Growth Milestones – FOUR MONTHS

“Emerging Personality”

The 4-month-old infant is beginning to settle in by establishing regular sleeping and feeding cycles. He or she is also showing endless interest in his or her environment. The following comments are designed to help you and your partner enjoy your 4- month-old while continuing to gain confidence in yourselves as parents. This information is not intended as a substitute for well-baby visits by your newborn’s pediatrician. Never hesitate to ask your child’s physician for guidance concerning specific problems. This is the reason for regular well-baby checkups.

Parenting and Behavioral
  • This is an enjoyable time for you and your baby. He or she is more fun and less work. He or she is exploring more and trying to make contact with his or her surroundings
  • Continue to hold, cuddle, talk to, sing to and rock your baby as much as you can. Every interaction stimulates brain development. He or she needs an interested audience and a chance to use his or her laughing skills
  • Now is the time to think about getting your baby a playpen and some suitable toys to keep him or her entertained
  • Read brightly colored books to your baby. Reading is important to succeed as an adult and you can not start early enough.
  • Since the 4-month-old infant is more active, spitting up is common at this age, so have a good supply of absorbent bibs to protect your baby’s skin and clothing from being constantly wet
  • If the mother has returned to a second job outside the home, she needs to feel comfortable with the child care arrangements she has made for her baby
  • Parents need to keep in contact with friends and family to avoid social isolation
  • A baby’s development proceeds in a head to foot direction. At this age the typical child can hold his or her head high and raise the body on his or her hands while lying on his or her stomach.
  • The 4-month-old baby keeps his or her hands open while at rest. He or she will play with his or her hands, bat at mobiles and reach for rattles. Any object he or she holds goes directly into his or her mouth.
  • Most babies this age will show a clear preference for parents and other caregivers. They will turn toward a sound and recognize their parent’s voices. Four-month-old infants babble, smile, laugh and squeal.
  • The 4-month-old baby also begins to learn cause and effect. He or she shakes a rattle and it makes noise, you wind the mobile and it begins to move.
  • Feeding times may become interesting! Your baby will begin responding to all the sights and sounds of his or her environment. Frequently, the baby may become so interested in his or her world that he or she may refuse to settle down to eat. He or she will take a few swallows of formula or breast milk and then stop to see what is going on in the room.
  • Most pediatricians start solid foods sometime between ages 4 and 6 months. If your baby sits well when supported, holds his or her head up and seems to be hungry, it may be time to being cereal. Begin with infant rice cereal. Mix a couple of teaspoons with breast milk or formula until it becomes a thin soup. Place the spoon about half way back on the baby’s tongue to teach swallowing. As your baby gets the hang of it, increase the thickness and amount of the cereal. If your baby pushes the solid food out of his or her mouth, it does not necessarily mean he or she does not like what your giving him or her. Babies have a tongue reflex that causes them to push anything out of their mouth.
  • Remember to give vitamins and/or fluoride if prescribed by your child’s doctor.
  • Never put your baby to bed with a bottle or prop it in his or her mouth.
  • Ask your pediatrician about giving diluted juices.
  • Between now and the next checkup, many babies begin to drool. This is quite common and does not necessarily indicate early teething. It is probably due to a lot of saliva that the baby has not yet learned to swallow.
  • Always put your baby to sleep on his or her back. Alternate the end of the crib where you place his or her head so he or she does not always sleep with his or her head on one side.
  • Encourage your baby to console himself or herself by putting your child to bed awake. Teach your 4-month-old self-soothing techniques by providing him or her with a transition object, such as a stuffed animal, blanket or favorite toy.
  • Keep to your establish a bedtime routine and other habits to discourage night awakening assistance from relatives and friends.
  • Most babies will sleep through the night by 3 months old. “Lucky” parents get a good nights sleep sooner. To achieve this, many babies need encouragement. Put the infant to bed when they are drowsy but awake. Avoid rocking your baby to sleep or holding him or her until he or she falls asleep. You baby needs to learn to fall asleep on his or her own. Try to ignore the baby is he or she is just squirming or whimpering. Your infant may go back to sleep on his or her own!
At this Checkup
  • An important part of each well-child visit is the evaluation of the baby’s growth. In the vast majority of children, growth falls within normal ranges on the standard growth curves for weight, height or head size. The smooth curves of a growth chart might create the impression that a baby grows in a continuous, smooth manner. Instead, growth usually occurs in spurts. Therefore, single growth (height , weight, head size) measurement at any particular month in a child’s life is of limited value – more important is the child’s rate of growth over time.
  • The 4-month old will also be checked thoroughly both physically and developmentally.
  • Ask your baby’s doctor about possible side effects (fever, irritability, tenderness over the injection site).
  • Keep a record of your child’s immunizations.
  • Now that your baby is more active, parents need to be more careful than ever not to leave the child anyplace from which he of she can fall. Always keep one hand on the baby and never turn your back, for even a second, when you put your infant on a sofa, bed, changing table or any other high place. Your baby demands your full attention
  • Continue to use an infant car seat that is properly secured in the back seat at all times
  • If your home uses gas appliances, install and maintain carbon monoxide detectors
  • Do not leave your baby alone in a tub of water or on high places such as changing tables, beds, sofas or chairs.
  • Always keep one hand on the baby.
  • Continue to keep the baby’s environment free of smoke. Keep the home and car nonsmoking zones
  • Never shake or jiggle the baby’s head vigorously.
  • Never leave the infant alone in the house or car, even for a minute.
  • Do not place strings or necklaces about a baby’s neck or use a sting to attach a pacifier.
  • Never hold your baby while drinking a hot liquid.
  • Remember, everything a 4-month holds goes in his or her mouth, so keep toys with small parts out of reach. Warn siblings to keep these objects away from their little baby brother or sister
  • . Do not use an infant walker at any age. The walkers are dangerous and do not help your baby’s motor development
  • Your baby will have his or her own frequency of bowel movements.
  • Most babies strain, grunt and fuss when they have bowel movements. This does not mean they are constipated.
When to Call the Doctor
  • Anything that bothers you!
  • Fever.
  • Not gaining weight.
  • Excessive vomiting, especially if it is forceful and goes across the room.
  • Uninterested in eating.
  • Irritability or lethargy.
  • Unusual skin rashes.
  • Eyes are crossed most of the time
  • Your baby seems very stiff or very floppy.
  • You have not seen any developmental changes since the last checkup
The information presented in Growth Milestones was obtained with the help of our pediatric experts and with material from The American Academy of Pediatrics’ Guidelines for Health Supervision and Bright Futures’ Guidelines for Health Supervision of Infants, Children, and Adolescents. Bright Futures is supported by the Maternal and Child Health Bureau, U.S. Department of Health and Human Services. Revised 05-08-07