The 4-Month Well-Baby Visit
Here’s what will happen at your little one’s 4-month well-baby visit, including the physical checkup, developmental milestones and shots.
Rolling over, reaching, grabbing and giggles — at 4 months old, your infant’s changing so fast that it’s hard to keep up! Your baby’s doctor will want to note every adorable new skill at this month’s checkup, which will also include another round of vaccines. Here’s what you can expect.
The physical checkup
It’s checkup time — and that means you get to check out your little one’s growth. Your baby’s doctor will look at the overall trend of your baby’s length, weight and head circumference measurements. Are your baby’s length and weight increasing at a healthy pace? Is he happy, active and alert? Is development on target?
If the answer to these questions is yes, then whether he’s in the 10th or the 90th percentile at his 4-month visit doesn’t matter … he’s just the right size for him!
Your doctor will also perform checks of baby’s eyes, hearing and overall health. The American Academy of Pediatrics (AAP) recommends that moms be screened for postpartum depression at the 4-month checkup, so ask if you have any questions about your moods or your partner’s.
Your little one does much of his developing while he sleeps — although you may be wondering when he’ll develop the ability to sleep through the night! Some (but certainly not all) babies start to sleep for longer stretches at night around 12 weeks, and some even sleep through the night. The doctor will want to know all about your infant’s sleep patterns, including naps and nighttime sleep, so keep notes handy on your phone. Your baby’s doctor will also want to know if your baby is …
- Doing baby push-ups — raising his head and possibly his chest while on his tummy
- Rolling from tummy to back; some babies will have started flipping over, while others may not
- Holding his head up when in your arms or even when held upright
- Paying attention to small objects and trying to reach for everything he sees
- Watching an object move in a 180-degree arc, from one side to the other
- Mixing up those breathy coos with some consonants and other sweet sounds (laughing! giggling!)
Remember, every baby is one-of-a-kind — and there’s a wide range of normal when it comes to development. Still, if you have any concerns about your little one’s milestones, make sure you check with your doctor. You can also ask him or her about ways to keep your baby’s development on track or boost it.
With a cuddle, a favorite toy or paci, your baby will likely sail through this month’s vaccines. Most will be the second dose in a series, and each one of the doses recommended is vital in helping protect your little one against serious illnesses. Vaccines given at the 4-month visit include:
- DTaP (diphtheria, tetanus and pertussis)
- Hib (haemophilus influenzae type b)
- IPV (inactivated poliovirus)
- PCV13 (pneumococcal disease)
- RV (rotavirus)
Questions to ask your doctor
With new milestones, there are sure to be new questions. Here are some things you may want to ask the pediatrician about at this well-baby visit:
- My baby is starting to sleep for longer stretches overnight. Is it time to start sleep training?
- He’s drooling up a storm and sucking on everything — could he be teething already?
- My baby is starting to suck his thumb. Should I discourage him from doing it?
- When should we transition him from a bassinet to a crib?
- Is it safe to keep swaddling him?
- How many poops should he be doing a day now?
As always, don’t forget to make the next appointment — this time for baby’s 6-month visit — before leaving the doctor’s office.
Baby’s 4-Month Checkup: What to Expect
By now, your baby may be smiling, laughing, and cooing. They are also growing fast. Their birth weight may have almost doubled. You’ll probably have a lot of questions for your baby’s doctor at this visit.
Here’s what to expect at your baby’s 4-month checkup.
You Can Expect Your Baby’s Doctor to:
- Check your baby’s weight, length, and head circumference
- Perform a physical exam of your baby
- Give your baby a 2nd round of vaccines (DTaP, Hib, polio, PCV, and rotavirus)
Questions Your Baby’s Doctor May Ask
- Is your baby rolling over one way yet?
- Is your baby able to push up onto their forearms and lift their head yet?
- Does your baby have good head control when upright?
- Is your baby cooing or babbling yet?
- Does your baby respond to loud noises?
- Does your baby follow an object with their eyes?
Developmental Questions You May Have
- When will my baby sit up?
- When will my baby start crawling?
- My baby drools a lot. Are they teething?
