Your Baby's 4-Month Checkup

Today's visit was a chance to check in on your baby's growth, development, and overall health. Here's some information to help you care for your baby in the months ahead.

  • Continue giving your baby breast milk or iron-fortified formula. Do not give cow's milk or dairy-alternative drinks that are not labeled as infant formula.
  • Don't give low-iron formula or add water to your baby's formula.
  • If desired, you can pump your breast milk and give your baby a bottle filled with breast milk.
  • Give any vitamin supplements as recommended by your healthcare provider.
  • If you and your healthcare provider decide that your baby is ready for solid foods:
    • Feed your baby a little bit of soft, mushy foods with a small spoon.
    • Give one new food at a time and wait a few days before adding another to make sure your baby doesn't have a reaction to the food.
    • There's no specific order that you need to follow when beginning to feed your baby solid foods. But iron-fortified infant cereal mixed with water, breast milk, or formula, and pureed meats are good choices because they give your baby the nutrients they need.
    • You can also give pureed vegetables and fruits, whole milk yogurt (without added sugar), eggs, and soft fish (without bones). 
    • Once your baby is eating other soft or pureed foods, you can give a small amount of peanut or other nut butter thinned with water, breast milk, or formula. 
    • Don't give your baby foods that can cause choking, such as hot dogs, whole grapes, raisins, nuts, popcorn, hard candy, gum, peanut or nut butter that hasn't been thinned, raw or hard fruits and vegetables, chunks of meat, or hard cheese.
  • Don't give your baby honey or unpasteurized food or drinks. It could make them sick.
  • Don't give juice before your baby is 12 months old. It can lead to tooth decay and weight gain.

Your baby's poops may change once they start eating solid food. But as long as the poop is soft and your baby seems well, don't worry about how often your baby poops.

Sleep

  • Babies this age should get about 12–16 hours of sleep in 24 hours, including naps. Many babies still wake up for feedings during the night.
  • Put your baby in the crib when they're sleepy but not yet asleep. This helps babies learn to fall asleep on their own.
  • To help prevent SIDS (sudden infant death syndrome):
    • Always put your baby on their back for sleep.
    • Put your baby in a crib or bassinet with a firm, flat surface that meets all safety standards.
    • Never put wedges, sleep positioners, pillows, blankets, bumpers, or toys in the crib or bassinet.
    • Keep the crib or bassinet in the room where you sleep. Don't have your baby sleep in bed with you.
    • Breastfeed your baby, if possible.
    • Offer your baby a pacifier at naptime and bedtime.
    • Keep the room at a comfortable temperature. Do not overdress your baby. Watch for signs of overheating, such as sweating.
    • If your baby falls asleep in a car seat, stroller, sling, or baby carrier, move them to the crib or bassinet as soon as possible.
    • Don't let anyone smoke around your baby. Make your home and car smoke- and vapor-free. For help quitting, call 800-QUIT-NOW (800-784-8669) or visit smokefree.gov.
    • Make sure everyone who cares for your baby follows these safe sleep practices.

Development

  • Babies this age learn best by talking and playing with others and touching things in their world. It is best to avoid screen time, including videos, video games, TV, and phone apps. Video chatting (such as FaceTime or Zoom) is OK.
  • To help your baby's muscles get stronger, put your baby on their belly for “tummy time.” Do this 2–3 times a day for 3–5 minutes when your baby is awake. Build up to more tummy time as long as your baby doesn't get frustrated. Be sure an adult stays with your baby during tummy time.

Routine Care

  • Get all immunizations (vaccines) and tests that your baby's healthcare provider recommends.
  • Bathe your baby a few times a week in a sink or infant tub lined with a towel. Use warm water and fragrance-free soap. Always keep your eyes and a hand on your baby during a bath.
  • If your baby has sore gums from teething, rub the gums with one of your fingers or give your baby a firm rubber teething ring. Don't use frozen teethers or put teething medicine on your baby's gums.

Safety

  • In the car, put your baby in a rear-facing car seat in the back seat. Follow the manufacturer's instructions on installing and using the car seat or go to a child safety seat check (cert.safekids.org/get-car-seat-checked).
  • Be sure you know what to do if your baby is choking. If you haven't taken an infant first aid/CPR class, sign up for an online or in-person class at redcross.org.
  • To prevent burns, set your water heater lower than 120°F (48°C) and don't drink hot liquids while holding your baby.
  • Put smoke and carbon monoxide alarms near all sleeping areas and on every level of your home.
  • When using a changing table, keep a hand on your baby and use the safety buckle.
  • Don't use a baby walker. They can lead to serious injuries.
  • To prevent choking, keep balloons and small objects such as coins and toys away from your baby.
  • To prevent suffocation, keep plastic bags and drapery/blind cords away from your baby.
  • If there's a mobile over your baby's crib, take it down as soon as your baby starts to push to their hands and knees or when your baby turns 5 months old, whichever comes first.
  • It's best not to use sunscreen on babies younger than 6 months, but you may use a small amount if shade and clothing don't give enough protection.
  • Never shake your baby — it can cause bleeding in the baby's 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 so you can get help. See below for ways to get help.

  • Your baby:
    • Has a rectal (in the bottom) temperature of 100.4°F (38°C) or higher
    • Gets a rash, vomits, or has any reaction to a food.
    • Has hard, dry poop or trouble pooping.
    • Doesn't seem to be growing or developing normally
  • You are struggling with food, housing, healthcare costs, or substance use.

Go to the ER if...

Your baby:

  • Has a rectal (in the bottom) temperature of 100.4°F (38°C) or higher and you can’t reach your healthcare provider, or your baby isn’t feeding well or seems very ill
  • Vomits more than a few times in a 24-hour period

If you are feeling very overwhelmed, anxious, or sad, have thoughts about hurting yourself or your baby, or see or hear things that aren’t there, put your baby safely in a crib or bassinet and get help right away.

Where to get help:

  • Call Postpartum Support International at 800-944-4773 or visit postpartum.net. You can also text HELP to 800-944-4773 (English) or 971-203-7773 (Spanish).
  • Call or text 988 or visit 988lifeline.org (Suicide & Crisis Lifeline). You can also go to the nearest emergency room.
  • Text HOME to 741741 (National Crisis Text Line).
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