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2GENERAL PEDIATRIC CLINIC / 4 MONTH VISIT
ANTICIPATORY GUIDANCE FOR 4 MONTH VISIT
F-1068C (01/11)
Page 2
Diet
Sibling Rivalry
Plan adding only one new food per week. It is okay to let the
The baby is now very responsive to everyone and gets a lot
parents choose what to add but still keep away from allergenic
more attention from father and visitors. Sibs close in age may
foods. With addition of solids, stools will become more firm. Add
show more signs of sibling rivalry now. May revert to more
juices and fruits PRN (see 6-8 week visit).
immature behaviors.
Vocal Stimulation — The parents should respond to baby's
Anticipatory Guidance
"noises" with speech.
Teething, discuss the timing of first teeth (5-9 months), the wide
range of normality, the normal sequence of teeth eruption and
Safety
again great variation in this sequence, gums do most of the
chewing so the baby does not need teeth to eat solids.
Use the playpen as a safe place to leave the baby. This is
especially needed when there are older sibs running around. The
Drooling, increased mucus, irritability, need to chew, possibly
use of the playpen at this time will get the child used to his own
loose stools may all be related to teething. Most babies do not
"safe territory." As the baby becomes more mobile, the playpen can
have fever, runny nose or overt diarrhea. Drooling is also due to
prevent accidents from occurring when the baby is left alone for a
increased saliva at this age. Chewing is partially from teething but
few minutes while the parent goes to the bathroom, answers the
also from the development of "hand-mouth" reflex. A cool pacifier
phone, goes to the front door, etc. When using infant seats, they
gives comfort to the swollen gums. Use solid teething ring kept
should always be placed on the floor. Toys should be large, colorful
cool in the refrigerator. Do not use a ring with liquid inside.
and washable. The prevention of aspiration of objects should be
gone over by reminding parents to always close safety pins and not
Colds — see handout. Discuss decreased maternal protection by 6
leave small toys or hard food near the baby.
months. More exposure to people, so babies are more apt to get
viruses. Diseases may last 7-14 days and the baby can get a new
Home water temperature should be turned to below 120° now.
"cold" every two weeks or so.
Fever review — see "6-8 week visit"
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