4 Month Visit
Your baby’s primary source of nutrition will continue to be breast milk or formula. You
may introduce solids between 4-6 months of age. Signs that the baby may be ready
for solid food include good head control, interest in watching others eat, and drinking
more than 32oz/day. We recommend introducing cereal first then stage I vegetables
and fruits. All of these foods are to be fed with a baby spoon, not an infant feeder or
Weight: _______ Lbs______oz (_______ %)
bottle. Cereal mixing instruction: start with a teaspoon or two of rice cereal mixed with
Height: ________ inches (________ %)
enough formula or breast milk to make a thin paste. Gradually make the cereal thicker
Head circ.: _______ cm (__________%)
and increase the quantity of the cereal up to even a few tablespoons. Although the
baby may spit it out at first, he/she will eventually get the idea. More detail is avail-
able on our website article “Helpful Hints for Feeding Your Baby.” Continue Vitamin D
At this age you may notice your baby:
supplementation for breast fed babies or if formula intake is below 32 oz.
• Smiles, laughs, squeals, blows bubbles/raspberries
• Initiates interaction, making good eye contact
Please continue giving each new food for about 3-5 days before trying another
• Drools and puts objects in mouth to explore them
food. That way, if there is an adverse reaction to any food, it can be identified and
• Lifts head and chest when lying on tummy, pushing
withdrawn. Here’s a great schedule to eventually work up to:
up on arms, and often attempts to roll over
• Shows good head control
Cereal and stage 1 fruit
Cereal and stage 1 veggie
• Sees and intentionally reaches for objects
Always put the baby to sleep on their back on a firm mattress with a fitted sheet.
There should not be anything else in the crib with the baby (i.e. pillows, bumpers,
• Encourage your baby to play on his/her tummy a few
blankets, toys). Most babies are sleeping through the night between 4 and 5 months
times every day.
of age. Consistently making sure your baby falls asleep from the awake or drowsy
• Join your baby in quiet play (reading, talking, singing
state helps. Avoid feeding or rocking your baby to sleep. Consider putting your baby in
or cuddling) and active play (playing on the floor or
his/ her own room to sleep if the baby is still in your room. Try to stop any middle-of-
with a baby gym, mobile, or mirrors) every day.
the-night feeds. Develop a good bedtime routine for your baby and be consistent.
• Your child will learn to roll over if not already rolling.
Help your child practice sitting by placing him/her in
a sitting position on a flat surface and providing
support at the lower back/hip level. Your child might
• It is advised to use sunscreen with SPF >= 30.
learn to lean forward and “tripod” sit.
• Insect repellents containing 10-24% DEET are safe and most effective. Do not use
• Your child might learn to transfer objects from one
combination products with DEET and sunscreen because the sunscreen needs
hand to another and to babble by the next visit.
more frequent application.
• Never leave the baby unattended in the car, in the bath, or on elevated surfaces.
FOCUS ON FAMILY
• We do not recommend a walker, although stationery sitting devices are fine.
• Your child’s car seat should be placed in the middle of the back seat facing
• If mom has started back at work, consider
redistributing household responsibilities in order for
• Choose toys that have soft edges and are too large to swallow.
both parents to have time with the baby and time
• Avoid any and all smoke exposure.
• To access the most up-to-date TIPP Safety Sheets from the AAP, please visit
• Try to find time for you and your partner to be alone.
the Patient Education Online search tool on our website under Resources.
Taking care of yourselves will allow you to take better
care of your family.
Today your child will receive the vaccination(s) circled below. Common side effects
to vaccinations are fever, fussiness, or soreness at the site. You may give your baby
Next visit at 6 months
acetaminophen as needed for fever or fussiness over the next 24-48 hours. Refer to
our website for the helpful dosing calculator. No ibuprofen until 6 mos of age.
Please refer to our website to access the most up-to-date Vaccine Information
Sheets from the CDC.
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Revised June 2015