Because your baby grows rapidly during these months, your questions may move from simple sleeping and eating concerns to those about physical development and motor skills. Your doctor will monitor your baby's progress and answer your questions.

Most likely your baby will now be seen at 4 months and at 6 months, but your doctor may have a different schedule for well-baby visits. Extra visits may be scheduled to check on a problem found earlier.

Many parents call the doctor more often about suspected colds or ear infections during these months, especially in wintertime. Once babies can reach out and grab objects, and start having contact with more people, they can be at increased risk for contagious illness, particularly if entering childcare or if they have older siblings. Also, much of the immunity that they received from their mothers before birth is "wearing off" now.

What to Expect at the Office Visit

Well-baby visits vary from doctor to doctor, but here are some common elements of a checkup:

• Measurement of your baby's length, weight, and head circumference. Growth will be plotted on a growth chart, and you'll be advised of the progress.
• A physical exam to check for normal function of the eyes, ears, heart, lungs, abdomen, arms and legs, etc. The doctor will check the baby's soft spot (fontanel) at the top of the head, and may check baby's mouth for signs of teething.
• A review of your baby's physical and emotional development through both observation and your progress report. Can your baby hold up his or her head? Is your tot rolling over? Attempting to sit up after 6 months? Trying to use his or her hands more and more? How does he or she react to strangers? Your doctor may ask you these questions and more.
• You may be asked how you are doing with your baby and how the rest of the family is doing. Your doctor may go over safety questions with you: Have you babyproofed your home? Is your little one in an appropriate safety seat while in the car? Have you begun removing mobiles and bumpers from the crib if your baby can pull himself up?
• A discussion of your baby's eating habits, including the likelihood that solid foods will be introduced soon.
• Advice on what to expect in the coming months.
• Your baby will receive immunizations during some visits (see below).

Sometime during the 6 months before their first birthday babies are checked for anemia (low red blood cell count — usually due to iron deficiency at this age). This can be done with a simple finger prick to collect a drop of blood for examination. Other than this test, most babies do not need any routine laboratory tests in the first year of life.

Bring to the doctor any questions or concerns you may have at this time. Make sure to write down any specific instructions you receive regarding special baby care. Keep updating your child's permanent medical record, listing information on growth and any problems or illnesses.

Immunizations Your Baby Will Receive

Immunizations generally given at the 4-month visit:

• second diphtheria, tetanus, acellular pertussis (DTaP) vaccine
• second Haemophilus influenzae type b (Hib) vaccine
• second polio vaccine (IPV)
• second pneumococcal conjugate (PCV) vaccine
• second rotavirus (RV) vaccine
• second hepatitis B (HBV) vaccine (can vary depending on whether your doctor uses combination vaccines)

At the 6-month visit, your baby may receive:

• third diphtheria, tetanus, acellular pertussis (DTaP) vaccine
• possibly the third polio vaccine (IPV) at this time
• third hepatitis B vaccine (if first two doses have been given earlier)
• third Haemophilus influenzae type b (Hib) vaccine
• third pneumococcal conjugate (PCV) vaccine
• possibly a third rotavirus (RV) vaccine
• a flu shot

Babies at high risk of developing a meningococcal disease, which can lead to bacterial meningitis and other serious conditions, may receive an additional vaccine. (Otherwise, the meningococcal vaccine is routinely given at 11-12 years old.)

When to Call the Doctor

Colds and other illnesses are a part of growing up. Your baby is beginning to explore and probably is being exposed to other kids. While it's hard to see your baby fight a stuffy nose or suffer with an ear infection, rest assured that most kids grow out of the frequent-illness stage (though perhaps not for some time).

Meanwhile, these safeguards can help keep your baby well:

• Breastfeeding your baby will provide antibodies and enzymes that help protect against illness.
• Try to keep your baby away from kids you know are sick, especially those with infectious diseases such as chickenpox.
• Family members who are sick should not share food or drink with the baby, and they should wash their hands well before handling the baby and your tot's toys.
• Be vigilant about your baby's vaccines. Stick to the immunization schedule recommended by your doctor.

Call your doctor right away if your baby seems lethargic or less energetic, refuses to eat, suddenly has trouble sleeping, has diarrhea, or is vomiting. Also, a temperature over 101°F (38.3°C) should be reported to the doctor immediately, even if your baby seems well otherwise.

Reviewed by: Steven Dowshen, MD
Date reviewed: September 2011