Four Month Well Child Visit

Vaccines

  • Pediarix: combination vaccine of DTaP (Diptheria, Tetanus, whooping cough), Polio, and Hepatitis B.

  • HiB: Haemophilus Influenza Type B (not Flu).

  • Prevnar: Pneumonia Vaccine.

  • Rotavirus: Prevents rotavirus diarrhea – Given by mouth.

Side Effects

  • Babies generally do well the first vaccine series; some side effects include low grade fever ( 100- 101F), fussiness, excessive crying, vomiting, sleepiness, and swelling at injection site.

  • Give about 0.6 ml (3/4 dropper of Tylenol Infant drops) every 4 hours twice if needed.

Feeding

  • Babies at four months can be started on solids or baby foods.

  • Wait five to seven days in between starting new foods to ensure the baby does not have allergies to those foods.

General care and safety

  • Babies tend to spit up frequently at four months; however, this will get better by six months. If spitting up is excessive or if the baby is not gaining weight notify your healthcare provider.

  • Although generally not recommended at four months sun block lotions or bug sprays may be used if needed.

  • Place baby on his back to sleep.

  • Do not use soft bedding, pillows or stuffed toys in crib.

Colic

  • Babies tend to be fussy a lot and may cry for hours.

  • Try to rock the baby gently, wrap up snugly, take them for a car ride, or try placing the baby in a vibrating chair.

  • If all else fails, take a break and have someone else take care of the baby.

Four Month Child Milestones

Physical and motor skills

  • Loses infant reflexes (Startle, fencing, and rooting reflex).

  • Has almost no head lag while in a sitting position.

  • Is able to sit up straight if propped.

  • Raises head 90 degrees when placed on stomach.

  • Is able to roll from front to back.

  • Tries to reach objects with hands (may miss).

  • Plays with rattle when placed in the hands, but won't be able to pick it up if dropped.

  • Is able to grasp rattle with both hands.

  • Is able to place objects in mouth.

Sensory & cognitive skills

  • Has well-established close vision.

  • Has beginning hand-eye coordination.

  • Babbles and coos.

  • Laughs out loud.

  • Anticipates feeding when able to see bottle or breast.

  • Begins to show memory.

  • Demands attention by fussing.

  • Recognizes parent’s voice or touch.

play

  • Place the baby in front of a mirror.

  • Provide bright-colored toys to hold.

  • Repeat sounds the infant makes.

  • Help the infant roll over.

  • Use a swing or stroller.

Developmental Health Watch

Although each baby develops in her own individual way and at her own rate, failure to reach certain milestones may signal medical or developmental problems requiring special attention.

If you notice any of the following warning signs in your infant at this age, discuss them with your pediatrician.

  • Head falls back when pulled to a sitting position.

  • Infant does not follow people with his eyes.

  • Moves one side of the body more than the other.

  • Babbles less than he used to.

  • Still has Moro or Startle reflex after four months.

  • Doesn't reach for and grasp toys at four months.

  • Doesn't babble by four months.

  • Doesn't bring objects to her mouth by four months.

  • Doesn't try to imitate any of your sounds by four months.

  • Doesn't push down with her legs when her feet are placed on a firm surface by four months.