Four Month Old Visit

Diet

Babies are usually eating 24-32 oz a day of formula. If nursing, they are usually doing 4-6 sessions a day.

We start baby foods off of a spoon at 4-6 months depending on the baby and if food allergies are present in the family. If significant food allergies, asthma or eczema in the family, it may be wise to wait till 6 months to try food.

Otherwise we start with rice cereal. Take 2-3 tablespoons of the dry cereal and mix in 1-2 oz of water, breast milk or formula. Initially make it thin, then thicken it up as the child tolerates it. You can start stage 1 baby foods. These are single items pureed with water. Offer solid foods twice a day. It is important to start with one new item at a time. Start with fruits and vegs then go on to meats.

Elimination

Infants are usually having less bowel movements than they were. Stools should still be soft. If having hard stools, add some prunes into their diet.

Environment

You should dress your child with one more layer than you are wearing. In the summer, it is fine to use sunscreen on infants less than 6 months old. You always want to avoid direct sunlight with infants.

Sleep

Most children are sleeping a 6-7 hour stretch at this point. Sometimes they sleep longer or shorter. Overall infants need 18 hours of sleep a day. This is the time to start putting your child down to sleep, awake but drowsy. You want the child to self soothe to get to sleep, not use feeding or rocking to get to sleep.

Development

Infants are usually laughing now. They are much more interactive and awake. They are learning to roll over, so be careful where you leave an infant. They should be able to hold their head and chest up. Tools like the exersaucer are helpful.

Safety

Infant car seats usually go up to 20 lbs. Child should be rear facing in the back seat until 1 years old and 20 lbs. Consult the guidelines on the car seat label.

Please use smoke detectors in your house. Check the batteries monthly.

Health Tips

Immunizations may be given today. The vaccines are the same ones given at 2 months. Your baby may have a fever and be fussy for 24 hours after the vaccines. You may give Tylenol every four hours to help with the discomfort. The injection site may get red or swollen. Ice can help.

Next appointment is at 6 months.