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UH Rainbow Northeast Pediatrics

4 Months

Caring for Your 4-Month-Old

Family Adjustment

  • As your baby’s personality is emerging, try to keep older siblings involved in a way that is helpful to you and allows them to feel included in the attention the baby is receiving.
  • Find ways to spend time alone with each child, and also time alone with your partner.
  • If you are returning to working outside the home, be sure that you have trustworthy child care in place.

Nutrition

  • Exclusively breast-fed babies require supplemental vitamin D (400 IU/day), which is available at most drug stores/supermarkets.
  • Bottles should be held, not propped, for babies.
  • Babies need to nurse/feed every three to four hours.
  • When babies show signs of readiness (being able to sit with some support, showing an interest in what others are eating, not feeling full after a feeding, being able to turn away when full), it is time to introduce solid foods.
  • Mixing cereal in a bottle does not teach the baby how to eat; only feeding with a spoon will accomplish this.
  • Start by mixing rice cereal and formula/breast milk/water in a bowl with a baby spoon. The mixture should start out thin and runny. As your baby gets better at eating, add less liquid so it is thicker.
  • Introduce one new food at a time, with two to three days between the addition of the next.

Elimination

  • Regular, easy-to-pass, soft yellow stools at least once daily are the norm in this age group.
  • With the addition of solid foods, your child’s stool may become thicker, less frequent and may change color. Ask your doctor if you are concerned about the consistency or frequency of your child’s stooling.

Baby Care

  • Bathe your baby in a small tub/bathinette, using warm (not hot) water and gentle soap, as frequently as every day. Never leave your baby alone during bath time.
  • When the child is fussy, a change of scenery can be helpful, so if the weather cooperates, try going for a walk.
  • Routines are important regarding sleeping and feeding schedules.

Growth and Development

  • Most 4-month-olds spontaneously smile and laugh, and love social interaction. Talk to your baby and prioritize face-to-face interaction.
  • Singing and cuddling with your baby will build trust and closeness.
  • Reading to your infant will promote language skills.
  • “Tummy time” helps your baby develop strong muscles in the neck and back that will eventually allow the baby to sit up. Most 4-month-olds can keep their heads and chests up when lying on their bellies.
  • Around four to five months of age, babies will start to learn to roll over on their own, often from front to back at first.
  • By four months old, most babies keep their hands open (not clenched) when at rest, and they may start to swat at toys or reach for items. Place age-appropriate toys within your child’s reach to promote these new skills.
  • Most 4- to 6-month-olds can support their heads and bodies well enough to play in a stationary jumper, such as an ExerSaucer or Jolly Jumper. Ask your doctor if your baby is ready for these toys. Baby walkers with wheels are dangerous and not recommended.

Sleep

  • Always place your baby on his or her back to sleep to reduce the chance of sudden infant death syndrome (SIDS). Co-sleeping, sleeping with your child, increases the risk for SIDS. Infants should sleep in a crib with a firm mattress covered by a fitted sheet. Keep bumper pads, pillows, blankets, loose bedding and soft objects, like stuffed toys, out of the crib.
  • Teach your baby to fall asleep independently of being rocked or fed. Put your baby to bed when he or she is somewhat sleepy, but still awake, to build confidence in going to sleep on his or her own. You may need to let your baby cry for awhile before he or she falls asleep.

Safety

  • Some babies can roll over at this age, so do not trust your infant if propped on a sofa or lying on a changing table.
  • Never leave your baby unattended in a tub or on sofas, countertops or other high surfaces.
  • Be sure pets and siblings are supervised when with the baby.
  • Keep the living environment (including the car) smoke-free, and keep small items (choking hazards) and hot liquids (burn risks) away from the baby.
  • All babies this age must ride in a rear-facing five-point harness car seat in the back seat of the vehicle.

This document contains general parenting information based on American Academy of Pediatrics recommendations and is not meant to replace the expert advice of your pediatrician.