A B C D E F G H I J K L M N O P Q R S T U V W X Y Z view all
print format  

Well Child Visit 1 Handout - 4 Months

4 MONTH


Date of Visit:  ___________
Weight:           ___________
Height:            ___________
HC:                 ___________
 
 
NORMAL DEVELOPMENT: Your baby may . . .  
 
•  Roll from back to stomach or vice versa.
•  Laugh aloud while socializing.
•  Reach for and bat at objects.
•  Shake a rattle.
•  No longer look cross-eyed.
•  Focus on objects at different distances.
•  Open and close hands and intertwine his/her fingers.
•  Hold head steady and erect for a short time.
•  Carry objects to his/her mouth.
 
DIET:
•  Continue breast milk or formula feedings as the main source of nourishment.
•  Between 4-6 months, baby cereal can be started.  Rice cereal is preferable, as it is the least allergenic.  One tablespoon mixed with breast milk or formula taken 1-2 times per day by spoon, not bottle, is enough to get started.  Continue feeding your baby rice cereal at least 5 days before trying a different type of cereal.  As long as no signs of intolerance or allergy are present, baby cream of wheat, barley, and oatmeal cereals may be introduced.  See “Feeding Guidelines” handout.
•  FLUORIDE RECOMMENDATION:  Babies do not require fluoride supplementation during the first six months of life.  After six months of age, if they continue to receive breast milk as their major source of milk, babies can receive fluoride through water.  With concerns about lead in tap water, you may use either bottled water with fluoride or filtered tap water.
•  IRON RECOMMENDATION:  Usually no iron drops are necessary.  Your child gets iron in his/her iron-fortified formula or in breast milk.  Breastfeeding moms should continue to take their multivitamins with iron.  Baby food, started at 4-6 months, is also a source of iron.  Exception:  Supplemental iron is necessary if breast milk is the only source of nourishment for the first nine months of life.  In this case, iron supplement should be started at 6 months in the form of polyvisol with iron, 1 cc or 1 ml by mouth once a day (available at your pharmacy).
 
HYGIENE:
•  Use a mild soap for your infant’s body (i.e. Dove, Neutrogena, or Baby Magic Formula).
•  Use only water on your baby’s face.
•  Clean only the outer ear with a cotton swab; never put a swab in the ear canal.
 
 
SAFETY:
•  Always restrain your baby in an appropriate infant car safety seat in the backseat.
•  Never prop a bottle—your baby may choke.
•  Toys and/or pacifiers should not be hung around the neck.  Pacifier clips are a better choice.
•  Never leave your baby alone on a bed, sofa, or other surface from which he/she can roll off.
•  Stay with your baby every minute he/she is in the bathtub.
•  Do not hold your baby while you are eating, drinking, or cooking hot foods.  Your baby may be starting to reach out and grab cups, dishes, and foods.
•  Install smoke alarms on every floor and change batteries twice a year.
•  Be sure no small objects are within your baby’s reach that could be choked on.  Any small objects could end up in your baby’s mouth.
•  Baby walkers are not recommended.  They do not help your baby walk earlier and are the cause of many accidents.
•  Never leave the baby alone or with a young sibling.
 
STIMULATION:
•  Your baby will delight in the sound of your voice as you talk, sing, or hum.
•  Limit the time your baby spends in a playpen.  Allow your baby to explore under your constant supervision.  
•  Your child will enjoy the sound of a ticking clock, a music box, or any kind of music.
•  Some favorite games to play with your baby are:  “This Little Piggy,” “Patty-Cake,” “Peek-a- boo,” and “SOOO Big.”
•  Your baby can never get too much hugging and cuddling.
 
TOYS:
•  Because everything goes in your baby’s mouth, all toys should be washable, too large to be swallowed, and made with paint labeled “non-toxic.”
•  Watch out for beads and small parts of toys that could come off and be swallowed.  Never give your child a toy on a long string and never tie toys to the crib or carriage with long strings.  These strings could strangle your baby.
 
HEALTH MAINTENANCE:
•  IMMUNIZATIONS:  DTaP, Hib, IPV, PCV (see vaccine information sheets).
•  ACETAMINOPHEN DOSAGE:  Acetaminophen (i.e., Tylenol, Tempra) can be given for fever every 4 hours (See Tylenol Dosing Handout).  Tylenol is dosed according to your baby’s weight.  
 
ANTICIPATORY GUIDANCE:  (Information credited to Brazelton’s Touchpoints)
 •  Feeding:  Expect your baby to be easily distracted during feeding times and at times feeding refusal when exciting events are occurring.
•  Sleeping:  Expect increased bursts of sleep at night, but be wary of light sleep periods at which your baby may not need to come fully awake.
•  Play:  Provide opportunities for your baby to play during daily routines.  Also encourage increased interest in manipulating objects.