Advanced Pediatrics

100 East Street SE, Suite 301

Vienna, VA 22180
(P) 703.938.5555

(F) 703.319.8580


4 Months Old


Your 4-month-old is growing more and more alert by the day. Babies at this age love to express themselves through smiles, laughs, gurgles, and coos.


By month four, your baby’s weight will likely have doubled from birth. If you’re concerned that your child isn’t eating well or isn’t gaining enough weight, talk to your pediatrician.  To receive adequate calories, most 4-month-old babies continue to wake at night for feeding. It is more common for infants to sleep 5-6 hours straight at night.  It is important to begin putting your baby down drowsy, but not fully asleep into the crib to help her learn to self sooth.  You can help her to fall asleep by talking softly or patting her back. 






Vaccinations for this visit

We recommend the following vaccines:


  • Pentacel (contains):  DtaP, IPV, & Hib
  • Prevnar
  • Rotavirus

What to Expect

Sleep


  • Nighttime feeding:  Most infants have the capacity to feed entirely during the daytime and sleep 8-9 hours straight at night.  Unfortunately, not all infants do this independently on their own and will require feeding to be weaned. 
  • Maintain a Routine:  Create a comforting bedtime routine.  Spend quiet time cuddling, singing, reading, or softly talking to baby before bedtime.
  • Learning to self sooth:  Begin putting your infant down partially awake in order that she begins to learn to fall asleep without feeding and without you helping.  You may rock or feed her in order to get her sleepy, but the idea is for her to finish the job herself.
  • Back to Sleep:  Continue to place your baby on his back to sleep; avoid loose bedding or spaces that could trap or smother the baby. 


Feeding


  • Intro of solids:  When your baby has good control of her head and neck and can sit up with support, she is ready to try solid foods. This happens around 4–6 months.  Start out with iron-fortified rice cereal. If your baby has no problems with this, then slowly add other foods.  After introducing a new food, wait a week before you add the next one. This gives you a chance to see whether your baby has a problem with the food. Make sure that all foods are soft or puréed.  Don’t give your baby hard, small foods like peanuts or whole grapes, or large chunks of meat or vegetables. Such foods can get stuck in your baby’s tiny throat and make her choke.   Don’t give your baby honey until she is a year old. It can cause food poisoning in infants.
  • Establish a routine:  Keep feeding and sleep schedules somewhat regular to help baby feel secure
  • Milk:  Keep giving your baby breast milk or iron-fortified formula for the first year. This milk is still her major source of nutrition.


Crying and Soothing


  • Most infants should be able to be calmed or comforted within a few minutes.
  • Colic and reflux, if present, usually are improving even without any intervention.  If you notice they are actually getting worse, contact your provider.


Development


  • Will start engaging with you in new ways (i.e. noises, giggles, finger play, etc.)
  • He will start to show you his personality and his unique qualities
  • He can start coordinating hand and eye movement
  • May begin to bear a bit of weight on his legs
  • Can raise up on his arms when you place him on his tummy
  • Might turn in the direction of your voice and complain when a toy is taken away.


Safety


  • Never put your baby to bed with a bottle of milk or juice. The sugar in these drinks stays in his mouth and can lead to tooth decay.
  • Do not allow your baby to play with things that can cover his nose and face. Plastic bags and balloons can be very dangerous!
  • When you take your baby outside, keep her out of direct sunlight. Don’t use sunscreen until she’s 6 months old. But put a brimmed hat on her head. Put a hood on the stroller or use an umbrella to shade her from the sun.
  • Think you can turn around to get a diaper while your infant is being changed on a diaper table or bed?  Think again.  We see it all the time, while they cannot roll completely over infants roll off beds in the split second it takes you to reach for a diaper or wipe.    Never leave your infant unattended!


Activities


  • Encourage older brothers and sisters to spend time with the baby.
  • Encourage family members to show affection for the baby and each other. 
  • Find safe, fun ways for your baby to spend time with other adults and children. Think about joining a parent-baby play group.
  • Believe it or not, this is a great time to read to a baby.  Start the routine of books now!
  • Continue tummy time in order to promote development of the trunk and core muscle groups.