Baby Development Tips
- Don’t expect baby to sit up or crawl for at least 2 more months.
- Your baby may be able to roll from front to back soon.
- Your baby can probably grab objects, including your hair or earrings.
- Your baby can also put objects into their mouth, so be aware of choking hazards! Give your baby different textures to explore, like a wooden spoon or furry toy. Hold a toy in front of your baby so they can reach for it and grab. Read and sing to your baby a little each day. Your baby will love it!
Questions You May Have About Solid Foods
- Is it too soon for my baby to eat solids?
- Should I cut back on nursing when my baby starts solids?
Tips for Starting Solids
Your baby must be able to sit up with support and hold their head and neck up properly before you start solids. Other readiness clues include drooling, mimicking eating by opening their mouth while watching you eat, and reaching for items on your plate.
- Try starting with an iron-fortified infant rice cereal mixed with breast milk or formula.
- Don’t worry if baby only takes one to two spoonfuls.
- Be sure to use a small, baby spoon as baby’s mouth is still very small.
- Your baby may push the spoon right back out with their tongue! This is normal at first.
- Expect to continue nursing or bottle-feeding through baby’s first year.
Safety Questions You May Have
- When should I baby-proof the house?
- What should I do first?
Baby Safety Tips:
If you haven’t already, start child-proofing now. Babies can develop new skills overnight!
- When your baby pushes up on their hands, take down mobiles.
- Continue to put your baby on their back to sleep.
- Never leave your baby alone on a sofa or bed. They may be able to roll off soon.
- Don’t leave small objects lying around that baby can put into their mouth and choke on.
- Put up safety gates around stairs and any other unsafe areas.
- Put your baby’s crib at its lowest height.
- Be sure to move cleaning and other toxic products out of baby’s reach.
Teething Questions You May Have
- What can ease my baby’s pain from teething?
- Teething may make your baby drool and become cranky and usually starts around 6 months of age.
- Rubbing your baby’s gums with a clean finger may ease the pain. To relieve pain, let baby chew on a clean, wet washcloth that has been in the freezer for a half hour. NOTE: Make sure to supervise your baby.
- You may be feeling a little more relaxed now since you’re beginning to understand your baby’s reactions.
- Be sure to continue encouraging baby’s development by playing peek-a-boo and making faces and different sounds. See how your baby responds.
Your Child’s Checkup: 4 Months
What to Expect During This Visit Your doctor and/or nurse will probably:
1. Check your baby’s weight, length, and head circumference and plot the measurements on a growth chart.
2. Ask questions, address concerns, and offer advice about how your baby is:
Feeding. Breast milk or formula is still all your baby needs. You can give iron-fortified cereal or puréed meats when your baby is ready for solid foods at about 6 months of age. Talk with your doctor before starting any solids.
Peeing and pooping. Babies this age should have several wet diapers a day and regular bowel movements. Some may poop every day; others may poop every few days. This is normal as long as the poop is soft. Let your doctor know if it gets hard, dry, or difficult to pass.
Sleeping. At this age, babies sleep about 12 to 16 hours a day, including naps. Most babies have a stretch of sleep for 5 or 6 hours at night. Some infants, particularly those who are breastfed, may wake more often.
Developing. By 4 months, it’s common for many babies to:
- turn when they hear voices
- smile, laugh, and squeal
- “coo” in response to your “coos”
- bring hands together in front of chest
- reach for and grasp objects
- have good head control when sitting
- hold up head and chest, supporting themselves on arms, while on tummy
- roll from front to back
There’s a wide range of normal and children develop at different rates. Talk to your doctor if you’re concerned about your child’s development.
3. Do an exam with your baby undressed while you are present. This will include an eye exam, listening to your baby’s heart and feeling pulses, checking hips, and paying attention to your baby’s movements.
4. Update immunizations. Immunizations can protect infants from serious childhood illnesses, so it’s important that your baby get them on time. Immunization schedules can vary from office to office, so talk to your doctor about what to expect.
5. Because postpartum depression is common, your baby’s doctor may ask you to fill out a depression screening questionnaire.
