons, we do not recommend you start solid foods until your baby is six months old.

E.  DEVELOPMENT AND BEHAVIOR

Four-month-old babies are beginning to roll over from front to back.  They usually have good head control.  Be sure to give your baby “tummy time” so she can learn to push up and roll around.  They typically become louder as they experiment with making sounds.  She will enjoy playing with rattles and squeaky toys.  She will love “talking” to you and will laugh and giggle.   Babies this age enjoy standing with support.  This will not cause her to be “bow-legged” so let her enjoy standing and bouncing.

Crying is normal for babies.  You cannot spoil a child this age by meeting her needs quickly.

Babies will drool excessively and put their hands or other objects in their mouths, but this is normal development and does not indicate teething.  The average age for getting the first tooth is around six or seven months, but this is highly variable.

Visit http://www.aap.org/family/2004PAFBrochure.pdf for a downloadable developmental checklist that covers ages three through fifteen months.

F.  SLEEP

Many four-month-olds are sleeping through the night and may nap 4 to 6 hours during the daytime.  Keep your baby on his back to sleep to minimize the risk of Sudden Infant Death Syndrome.

G.  GENERAL INFORMATION AND SUGGESTIONS

(1) VITAMINS, IRON, AND FLUORIDE: The formulas which we recommend contain the recommended amounts of vitamins, so additional vitamins are not necessary.  We may recommend fluoride if you have a well water supply with little or no natural fluoride. 

(2)  TEETHING: Most babies start getting teeth between 4 and 8 months of age.  Teeth erupt regularly until children have all 20 teeth, usually around two years of age.  It may take weeks or longer for teeth to erupt through the gum surface.  While babies may be fussier than usual around the time of an eruption, teething does not cause fever, vomiting, runny nose, or other symptoms of illness.

(3)  FEBRILE SEIZURES:  Approximately 5% of small children may experience a seizure associated with fever at some point during early childhood.  While these seizures can be terrifying for the parent, they almost never result in serious harm to the child.  In the unlikely event this happens to your child, remain calm and DO NOT PANIC.  Place your child on her side with the head slightly lower than the body to prevent aspiration of secretions or vomit.  DO NOT pry open his mouth or place objects in the mouth.  Usually the seizure will last only seconds to minutes.  Call us for further instructions.

H.   SAFETY TIPS

(1)  CAR SEAT SAFETY:  Motor vehicle accidents are the leading cause of death and serious injury after the first month of life.  Infants are required by law to remain in a rear-facing car seat in the back seat of a vehicle until they are BOTH one year of age AND at least 20 pounds.  For more information, visit http://www.buckleupnc.org/.  Carefully follow the manufacturer's recommendations to be certain the seat is properly installed in your vehicle. Remember, NEVER seat children in the front seat of cars with or without a passenger-side air bag.  For more information, call the National Highway Traffic Safety Administration at 1-800-424-9393, or visit their web site at http://www.nhtsa.dot.gov/.

(2)  CHOKING:  Should your baby ever choke, first attempt to remove all visible food or objects from his mouth.  Do not sweep blindly with your fingers because this could push the object in further.  If she cannot breathe and is turning blue, attempt to dislodge the object using a series of back blows and chest thrusts, as described in detail in the AAP book, "Caring for Your Child, Birth to Five."  If these measures are unsuccessful, call 911.   Prevention is the key, so do not put necklaces or strings around your baby’s neck, and keep drapery or blind cords away from the crib.  Use only unbreakable toys without small parts or sharp edges.

(3) FIRES AND BURNS:  Be sure to check smoke detectors monthly.  Develop and practice a fire escape plan.  Place safety plugs in electrical outlets.  Keep all electrical appliances out of the bathroom to avoid electrical shock.  Do not cook with your baby in your arms or at your feet.  Check formula temperatures carefully and do not warm it in a microwave oven since this may result in burns in the mouth from uneven heating.  Turn your hot water heater down to 120 degrees F (50 C).  Be sure to check the bathwater with your elbow to prevent scalding.

(4)  WATER SAFETY:  Never leave an infant or toddler alone in a bathtub, even for a moment.  Supervise your child continuously around any kind of water.

(5)  FALLS:  Keep crib and playpen sides up at all times.  Do not use walkers.  Install safety gates to prevent falls down stairways.  Check drawers, tall furniture, and lamps to make sure they cannot fall over easily.

(6)  SUN EXPOSURE:  Avoid direct sun exposure whenever possible.  Sunscreens are not officially approved in babies younger than six months of age.  

(7)  INSECT REPELLANTS:  During the time of year when mosquito bites are common, the AAP recommends that you protect your child with products that have 30% DEET as the active ingredient.  Other repellants simply do not work consistently or for long.  Do not use products that contain both sunscreen and repellant.  Apply the repellant with 30% DEET to exposed areas of skin, but avoid the nose, mouth, and eyes.  Wash the repellant off when you bring your baby back inside.

For additional safety tips, visit http://www.aap.org/healthtopics/safety.cfm

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 The next checkup is at 6 months of age.  Your child will be receiving immunizations at that visit.

Last modified: Monday February 16, 2015