4-Month-Old Well Child Check


Your baby continues to grow! He/she should be nursing every 3 to 4 hours or taking about 5 to 6 oz. of formula every 3 to 4 hours. You should continue to hold your baby during feedings. Do not prop the bottle or put him or her to bed with a bottle. These practices can lead to ear infections and cavities. Always check the temperature of formula or breast milk after warming.

It may be time to start cereal from a spoon if your baby can hold his or her head up steady and seems to need more to eat than breast milk or formula. Start by mixing 1 tablespoon of rice, barley or oat cereal with formula, making it very thin at first. Increase thickness as your baby increases skill at spoon-feeding and decreases tongue-thrusting. Increase cereal feedings to 2 Tablespoons twice daily. You may see a change in the number and consistency of your baby’s bowel movements. Continue to feed rice cereal only and hold fruits and vegetables until your baby is 6 months old, unless otherwise directed by your pediatrician/provider. When it is time, introduce new foods slowly approximately every week so you can monitor for any allergic reactions. If you are exclusively breast feeding your baby, he/she needs to take 1 dropperful of vitamin D drops such as D-Visol to prevent vitamin D deficiency.

If you have well water, your baby may need fluoride supplements so ask your doctor. Fluoride testing of well water is done by the Dept. of Public Health in Forsyth County by the Division of Public Health, 727-2760.

Development and Behavior

The four-month-old baby is often referred to as the picture-book baby. They smile frequently and entertain themselves and others with squeals and cooing. Your baby will turn to voices and take notice of people. They find their hands and begin reaching for objects. Sitting with support, grasping toys and rolling back to front are milestones that are soon to come. 

Some four-month-olds sleep through the night already. If your baby is not, we can help you teach you some techniques which might help. Please ask us! In general, you should set a bedtime routine and put your infant down to sleep when they are drowsy, but still awake. This will allow them to learn self-soothing skills.


“Back to sleep, Tummy for playtime.” Use a rear-facing car seat in the back seat every time you travel in the car. Make sure you are using it correctly. Never place your baby in a seat with an airbag or in the front seat. Do not leave your baby alone on a bed, couch or table -that time may be the first time he/she rolls over! Do not eat or drink anything hot while holding the baby. Keep your home and car smoke free.

In the crib or playpen, keep the sides up at all times. Select toys that are unbreakable, have no small or detachable parts, or are too large to swallow. If a toy fits through a toilet paper roll, it is too small for baby!

Now that your baby is reaching for things, it is time to start baby-proofing: check to see that there are no dangling cords or ropes in your home; never leave plastic bags or balloons around the baby; remove any hanging toys from the crib; check your home for other hazards as well. Install smoke and carbon monoxide detectors and check batteries regularly. Keep a fire extinguisher in your home.

Remember there is great potential for accidents and there are no developmental advantages in using a walker.

Immunizations and Shots

Today, your baby will receive the second Pediarix, Prevnar, Hib and Rotateq immunizations. Acetaminophen drops can be given after the shots for fever and irritability. You may repeat the dose every 4 hours up to 24 hours, if needed. Please review your printed information on immunizations and address any questions to your doctor.

Next Appointment

At 6 months your baby will receive a check-up, be measured for height, weight and head circumference, and receive the third set of Pediarix, Prevnar, Hib and Rotateq vaccines. Call our office at any time if you have any questions or concerns.