Here are some things to keep in mind until your baby’s next routine checkup at 6 months:
Breast milk or formula is still all your baby needs. Most babies are ready to eat solid foods at about 6 months, though some babies may be ready sooner. If your doctor recommends introducing solids: Share your family history of any food allergies. Start with a small amount of iron-fortified single-grain cereal mixed with breast milk or formula. You can also start with a puréed meat, another iron-rich food. Use an infant spoon — do not put cereal in your baby’s bottle. If your baby is pushing a lot out with the tongue, they may not be ready for solids yet. Wait a week or so before trying again. Wait until your baby successfully eats cereal from the spoon before trying other solids. Introduce one new food at a time and wait several days to watch for a possible allergic reaction before introducing another. If breastfeeding, continue to give vitamin D supplements. Breastfed babies may need iron supplements until they get enough iron from the foods they eat. Pay attention to signs that your baby is hungry or full. Do not give juice until after 12 months. Do not prop bottles or put your baby to bed with a bottle.
Many babies begin teething when they’re around 4 months old. To help ease pain or discomfort, offer a clean wet washcloth or a teether. Talk to your doctor about giving acetaminophen for pain. Clean your baby’s gums with a wet, clean washcloth or soft toothbrush. Sing, talk, read, and play with your baby. Babies learn best by interacting with people. TV, videos, and other types of screen time aren’t recommended for babies this young. Video chatting is OK. Continue to give your baby plenty of supervised “tummy time” when awake. Create a safe play space for your child to explore. Limit the amount of time your baby spends in an infant seat, bouncer, or swing. It’s common for new moms to feel tired and overwhelmed at times. But if these feelings are intense, or you feel sad, moody, or anxious, call your doctor. Talk to your doctor if you’re concerned about your living situation. Do you have the things that you need to take care of your baby? Do you have enough food, a safe place to live, and health insurance? Your doctor can tell you about community resources or refer you to a social worker.
To reduce the risk of sudden infant death syndrome (SIDS): Let your baby sleep in your room in a bassinet or crib next to the bed until your baby’s first birthday or for at least 6 months, when the risk of SIDS is highest. Always place your baby to sleep on a firm mattress on their back in a crib or bassinet without any crib bumpers, blankets, quilts, pillows, or plush toys. Avoid overheating by keeping the room temperature comfortable. Don’t over bundle your baby. Consider putting your baby to sleep sucking on a pacifier. Don’t use an infant walker. They’re dangerous and can cause serious injuries. Walkers also do not encourage walking and may actually hinder it. While your baby is awake, don’t leave your little one unattended, especially on high surfaces or in the bath. Keep small objects and harmful substances out of reach. Always put your baby in a rear-facing car seat in the back seat. Never leave your baby alone in the car. Avoid sun exposure by keeping your baby covered and in the shade when possible. Sunscreens are not recommended for infants younger than 6 months. However, you may use a small amount of sunscreen on an infant younger than 6 months if shade and clothing don’t offer enough protection. Protect your baby from secondhand smoke, which increases the risk of heart and lung disease. Secondhand vapor from e-cigarettes is also harmful.
What is 4-Month Well-Baby Checkup: Overview, Benefits, and Expected Results
Definition and Overview
A 4-month well-baby checkup is a visit to a pediatrician, a medical professional who focuses on monitoring the baby’s growth and development. Although the general idea of the consultation is to assess the baby’s overall health, it can also be used as a time to educate parents about the dynamics of childcare, detect potential health issues, and treat conditions.
As a 4-month-old, there are still many things that a baby cannot do. He cannot yet stand or say vowel strings. Parents may not hear them say Mama or Dada just yet. However, even at this young age, the baby already undergoes significant progress in terms of growth and development.
Around this age, the baby may be able to respond to certain sounds like coos and reach out to objects. He may also laugh and squeal more often, which means he’s becoming more engaged. Although he may not be able to stand yet, he may already sit up. In fact, babies this age are expected to know how to do a mini push-up, which means his arms can already fully support his body as he tries to lift himself off the floor. The baby may also begin to show signs of teething such as drooling and putting hands in his mouth. Parents may also introduce semi-solid food enriched with iron, although their main source of nourishment remains breast or formula milk.
