PEDIATRIC ASSOCIATES OF ORLANDO, P.A.
FOUR-MONTH CHECK UP
HEIGHT______________________% HEAD CIRC____________________%
WELL VISIT IMMUNIZATION SCHEDULE
18 – 24
** Please verify your vaccinations with your physician at the time of your visit **
These preventative immunizations can cause your baby to have a fever>100.4, decreased appetite, act
fussy or change in normal sleep pattern. The injection site may be red or slightly swollen, or form a knot.
If this occurs gently put a cool cloth over the injection site. Please see accompanying vaccine information
sheets. Give your baby Infant’s Acetaminophen Suspension (80 mg/0.8 ml) the following dosage:
1 ½ dropperful
You may repeat this dose every four hours for Tylenol, and every 6-8 hours for Motrin for
fever/fussiness. Notify your physician if your baby has any adverse side effects such as fever greater than
104, seizure activity, or hives.
Each month your baby gains between 1.5 – 2 lbs and grow 1 – 1.5 inches. These figures are only averages; your
doctor will plot your child on the growth chart and follow the rate of growth on their individual curve. At about four
months we recommend starting solids, although some breastfed babies may not require them until 6 months.
Starting two foods simultaneously makes it difficult to decipher which may be causing a rash or allergy therefore
INTRODUCE ONE NEW FOOD AT A TIME WITH 5-7 DAYS IN BETWEEN. Generally, iron fortified cereal is
the best to introduce first with two portions/day. Start with rice cereal 1-2 tbsp mixed with breast milk, formula or
juice (apple, white grape, or prune. NO orange juice or citrus juice until 12 months). You may want to gradually
thicken cereal to the consistency of applesauce. Your baby will generally spit out the cereal in the beginning until
they learn to coordinate swallowing the thickened cereal consistency. Then 5 – 7 days later, try oatmeal: 1 –2 tbsp
twice daily, then mixed cereal, which is a combination of rice, barley and oatmeal. Cereal can often produce harder
stools and constipation. If this occurs, mix cereal with undiluted apple, prune, or white grape juice. Gradually
introduce one new fruit or vegetable with 5-7 days in between until all are completed. Avoid citrus products
including oranges, pineapple, strawberries, tomatoes, papayas, and mangos until your baby is twelve months old.
DO NOT SUPPLEMENT WITH WATER, unless instructed by your physician.