Pediatric Associates Of Orlando, P.a. Four-Month Check Up Page 2
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2ANTICIPATORY GUIDANCE
Schedule next appointment for six months of age. Your child will again receive a complete physical exam and the
third set of immunizations at that time. Balance your time. Allow each parent alone time, time together as a family
unit, and arrange babysitting to go out as a couple. Do not put your baby to bed with a bottle or prop it in his mouth.
Encourage your partner and other children to help out with the baby.
SAFETY
A. Always guard against ingestion of harmful objects and substances. Check toys for vulnerability to
breakage, choking or ingestion such as buttons, or plastic tags.
B. Never hold infant when handling hot liquids.
C. Do not use or purchase4 a walker. Severe head injuries and skull fractures have resulted from infants
falling down steps while place in walkers.
D. Always seep one hand on your baby and do not leave him alone in the bathtub or on high places.
Bring all bath supplies into the bathroom prior to bath (shampoo, towel, diaper, pajamas). Never use
cordless telephone while bathing infant. Avoid answering door and phone. If you must step away,
carry the baby with you.
E. To avoid severe lung irritation due to breathing in powder, never use talc powder.
F. Be careful not to jiggle or shake baby’s head too vigorously. Always support baby’s head when
moving his/her body.
G. Place infant on backside to sleep to reduce SIDS. Keep smoke-free zone around your baby. Babies
and young children exposed to smoke have more colds and other upper respiratory tract infections, as
well as an increased risk of Sudden Infant Death Syndrome (SIDS).
DEVELOPMENT
Look for your baby to: Hold head high and start raising body on hands when lying on abdomen. Open hands while
at rest, discover and play with hands, hold a rattle. Look at mobile and activate arms. Follow objects with eyes
through a 180-degree range. Initiate social contact by smiling, cooing, laughing, and squealing. Recognize food
preparation and be able to wait a short time.
SLEEP
Many infants have developed relatively predictable sleep schedules. Establish a consistent daily bedtime routine.
Sleep is a highly organized process that is influenced by the care-taking environment. Putting an infant to bed alone
and helping your baby sleep through the night are important tasks. Babies who weigh 12 – 15 pounds usually can
sleep a 6- 8-hour stretch. Normal sleep is composed of two distinct states, rapid eye movement (REM), and non
rapid eye movement (NREM) sleep. REM is a lighter state of sleep characterized by irregular pulse, respiratory
rate, body twitches, suppression of muscle tone, and dreaming. Non REM sleep varies from drowsiness to deep
sleep with regular respiratory rate, pulse, and minimal body movements. A sleep cycle consists of N on-Rem sleep
followed by REM sleep lasting about 50 minutes. Infants often awaken during REM sleep and must learn to fall
back to sleep. Put your infant to bed while thy are still awake so they can learn internal devices to help themselves
fall asleep, and return to sleep alone after REM awakening. Teach you infant to fall asleep unaided without rocking,
holding, or feeding. Place your infant in the crib AWAKE after establishing a daily bedtime ritual…feeding, bath,
books, prayers, talking or singing. What your bedtime routine entails is less important that the fact that you are
consistent and establish a routine.
WHEN TO CALL YOUR PEDIATRICIAN
Axillary temperature greater than 101 degrees (unless your child received immunizations within the past two days
and is acting ok otherwise), projectile vomiting, green (bilious) vomiting, seizure, excessive irritability or lethargy.
Our telephone nurse is available during office hours for common pediatric questions. Life threatening emergencies,
such as severe respiratory distress, should be directed to the emergency room or 911.
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