Who Should Undergo and Expected Results
The well-baby checkup is a routine procedure that is part of childcare, which is performed by a pediatrician, a doctor who specializes in children’s health and conditions.
In some cases, the checkup becomes more necessary than in other times, such as when:
Parents notice any deviations in behavior as well as physical, cognitive, motor, and social development. For example, the baby does not have a regular bowel movement, cries more frequently and much longer than other children his age, doesn’t have any eye contact, or doesn’t know how to roll. It’s time for his vaccination. The baby is expected to receive his second dose of RV, DTaP, Hib, PCV, and IPV. If he hasn’t received these before, then the pediatrician has to catch up. The child is sick or the parent suspects that he is due to the presence of physical signs and symptoms. The child is already teething. Teething can be particularly stressful for the child. He may have difficulty sleeping, become more irritable, and avoid feeding. Some babies also tend to have a low-grade fever or diarrhea. The baby doesn’t sleep well through the night. At this age, the baby should be sleeping at least 6 hours at night with very minimal interruption, which is usually for feeding. The parent wants to know if the baby is ready for solid food. Only a pediatrician can determine when it’s all right to begin feeding the baby with food such as pureed vegetables, fruits, or meat. Usually, this is allowed once the baby can already sit properly while his body fully supports his chest, head, and neck, as well as when he begins teething.
How Does the Procedure Work?
Parents are often provided with a baby booklet, which shows different information about baby and childcare. In it can be the immunization schedule, expected developments of the child in different ages, and notes of the pediatrician. It may also include details on the best times to see the pediatrician for a well-baby checkup. Once the parent and the child arrive, a nurse will measure the baby’s weight, head circumference, and height, although this can also be performed by the pediatrician. The nurse also takes notes of any health concerns that the parent may wish to consult with the doctor.
During the checkup, the pediatrician will:
- Perform a physical exam on different parts of the body, such as the belly, hip, legs, ears, eyes, nose, skin, and heart
- Administer vaccines
- Treat the baby’s condition, if there’s any
- Assess development such as sleeping, bowel movement, urination, motor skills, cognition, and behavior
- Recommend supplements such as iron or vitamin D
- The pediatrician is also expected to ask the parents a number of questions, such as:
- Do you have problems with breastfeeding?
- Are you also providing formula milk?
- How much milk is the baby drinking in a day?
- Have you noticed any changes in the baby since the last visit?
The visit normally ends with plenty of safety and health tips addressed to the parents, as well as the schedule for the next visits.
Possible Risks and Complications A 4-month well baby checkup is a routine, safe procedure. However, children may face certain risks if vaccinations or treatment is provided during the visit. These include swelling at the injected site and low-grade fever, among others.
Checkup Checklist: 4 Months Old
Your baby is getting bigger! And at four months, it’s time for another appointment. Expect the standard procedures this time—measurements, developmental, psychosocial and behavioral observations, and a physical exam. Here some things to plan for at this visit:
At the 4-month visit, your baby may receive the second doses of the following vaccines.
- Rotavirus vaccine Diphtheria, tetanus, acellular pertussis vaccine (DTaP)
- Haemophilus influenza type B vaccine (Hib)
- Pneumococcal conjugate vaccine (PCV)
- Inactivated polio vaccine (IPV)
Hematocrit or hemoglobin screening: Your baby may receive this blood screening that helps detect anemia. Your pediatrician may ask you if your baby is drinking anything other than breast milk or iron-fortified formula, as it is a risk factor for developing anemia.
Maternal depression: Your pediatrician will ask you how you are feeling. If you are having postpartum issues with breastfeeding, anxiety, or sadness, or anything else, please feel free to discuss it with your baby’s pediatrician.
✅Feeding & development
Your pediatrician will measure and weigh your baby to make sure their growth is on track, observe their development and behavior, and perform a physical exam.
Questions your pediatrician may ask
- How does your baby fall asleep?
- Are you giving them a bottle?
