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4 Month Check Up

FEEDING :  After 4 months, it is ok to introduce solids into your baby’s diet, if  he or she seems interested, although breastmilk or formula will continue to provide complete nutrition until 6 months of age. Rice cereal is usually the first solid food, because it is so easily tolerated, and after that strained vegetables or fruits are good choices. Always feed your baby solids with a spoon (not with a bottle or feeder), start with a small amount, and go slowly.  Introduce one new food at a time and wait at least 3-4 days before starting another one to watch for any kind of reaction, including vomiting, diarrhea, or rash.  A good beginning schedule might be cereal 1-2 times a day and 1-2 small jars of fruits and vegetables per day, but each baby is different.Babies less than 1 year of age should not be given honey.

SLEEPING:   At 4 months your baby should be sleeping through at least one nighttime feeding and maybe even through the night.  If your baby has trouble winding down at bedtime, try to establish a consistent bedtime ritual, such as a bath, a story, or rocking quietly.  Keeping it dark and quiet at night will help your baby learn the difference between night and day.  

FEVER/ILLNESS:  After 2 months of age, fever is defined as a rectal temperature greater than 101.  If your baby is going to be in daycare or around large groups of children, we expect that he or she will get as many as 1-2 colds or viral illnesses each month.  Cold viruses usually cause nasal congestion, runny nose, cough, decreased appetite, and often fever.  Most cold viruses last up to 10 days, but the fever should not last more than 5 days.  If your baby has cold symptoms that last longer than 10 days, fever that lasts longer than 5 days, or high fever associated with not drinking or sleeping or extreme fussiness, it is a good idea to call the office.  Good handwashing is still the best way to prevent the spread of germs.  If your baby develops diarrhea, try to continue feeding with breastmilk or formula.  If your baby is also vomiting and cannot keep anything down, it’s a good idea to call the office to make sure she is not getting dehydrated.  Signs of ear infections include fever, irritability, difficulty sleeping, vomiting, and (once they are older) pulling at an ear.  If you are concerned about a possible ear infection, call the office.

TEETHING:  Sometime between 4 and 7 months most babies will start getting their first teeth.  Usually one of the bottom or top front teeth appears first.  Sometimes teething will cause mild fussiness, crying, excessive drooling, lowgrade fever (never more than 101 degrees), and the desire to chew on something.  You may gently massage your baby’s swollen gums with your finger or give her a teething ring made of hard rubber or a cold teether.  If your baby seems overly irritable or has a fever more than 101 degrees, it is probably not due to teething alone and you should call the office.  Once teeth have arrived, it is good to gently clean them with a wet washcloth before bed at night.  Toothpaste is not necessary at this age.

DEVELOPMENT:  At this age, most babies will be able to push up on their arms when on their tummies. A few will have already rolled over, usually from tummy to back.   At this age, your baby should also be able to bring interesting objects to her mouth.  Babies love to look at colosr, shapes, and movement, and their ability to follow moving objects is fairly well-developed by this age. By now, your baby should smile when you interact with her and make lots of cooing and babbling noises.  Most babies at this age are very fascinated by a mirror and love to watch their reflections. They don’t understand yet that they are looking at themselves, but that won’t stop them from looking, smiling, laughing, reaching, and enjoying. Many babies will learn to sit up alone between 5-7 months.

SAFETYBabies at this age still need to sleep on their backs to minimize the chance of SIDS (Sudden Infant Death Syndrome).  Be particularly careful not to leave your baby unattended on an elevated surface, as she may wiggle and squirm and roll off.  Your baby still needs to face backwards in the infant car seat until 1 year of age and 20 lbs.  Check smoke detectors regularly to assure they are working.  Never leave baby alone, even for a short time, during a bath, and check the temperature of bath water carefully.  Begin to think about “childproofing” at your home, and keep baby away from small items she may put in her mouth and other dangerous items that could cause choking or suffocation, including plastic bags, drapery or blind cords, toys with long strings, or pacifier holders with long strings.

CRYING/SHAKING:  All babies cry, and some cry more often than others.  If your baby cries often, experiment with different comfort techniques until you find something that soothes him.  Babies’ brains at this age are still very fragile, so always make sure that anyone who cares for your baby knows that shaking a baby can cause serious and permanent brain injury.