4 Month Check-Up Doctors Note Template


4 Month Check-Up
Weight _____lbs. ______oz.
Age _____________
Length ___________
Date _____________
Head Size ___________
Breast milk or iron-fortified infant formula is the best sources of nutrition for the first 4-6
months of your baby’s life. If your baby is bottle feeding, you should not put the bottle in the
baby's bed or prop it in your baby's mouth. Breast-fed infants should continue on a
multivitamin with a 400 IU of vitamin D.
Between 4-6 months is the appropriate time to introduce solids.
Pay attention to feeding cues. When ready, your baby will show interest in and readiness for
solids. Feeding should be a happy bonding time between you and your infant. Never force
solid food. If solids are rejected, stop, wait a week or two and try again. Eating from a spoon
is a learning process and may be slow-going at first.
Start with iron-fortified infant cereals. Rice or barley will least likely to cause allergies. Mix with
breast milk or formula to make a thin milky mixture, then thicken as tolerated. Start with 1-2
tablespoons and work up to 1/2-1 cup per feeding. Start at 1 meal a day and build up to 3
meals a day over the next 2-3 months.
Once your baby accepts cereals, new food groups may be added. Infants seem to be more
accepting of sweet fruit so starting with vegetables may encourage long term acceptance
resulting in a more balanced diet. However, fruits and vegetables are equals in the nutritional
food pyramid, so pick one that looks good and try it. Start a single food item and watch 5-7
days to make sure that your baby does not have a bad reaction to the new food. Reactions
may include rash, fussiness, vomiting or diarrhea. It is natural for babies to initially reject a
food and it may take offering the food 8-10 times before your infant will accept it.
Juice is a major source of calories and overuse is contributing to the epidemic of obesity in
children. Even 100% natural juice is mostly sugar water, so we do not encourage the use of
juice. If you decide to use juice, start after six months and limit to a total of 4-6 ounces per
day. White grape is often a reasonable first try.
Some infants (up to 8%) develop food allergies or sensitivities. Foods that are more likely to
cause reactions include milk, soy, eggs, wheat, nuts and fish.
In the past we recommended delay of introducing these foods. Research does not support that
delaying these foods actually reduces the risk of your infant developing a food reaction. If your
infant has a known food reaction or there is a family history of food reactions, be careful and
pay close attention for problems as new foods are introduced.


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