- Do you have questions about cleaning your baby’s gums and teething?
- If you are breastfeeding, are you giving your baby an iron supplement?
(The AAP recommends giving breastfed infants 1 mg/kg/day of a liquid iron supplement until iron-containing solid foods are introduced at about six months of age).
Questions you may have
- How do I know if my baby’s physical development is on track?
- When do I start my baby on solid foods?
- Which foods do I start with?
- My baby drools and blows bubbles a lot. Is this normal?
- When can I start reading to my baby?
✅Safety Questions your pediatrician may ask
- Where does your baby sleep at night?
- A safe sleep space is crucial. Are you placing baby in a rear-facing car seat?
- Was your home built before 1978?
- Have you tested your home for lead?
Questions you may have
- How do I help calm my baby when they get fussy?
- How often should I feed my baby?
- Is it safe to use amber teething necklaces?
✅ Communication tips
Never hesitate to call your pediatrician’s office with any questions or concerns—even if you know the office is closed. If your pediatrician is unable to see you but believes your baby should be examined, they will advise you on the most appropriate place for your baby to receive care and how quickly your baby should be seen.
Well-Baby Checkup: 4 Months
At the 4-month checkup, the healthcare provider will examine your baby and ask how things are going at home. This sheet describes some of what you can expect.
Development and milestones
The healthcare provider will ask questions about your baby. He or she will observe your baby to get an idea of the infant’s development. By this visit, your baby is likely doing some of the following: Holding up his or her head Reaching for and grabbing at nearby items Squealing and laughing Rolling to one side (not all the way over) Acting like he or she hears and sees you Sucking on his or her hands and drooling (this is not a sign of teething)
Keep feeding your baby with breastmilk or formula. To help your baby eat well: Continue to feed your baby either breastmilk or formula. At night, feed when your baby wakes. At this age, there may be longer stretches of sleep without any feeding. This is OK as long as your baby is getting enough to drink during the day and is growing well. Breastfeeding sessions should last around 10 to 15 minutes. With a bottle, gradually increase the number of ounces of breastmilk or formula you give your baby. Most babies will drink about 4 to 6 ounces but this can vary. If you’re concerned about the amount or how often your baby eats, discuss this with the healthcare provider. Ask the healthcare provider if your baby should take vitamin D. Ask when you should start feeding the baby solid foods (solids). Healthy full-term babies may begin eating single-grain cereals around 4 months of age. Be aware that many babies of 4 months continue to spit up after feeding. In most cases, this is normal. Talk with the healthcare provider if you notice a sudden change in your baby’s feeding habits.
Some babies poop (bowel movements) a few times a day. Others poop as little as once every 2 to 3 days. Anything in this range is normal. It’s fine if your baby poops even less often than every 2 to 3 days if the baby is otherwise healthy. But if your baby also becomes fussy, spits up more than normal, eats less than normal, or has very hard stool, tell the healthcare provider. Your baby may be constipated. This means they are unable to have a bowel movement. Your baby’s stool may range in color from mustard yellow to brown to green. If your baby has started eating solid foods, the stool will change in both consistency and color. Bathe the baby at least once a week.
