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Growth & Development

American Academy of Pediatrics

Bright Futures Parent Handout: 4 Month Visit

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ICD10

  • Z00.12

  • 99381

  • 99391

Here are some suggestions from Bright Futures experts that may be of value to your family.

How Your Family is Doing

  • Learn if your home or drinking water has lead and take steps to get rid of it. Lead is toxic for everyone.

  • Take time for yourself and with your partner. Spend time with family and friends.

  • Choose a mature, trained, and responsible babysitter or caregiver.

  • You can talk with us about your child care choices.

Feeding Your Baby

  • For babies at 4 months of age, breast milk or iron-fortified formula remains the best food. Solid foods are discouraged until about 6 months of age.

  • Avoid feeding your baby too much by following the baby’s signs of fullness, such as

    • Leaning back

    • Turning away

If Breastfeeding

  • Providing only breast milk for your baby for about the first 6 months after birth provides ideal nutrition. It supports the best possible growth and development.

  • Be proud of yourself if you are still breastfeeding. Continue as long as you and your baby want.

  • Know that babies this age go through growth spurts. They may want to breastfeed more often and that is normal.

  • If you pump, be sure to store your milk properly so it stays safe for your baby. We can give you more information.

  • Give your baby vitamin D drops (400 IU a day).

  • Tell us if you are taking any medications, supplements, or herbal preparations.

If Formula Feeding

  • Make sure to prepare, heat, and store the formula safely.

  • Feed on demand. Expect him to eat about 30 to 32 oz daily.

  • Hold your baby so you can look at each other when you feed him.

  • Always hold the bottle. Never prop it.

  • Don’t give your baby a bottle while he is in a crib.

Your Changing Baby

  • Create routines for feeding, nap time, and bedtime.

  • Calm your baby with soothing and gentle touches when she is fussy.

  • Make time for quiet play.

    • Hold your baby and talk with her.

    • Read to your baby often.

  • Encourage active play.

    • Offer floor gyms and colorful toys to hold.

    • Put your baby on her tummy for playtime. Don’t leave her alone during tummy time or allow her to sleep on her tummy.

  • Don’t have a TV on in the background or use a TV or other digital media to calm your baby.

Healthy Teeth

  • Go to your own dentist twice yearly. It is important to keep your teeth healthy so you don’t pass bacteria that cause cavities on to your baby.

  • Don’t share spoons with your baby or use your mouth to clean the baby’s pacifier.

  • Use a cold teething ring if your baby’s gums are sore from teething.

  • Don’t put your baby in a crib with a bottle.

  • Clean your baby’s gums and teeth (as soon as you see the first tooth) 2 times per day with a soft cloth or soft toothbrush and a small smear of fluoride toothpaste (no more than a grain of rice).

Safety

  • Use a rear-facing–only car safety seat in the back seat of all vehicles.

  • Never put your baby in the front seat of a vehicle that has a passenger airbag.

  • Your baby’s safety depends on you. Always wear your lap and shoulder seat belt.

  • Never drive after drinking alcohol or using drugs. Never text or use a cell phone while driving.

  • Always put your baby to sleep on her back in her own crib, not in your bed.

    • Your baby should sleep in your room until she is at least 6 months of age.

    • Make sure your baby’s crib or sleep surface meets the most recent safety guidelines.

    • Don’t put soft objects and loose bedding such as blankets, pillows, bumper pads, and toys in the crib.

  • Drop-side cribs should not be used.

  • Lower the crib mattress.

  • If you choose to use a mesh playpen, get one made after February 28, 2013.

  • Prevent tap water burns. Set the water heater so the temperature at the faucet is at or below 120°F /49°C.

  • Prevent scalds or burns. Don’t drink hot drinks when holding your baby.

  • Keep a hand on your baby on any surface from which she might fall and get hurt, such as a changing table, couch, or bed.

  • Never leave your baby alone in bathwater, even in a bath seat or ring.

  • Keep small objects, small toys, and latex balloons away from your baby.

  • Don’t use a baby walker.

What to Expect at Your Baby’s 6 Month Visit

We will talk about

  • Caring for your baby, your family, and yourself

  • Teaching and playing with your baby

  • Brushing your baby’s teeth

  • Introducing solid food

  • Keeping your baby safe at home, outside, and in the car

The information contained in this handout should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances. Original handout included as part of the Bright Futures Tool and Resource Kit, 2nd Edition.

Listing of resources does not imply an endorsement by the American Academy of Pediatrics (AAP). The AAP is not responsible for the content of external resources. Information was current at the time of publication.

The American Academy of Pediatrics (AAP) does not review or endorse any modifications made to this handout and in no event shall the AAP be liable for any such changes.

© 2019 American Academy of Pediatrics. All rights reserved.