4 Month Well-Child Checkup

What Happens at the Visit? 

At your 4-month-old’s well-child checkup, the doctor and/or nurse will:

• check and record your baby's weight, length, and head circumference on a growth chart
• discuss feeding, sleeping, peeing, pooping, and development for your 4-month-old baby
• do an exam with your baby undressed, including eye exam, heart check, listening to the lungs, hip check, and watching the baby’s movements
• give vaccines to protect against serious childhood illnesses and discuss the schedule with you
• ask about postpartum depression and do a screening questionnaire

What to Expect When Your Baby Is 4 Months Old

Feeding

Breast milk or formula is still all your 4-month-old baby needs. Talk with your doctor before starting any solid foods. Most babies are ready for solid foods at about 6 months of age. Doctors often recommend starting with a small amount of iron-fortified cereal or puréed meat on an infant spoon.

Peeing & Pooping

At 4 months, babies should have several wet diapers a day and regular bowel movements. Some may poop several times a 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 is difficult to pass.

Sleeping

At this age, babies sleep about 12–16 hours a day, including naps. Most 4-month-old babies have a stretch of sleep for 5 or 6 hours at night. Some infants, especially those who are breastfed, may wake more often.

Developing

By 4 months, most babies will:

• turn their head at the sound of your voice
• make sounds like "oooo" and "aahh" (cooing), especially in response to your talking
• smile and chuckle (not yet a full laugh)
• look at you, make sounds, or move around to get your attention
• be interested in their hands
• hold a toy when placed in the hand
• hold head steady when held
• push up onto elbows while on the tummy
• use arms to bat at toys

Looking Ahead

Here are some things to keep in mind until your baby's next routine checkup at 6 months:

Feeding

• Breast milk or formula is still the only nourishment needed.
• Pay attention to signs that your baby is hungry or full.
• 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 food allergies.
  • Start with a small amount of iron-fortified, single-grain cereal, or puréed meat, mixed with breast milk.
  • Use an infant spoon — do not put cereal in your baby's bottle.
  • Do not prop bottles or put your baby to bed with a bottle.
  • If your baby is pushing a lot of food out with the tongue, they may not be ready for solids. Wait a week before trying again.
  • Wait until your baby eats cereal from the spoon before trying other solids. Introduce one new food at a time, and wait several days to watch for allergic reactions.
  • If breastfeeding, continue to give vitamin D supplements. Breastfed babies may need iron supplements until they get enough iron from the foods they eat.
  • Do not give juice until after 12 months.

Routine Care

• 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 4-month-old 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. 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 4-month-old 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.

Safety

To reduce the risk of sudden infant death syndrome (SIDS):

• always place your baby to sleep on a firm, flat mattress on their back, and not on the stomach or side
• do not use crib bumpers, blankets, quilts, pillows, or plush toys in a crib or bassinet
• 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
• avoid overheating by keeping the room temperature comfortable (Dress your baby for the room temperature, don't over bundle, and don't cover your baby's head while sleeping. Watch for signs of overheating, like sweating or feeling hot to the touch.)
• consider putting your baby to sleep sucking on a pacifier, but if your baby rejects the pacifier, don't force it; if the pacifier falls out during sleep, you don't have to replace it
• don’t let your baby fall asleep on a product that isn’t flat, firm, and specifically designed for sleeping babies. For example, products like a sitting device (such as a car seat), a feeding pillow (like the Boppy pillow), or an infant lounger (like the Dock-a-Tot or Podster) are still sold, even though they are not recommended for sleep.
• don’t use products or devices that claim to lower the risk of SIDS, such as sleep positioners (like wedges or incliners) or monitors that can detect a baby’s heart rate and breathing pattern; no known products can do this
• make sure that all sleep surfaces and products you use have been approved by the U.S. Consumer Product Safety Commission (CPSC) and meet federal safety standards

Other important safety practices include:

• Do not use an infant walker. They're dangerous and can cause serious injuries. Walkers also do not encourage walking and may hinder it.
• Keep small objects and harmful substancesout of reach of your baby who will be reaching, grasping, and moving things to their mouth. Keep your baby away from cords, wires, and toys with loops or strings.
• Other than when in a crib or bassinet, never leave your little one unattended. This is especially important on high surfaces or in the bath.
• Never shake your baby — it can cause bleeding in the brain and even death. If you are ever worried that you will hurt your baby, put your baby in the crib or bassinet for a few minutes. Call a friend, relative, or your health care provider for help.
• Always put your baby in a rear-facing car seat in the back seat. Never leave your baby alone in the car.
• Don't smoke or use e-cigarettes. Don't let anyone else smoke or vape around your baby.
• Avoid sun exposure by keeping your baby covered and in the shade. 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.

These checkup sheets are consistent with the American Academy of Pediatrics (AAP)/Bright Futures guidelines.