At 4 months of age, most babies sleep around 15 to 18 hours each day. Babies of this age commonly sleep for short spurts throughout the day, rather than for hours at a time. This will likely improve over the next few months as your baby settles into regular naptimes. Also, it’s normal for the baby to be fussy before going to bed for the night (around 6 p.m. to 9 p.m.). To help your baby sleep safely and soundly: Place the baby on his or her back for all sleeping until the child is 1 year old. This can decrease the risk for SIDS (sudden infant death syndrome), aspiration, and choking. Never place the baby on his or her side or stomach for sleep or naps. If the baby is awake, allow the child time on his or her tummy as long as there is supervision. This helps the child build strong tummy and neck muscles. This will also help minimize flattening of the head that can happen when babies spend too much time on their backs. Ask the healthcare provider if you should let your baby sleep with a pacifier. Sleeping with a pacifier has been shown to decrease the risk for SIDS. But it should not be offered until after breastfeeding has been established. If your baby doesn’t want the pacifier, don’t try to force him or her to take one. Wrapping the baby tightly in a blanket (swaddling) at this age could be dangerous. If a baby is swaddled and rolls onto his or her stomach, he or she could suffocate. Don’t use swaddling blankets. Instead, use a blanket sleeper to keep your baby warm with the arms free. Don’t put a crib bumper, pillow, loose blankets, or stuffed animals in the crib. These could suffocate the baby. Don’t put your baby on a couch or armchair for sleep. Sleeping on a couch or armchair puts the baby at a much higher risk for death, including SIDS. Don’t use infant seats, car seats, strollers, infant carriers, or infant swings for routine sleep and daily naps. These may lead to blockage (obstruction) of a baby’s airway or suffocation. Don’t share a bed (co-sleep) with your baby. Bed-sharing has been shown to increase the risk for SIDS. The American Academy of Pediatrics recommends that babies sleep in the same room as their parents, close to their parents’ bed, but in a separate bed or crib appropriate for babies. This sleeping arrangement is recommended ideally for the baby’s first year. But it should at least be maintained for the first 6 months. Always place cribs, bassinets, and play yards in hazard-free areas—those with no dangling cords, wires, or window coverings—to reduce the risk for strangulation. This is a good age to start a bedtime routine. By doing the same things each night before bed, the baby learns when it’s time to go to sleep. For example, your bedtime routine could be a bath, followed by a feeding, followed by being put down to sleep. It’s OK to let your baby cry in bed. This can help your baby learn to sleep through the night. Talkwith the healthcare provider about how long to let the crying continue before you go in. If you have trouble getting your baby to sleep, ask the healthcare provider for tips.
By this age, babies begin putting things in their mouths. Don’t let your baby have access to anything small enough to choke on. As a rule, an item small enough to fit inside a toilet paper tube can cause a child to choke. When you take the baby outside, avoid staying too long in direct sunlight. Keep the baby covered or seek out the shade. Ask your baby’s healthcare provider if it’s OK to apply sunscreen to your baby’s skin. In the car, always put the baby in a rear-facing car seat. This should be secured in the back seat according to the car seat’s directions. Never leave the baby alone in the car. Don’t leave the baby on a high surface such as a table, bed, or couch. He or she could fall and get hurt. Also, don’t place the baby in a bouncy seat on a high surface. Walkers with wheels are not recommended. Stationary (not moving) activity stations are safer. Talk to the healthcare provider if you have questions about which toys and equipment are safe for your baby. Older siblings can hold and play with the baby as long as an adult supervises.
Based on recommendations from the Centers for Disease Control and Prevention (CDC), at this visit your baby may receive the following vaccines: Diphtheria, tetanus, and pertussis Haemophilus influenzae type b Pneumococcus Polio Rotavirus Having your baby fully vaccinated will also help lower your baby’s risk for SIDS.
Going back to work
You may have already returned to work, or are preparing to do so soon. Either way, it’s normal to feel anxious or guilty about leaving your baby in someone else’s care. These tips may help with the process: Share your concerns with your partner. Work together to form a schedule that balances jobs and childcare. Ask friends or relatives with kids to recommend a caregiver or daycare center. Before leaving the baby with someone, choose carefully. Watch how caregivers interact with your baby. Ask questions and check references. Get to know your baby’s caregivers so you can develop a trusting relationship. Always say goodbye to your baby, and say that you will return at a certain time. Even a child this young will understand your reassuring tone. If you’re breastfeeding, talk with your baby’s healthcare provider or a lactation consultant about how to keep doing so. Many hospitals offer return-to-work classes and support groups for breastfeeding moms.
The 4-month well-baby checkup
At four months, your baby might already be smiling, cooing, and laughing. He has grown up fast since he was born, and you can already see changes in his behaviour and feeding. It is also time for his 4th-month check-up at the paediatrician. If your baby is due for this checkup in the near future, this article has all you need to know about what to expect and how to prepare for it. What Does the Doctor Do in the 4-Month Checkup?
