4 Month Well-Child Visit

By four months your infant is beginning to develop a personality and interact more with you and his or her environment. Growth is still rapid but starting to slow down a little. Booster vaccinations are due. What can you expect at this visit with the Pediatrician?

Vitals – Heart rate and respiratory rate will be counted, temperature is taken.

Growth measurements – Length, weight, and head circumference are updated at the four month visit. These are plotted on a growth chart that is specific to your baby’s gender and will be compared to the previous measurements to make sure growth occurs appropriately and proportionally. Remember, the goal is for your baby to grow consistently on the curve.  I often tell parents that I am more interested with seeing steady growth along a curve more than worrying about which curve the infant is on. Growth curves are measured in “percentiles” where 50th percentile is the average measurement for age and gender. Infants who fall above the 50th percentile are “above average” for that measurement, while infants who fall below the 50th percentile are “below average.” Keep in mind that many factors affect where your baby falls on the curve – genetics, feeding patterns, prematurity.

Development – 4 month old infants are fun!

• Social: They smile and laugh in response to interaction with others. They stare at strangers but aren’t usually afraid of them yet. 
• Speech & Language: They make cooing noises for longer periods of time and are squealing loudly. They turn towards voices to locate the source. 
• Gross (large) motor: They push up on hands or elbows when on stomach during tummy time. Sometimes infants are able to roll from their stomach to their back. 
• Fine motor: They bring hands together and bring objects to their mouth. They are able to reach for toys and grasp them. 

Questions from the Pediatrician – your baby’s doctor will ask questions about feeding, burping, sleeping, voiding (urination) and stooling (bowel movements), spit up, and development.

Nutrition – at this age, it is recommended to continue to exclusively breastfeed if possible. If breastfeeding, an extra Vitamin D supplement continues to be recommended. If formula feeding, expect your infant to take in about 25-30oz per day. If possible, delay solid food (puree) introduction to closer to 6 months of age. 

Exam – your infant will have a head-to-toe exam at every well-child visit. 

Vaccinations – the CDC recommended vaccination schedule continues at 4 months of age. Infants receive booster vaccines of DTaP (Diphtheria, Tetanus, acellular Pertussis), Hepatitis B, Polio, Hib (Haemophilus influenza type b), Pneumococcal, and Rotavirus vaccinations. Many offices will give a combination vaccine to reduce the number of “pokes” your infant receives. I discuss infant vaccines in more detail in a separate post, if you would like more information.

Questions from you – as your child interacts more with the environment and people around them, you will likely have more questions about proper developmental milestones, nutrition, sleep habits, and more. Bring your questions to the visit so you don’t forget them!

Safety information – part of every well-child visit is discussion of safety that is appropriate for age. For infants, this includes:

• sleep practices – infants should sleep on their back in their own basinet or crib. There should be no extra blankets, pillows, crib bumpers, stuffed animals, or sleep positioners in the crib. Infants should never sleep in parents’ bed, in swings, or in reclined sleepers. 
• car seat instructions – infants should be in their infant car seats, in the back seat, facing backwards. 
• water safety during bath time – infants should never be left alone in the water, even if it is only a few inches or only for a short amount of time. Drowning occurs quickly. 
• fall risks – four month old infants are starting to develop the ability to roll, which puts them at a higher risk for falls.  They should not be left alone on couches, changing tables, beds, or any other elevated surface. 
• choking – at this age, infants put EVERYTHING in their mouths. Avoid contact with small objects and plastic bags. 

Next visit: 6 months

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