Your Four Month Old

What You Need To Know

Baby girl wearing a matching hat and dress
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Infant Nutrition

At this age, breast milk or an iron-fortified infant formula is the only food that your infant needs at this age and he should be nursing or drinking about 5-6 ounces 4-6 times each day (24-32 ounces), but over the next month or two, you can start to familiarize your infant with the feel of a spoon and start solid baby foods.

Cereal is the first solid you should give your infant and you can mix it with breast milk, formula or water and feed it to your him with a spoon (not in a bottle). Start by feeding one tablespoon of an iron-fortified Rice cereal at one feeding and then slowly increase the amount to 3-4 tablespoons one or two times each day. This is a very important source of iron for your growing infant (especially if you are breastfeeding). You can then begin vegetables and fruits at about six months of age.

Your infant will probably have given up middle of the night feedings by this age (although some breastfed infants continue to have a feeding in the middle of the night). If not, and your baby is gaining weight well, slowly reduce how much you are putting in the bottle each night and gradually stop this feeding all together.

Feeding practices to avoid are putting the bottle in bed or propping the bottle while feeding, putting cereal in the bottle, feeding honey, using a low-iron formula or heating bottles in the microwave.

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Infant Growth and Development

At this age you can expect your infant to roll over (front to back), bear weight on his legs, sit with support, hold up his head and chest and support himself on his elbows if he is on his stomach, pull to a sitting position and hold on to a rattle. Over the next few months, your infant will start to imitate speech sounds, reach for objects and sit without support.

If using a pacifier, try and restrict its use to when your baby seems to need the self-comforting behavior of sucking. Avoid using it every time your baby cries and to be safe, use a one-piece commercial pacifier and do not hang it around your baby's neck. After six months of age, you should restrict pacifier use to when your baby is in his crib.

Most babies take at least two to three naps (length of naps are usually very variable between different children, but naps are usually 1 1/2-2 hours each) during the day at this age and are able to sleep for the majority of the night. If not, check to make sure that your baby has a good bedtime routine and has developed the proper sleep associations.


Accidents are the leading cause of death for children. Most of these deaths could easily be prevented and it is therefore very important to keep your child's safety in mind at all times. Here are some tips to keep your infant safe:

  • According to the latest car seat guidelines, you should use a rear-facing infant or convertible car seat, and place it in the back seat until your baby is two years old or outgrows the rear-facing weight or height limits, and never place your baby in the front seat of a car with a passenger side airbag.
  • Make sure his crib is safe: have no more than 2 3/8 inches between the bars; the mattress should be firm and fit snugly within the crib; place it away from windows and drafts; avoid placing fluffy blankets, stuffed animals, or pillows in the crib as they can cause smothering.
  • Make sure that used or hand-me-down equipment, such as car seats, strollers, and cribs, etc, haven't been recalled for safety reasons. Call the manufacturer or the Consumer Product Safety Commission for an up to date list of recalled products.
  • Set the temperature of your hot water heater to 120 F to prevent scalding burns.
  • To prevent choking, never leave small objects or plastic bags in your baby's reach.
  • Back To Sleep: put your baby to sleep on his back (alternate positions) to reduce his risk of SIDS and never put him down alone on a waterbed, beanbag, or soft blanket that can cover his face and cause choking.
  • Prevent falls by not leaving your baby alone on a bed or changing table.
  • Install smoke and carbon monoxide detectors and use flame retardant sleepwear.Until your baby is older and his immune system is stronger, it is probably a good idea to keep him from large groups of people or other sick children to minimize his exposure to infections.
  • Know signs and symptoms of illness: fever (call your Pediatrician right away if your baby has a temp over 100.4 before he is 2-3 months old), decreased appetite, vomiting, irritability, and lethargy.

Taking Your Child to the Doctor

You will be making frequent visits to your Pediatrician during the first year of your child's life so that his growth and development can be closely monitored. Remember to write down any questions you may have for your doctor before the visit so that you don't forget them.

At the four month checkup, you can expect:

  • A complete physical exam, with special attention to his hips.
  • An examination of your infant's growth and development.
  • A review of feeding and sleep schedules.
  • Measurement of his height, weight and head circumference.
  • Counseling for injury prevention.
  • Immunizations: DTaP, HepB, Hib, IPV, Prevnar, and RotaTeq.

The next check up with your pediatrician will be when your infant is six months old.

Common Infant Problems

  • Constipation: defined as the passage of hard, pellet-like stools that cause pain or bleeding (groaning or straining is normal) and not so much by how often your baby has a bowel movement (some breastfed babies only have one BM each week). Initial treatment is by giving 2-4 ounces of water or diluted prune juice once or twice a day or by changing to a soy based formula.
  • Stuffy Nose/Sneezing: very common and usually caused by irritation from dry air, smoke, or dust. Try to eliminate common irritants. You can try using a humidifier or salt water nose drops.
  • Thrush: white patches that coat the inside of the cheeks and tongue and cannot be easily wiped off. It is caused by a very mild yeast infection and is easily cleared up with a prescription medicine called Nystatin or Fluconazole.
  • Rashes: very common in infants and includes baby acne, drooling rashes, and flaky skin that will usually clear up on their own without treatment.
  • Dry Skin: use a mild soap and a moisturizer once or twice a day.
  • Spitting Up: many babies spit up (reflux) after eating due to overfeeding or because the valve that closes the upper part of the stomach is immature. It is usually not a concern as long as your baby is gaining weight and it is not causing him to cough or choke. Some steps to take to improve this problem are feeding smaller amounts, more frequent burping during feeds, avoiding pressure on his belly or vigorous activity after eating. It improves with age, usually without treatment.
  • Watery Eyes: this is usually caused by a blocked tear duct and is not a concern unless the eyes become infected (let your Pediatrician know so that they can prescribe antibiotic eye drops). It usually clears up on its own before your baby is 12 months old.
  • Diaper Rashes: very common and usually clear up in 3-4 days with a diaper rash cream. If it is not clearing up or is bright red and surrounded by red dots, your baby may have a yeast infection and will need an antifungal cream to help clear it up. Diaper rashes can be prevented by frequent diaper changes, increasing air exposure by keeping the diaper off as much as possible and using a mild soap only after bowel movements (rinse with just warm water at other times).
  • Upper Respiratory Infections: these are very common and include symptoms of a clear or green runny nose and cough and are usually caused by cold viruses. The best treatment is to use saltwater nasal drops and a bulb suctioner to keep their nose clear. Call your Pediatrician if your child has high fever, difficulty breathing or is not improving in 7-10 days

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