Here are a few things you can expect at the 4-month paediatrician appointment :
1. Measure the length, head circumference and weight
You will have to undress your baby completely for this procedure so the doctor can accurately weigh him on a scale. Next, your baby’s length and head circumference will be taken, and, together, all the numbers will be plotted on a growth chart. The growth chart compares how your baby is developing compared to others of his age. What is important about this value is that there must be some development since his last visit regardless of where he places on the percentile.
2. Complete physical examination
The physical examination involves a check-up of all the body parts to look for healthy growth or abnormalities. It will include:
- Heart and lungs: The doctor will listen to your baby’s heart rhythm to look for abnormalities and listen to the breathing to look for problems or blockage.
- Eyes: The eyes will be checked for any congenital disabilities and to ensure proper functionality. The doctor will also look for problems such as blocked tear ducts.
- Ears: Ear examination will involve checking how your baby responds to sounds and if hearing is normal. There will also be a physical exam to look for infections in the ear.
- Mouth: The mouth cavity will be examined for any congenital disabilities and infections such as oral thrush. The gums will also be examined for emerging teeth.
- Head: The head check-up will reveal if the head’s shape is normal or developing a flat spot. The doctor will also check the soft spots (fontanels) for proper development.
- Body: The doctor will check your baby’s body for the development of muscles, his physical reflexes and examine the skin for rashes, allergies, or infections. The baby might also be put on his tummy to check the head and neck control.
- Belly: A belly examination will reveal any internal developmental defects such as a hernia or enlarged organs.
- Genitals: The doctor will open the baby’s diaper to examine the genitals to check for rashes or infections.
- Hips and legs: The hip and leg joints will be checked for proper functioning by moving them around.
3. Discuss other concerns
The doctor will take the time to address any problems that may have been discovered in your baby. If your baby is experiencing constipation or diarrhoea related to bugs, the ways to deal with it will be discussed. Finally, if you are exclusively breastfeeding your baby, Vitamin D drops will be recommended to supplement the deficiency. Babies who drink between 17 to 32 ounces of formula every day will not be given any Vitamin D supplements.
4. Look for development milestones
The doctor will observe your baby for development milestones that should be seen in babies of 4 months age. By this time, your baby should be able to support his head or look up when placed on the bed. He should be able to look at attractive objects, such as toys, and track them when moved in front of him. He should also be able to make an effort o grab the toy if he finds it appealing. He should be able to respond to sounds.
5. Immunization shots
There are a few immunisation shots for common diseases that your doctor will give at the end of the session. The procedure is usually done by a nurse and is reserved till the end of the check-up, so there will be plenty of time to settle your baby down.
Questions That the Doctor May Ask
Your doctor will ask you a range of questions to assess your baby’s health and development, such as:
1. How are your baby’s eating habits? With this question, the doctor will know how much and how often your baby is feeding. It can give a picture of whether he is getting enough nutrition or he needs to be supplemented with formula. Most babies can’t start on solids at 4 months but now is the time if you wish to talk about it. You could also ask about vitamin supplements.
2. How well does your baby sleep? At this stage, your baby spends more time sleeping than being awake. Your doctor will want to know if the baby sleeps in a more predictable routine with six or more hours in the night and three to four daytime naps. You could discuss irregular sleep and other concerns you may have at this stage.
3. How is your baby’s bowel movement? Baby stools can vary depending on how much they are feeding and what goes into their milk. Faeces that is soft indicates your baby is in good health even though the colour might vary. If you have seen that the baby passes stools that are smelly, watery, mucus-filled, and more frequently than usual, it could be diarrhoea. Discuss how to deal with loose stools and stomach upsets.
4. Can your baby sit with support or roll over on one side? Many babies develop these two skills around this time. They will be able to sit with support and roll over on one side but not both. Your baby can sit without support or rollover on both sides by the time he is 6 months old. These are important developmental milestones.
5. Can he do a mini-pushup? While this is not a regular ‘push-up’ in the true sense of the word, it still allows baby simple control of the head. By 4 months your baby should be able to lift his head up and look ahead while his arms and shoulders are still on the bed. If your baby still can’t do this or struggles with it, let the doctor know.
