The Four Month Old

dearborn-peds-first-year-visits

Robert Levy, MD    Joel Moses, MD

Houda Dagher-Rodger, MD       Melissa Hoisington, MD

Tiffany A. Harris, CPNP   Kerri Bernard, CPNP

2845 Monroe    Dearborn MI  48124    Telephone:  313-730-0070

 

Four Month Visit

Today’s Measurements:  Height:  __________    Weight:  __________    Head:  __________

Feeding:

  •     Breast milk or formula continues to be the most important source of nourishment.  The number of feedings can range from four to six times per day by now.  Bottle fed babies can take up to thirty two ounces per day.  Periods of high demand may indicate a growth spurt.
  •     Between four to six months of age, you may begin the introduction of solid foods.  The American Academy of Pediatrics recommends that moms who are exclusively nursing wait until six months of age to introduce solid foods.  Also, your infant should have good head control in order to be able to feed safely.
  •     Introduction of solid foods (pureed) begins with a single grain rice cereal. Use a soft tip spoon.  Mix four tablespoons breast milk or formula with one tablespoon of rice cereal.  Slowly decrease the amount of liquid to increase the texture of feeds.  You can do this over several days.
  •     Take cues from your baby and proceed at his/her comfort level.  The best time of day to feed solids will vary depending on your family’s schedule.  It is important to create a relaxed environment and not try to introduce something new when baby is very hungry.  Your baby will be more receptive if you introduce the cereal about a half an hour prior to time of next expected feeding.
  •     After rice cereal you may progress to the other grain cereals, meats, fruits and/or vegetables.  Introduce each new food no more often than every two to three days.  You may want to try to give vegetables before fruits to allow your baby a chance to develop a taste for non sweet tasting foods.  This may pay off later.   Once your baby becomes accustomed to solids, he/she can eat them 2-3 times per day.  The quantity at each feeding may vary from a few spoonfuls to one 4 ounce jar.
  •     Those with a strong family history of food allergies may wish to discuss an alternate food schedule with the provider.
  •     Never give a child under the age of one year honey or corn syrup, as this increases the risk of botulism.
  •     Infants under the age of six months do not require water.  Giving water to an infant may lower the level of certain electrolytes in the blood and cause seizures.  If you think your baby is thirsty, give breast milk or formula.  Both are water based.

 A Note about Juice:

  •     Infants and children generally do not need juice.  If your child has hard stools or is not getting Vitamin C from some other source, you may give four ounces of juice per day diluted in water.  This is per the recommendation of the American Academy of Pediatrics.
  •     Get your baby accustomed to gum and dental care beginning at this age.  Wipe the gums down with a soft washcloth after feeds.  If your baby is an early teether and has teeth between four to six months of age, begin to wipe them down after each feed.
  •     Never put a baby with teeth down to sleep without cleaning them or with a bottle in the mouth as this promotes tooth decay.  Sleeping with a bottle in the mouth also promotes dysfunction of the middle ear and ear infections.

Vitamins:

If your baby is exclusively breast fed or gets a least half of milk intake as breast milk; continue to give Tri-Vi-Sol at 1 cc per day.

 Elimination:

  •     Stool patterns will change as expected based upon changes in daily intake.  They may be orange, green or yellow.  They should be soft and may occur once a day or every two to four days.
  •     Let us know if your baby is having consistently hard stools or blood in the stools.

Sleep:

  •     Sleep patterns are more established and predictable at this age.  Some babies may even be sleeping through the night.  Up to sixteen hours of sleep per day is normal.
  •     Begin a consistent nighttime routine to establish good sleeping patterns. Put your baby down to sleep while drowsy and progress slowly to putting him/her down to sleep while more awake.  This will promote good sleep behavior and teach your baby to fall asleep on his/her own. This is especially important for when your baby becomes nine to ten months of age and begins to develop a sense of being separated from you.  Beginning a consistent sleep regimen now will avert night time awakenings at this age which are often mistakenly attributed to hunger or teething.
  •     Avoid feeding your baby just prior to sleep and laying him/her down full asleep.  Instead, read a book or spend quiet time just prior to laying baby to sleep.

Development:  Your baby is changing every day.  These are some milestones for this age:

  • Motor:  Holds head steadily, raises body from stomach to back and vice versa; bears weight on legs.
  • Fine Motor:  Reaches for and grabs objects; puts hands together, playing with them; grabs a rattle and releases it voluntarily.
  • Sensory:  Responds to sounds.  Tracks and follows objects 180 degrees.
  • Communication:  Coos reciprocally; expresses needs through different types of crying; blows bubbles or raspberries.
  • Social:  Smiles readily or may laugh or squeal; different reactions to Mom, Dad, siblings, strangers.

Safety:  Accidents are the leading cause of death in children

  •     Never leave a baby unattended in a bed or on a changing table.
  •     Infants at this age reach for things so do not hold your baby while drinking a hot liquid.
  •     Toys should be age appropriate, too big to swallow, without detachable parts or sharp edges.  Your baby is experiencing the world through his/her mouth at this age.
  •     Continue to limit second hand smoke.
  •     Always supervise your baby around siblings and pets.

All car seats should face the rear, even if baby has outgrown the infant car seat and graduated to a larger seat.  Infants must be rear facing until two years of age.  Lower the crib mattress all the way down when your baby reaches four months of age.  Never leave a mobile above the crib unattended once your baby starts reaching for it easily.  It may become entangled around baby and cause injury (usually at four to five months).