6. What sounds can your baby make? As your baby grows, he will gain more control of his lips and vocal cords to make more sounds than before. You would notice that he smiles, coos and laughs when you tickle him or smile at him. These early movements, squeals, and babbles are important to develop sounds and verbal skills later on. If you notice your baby makes fewer sounds, then report the same to your doctor.
7. How good are your baby’s motor skills? Like all his other developmental milestones, your baby should be developing motor skills at a noticeable rate. He will be able to reach for and grab things such as attractive toys or even bring both of his hands together in front of him. He should also be kicking with both of his legs and bouncing them up and down when held on the floor or over your lap. If he becomes stiff, instead, report this to your doctor. If he also uses one arm more than the other, report it.
8. Do you notice anything unusual about your baby’s eyes? Babies should be able to comfortably track objects with their eyes and look at things they are interested in. The doctor check for normal eye structure development on every visit along with the alignment. If you notice anything odd with how your baby struggles to look at things, bring it up at the next visit.
9. How is your baby’s hearing? At 4 months, babies should be able to respond to sounds by turning around and looking at the source. If your baby takes too long to respond or responds only to loud sounds, it could indicate a problem. Hearing problem treatment success depends on how soon they are discovered.
Your baby will receive these 4-month checkup shots: PCV (Pneumococcal) DTaP Hib Polio vaccine Oran Rotavirus vaccine baby being examined
Questions You May Have During The Checkup
Here are questions to ask at 4-month check-up:
- Can I start my baby on solid foods or is it too early?
- Should I cut back on breastfeeding if I start my baby on solid foods?
- Can I shift to infant formula from breastfeeding?
- Should I change my diet if I see signs of allergies in my baby?
Other Recommendations By the Doctor If you really want to start with solids, there is no single food that is ideal. You can start with anything that the baby likes. It’s best to start with purees to help them process new foods at first and then transition to fruits, vegetables, and baby cereals.
If your baby is exclusively breastfed, continue with the Vitamin D supplements. When planning to return to work, talk to a lactation consultant about continuing breastfeeding or switching to formula. 4 months is a transition stage when your infant moves from being fussy to developing his own personality. You should be able to see some, if not all, relevant development milestones. If you have doubts or concerns, write them down in a diary and take it with you on the visit.
What to expect during your child’s 4-month well child exam
You may be balancing the smiles with some sleepless nights with your four-month-old baby. At your well child checkup, your provider will talk about your child’s new developments and make sure he is on track for healthy growth and development.
Below are some of the things your doctor may do at your child’s 4-month checkup.
What your pediatrician may do during your child’s 4-month checkup
- Address any concerns of the new parent or caretaker
- Do you have a list of questions we can go over together?
- Has anything come up since our last visit?
- Observe the overall development of your child
- Do you have any new concerns about your baby’s development?
- Has your child reached some of the common project developmental milestones for this age?
- Is your child starting to roll over, grab things or do a mini push-up?
Complete physical examinations to ensure proper growth
- How is your child’s weight and height looking or compare on a growth chart?
- How often is your baby eating, and how much?
- How many wet or dirty diapers are you seeing?
- Can you describe your child’s sleep patterns?
- How do your baby’s eyes and ears look?
- How is your baby’s heart and breathing?
Perform recommended laboratory screenings and immunizations
- Do you plan for your child to get the CDC recommended vaccines for DTaP, Polio (Ipv), HiB, PcV-13 and Rotavirus?
- Are you interested or want to know more about immunizations?
- Discuss the overall life of the child and give general guidance or medical recommendations
- Do you have questions about your child’s eating or sleeping?
- Do you have questions about interacting with your baby?
- Are you able to play games with your child or is he following objects with his eyes?
The 4-Month Well-Baby Visit
Baby’s 4-Month Checkup: What to Expect
Your Child’s Checkup: 4 Months
What is 4-Month Well-Baby Checkup: Overview, Benefits, and Expected Results
Checkup Checklist: 4 Months Old
Well-Baby Checkup: 4 Months
The 4-month well-baby checkup
What to expect during your child’s 4-month well child exam