What to expect at your four-month visit
Here are a few things your doctor might discuss with you at the four-month visit.

• Within the next month your baby will likely be ready for solid foods.
• Now is the time to discuss and set up a regular sleeping pattern, generally with two naps during the day (for two to three hours) and sleeping six hours at night. If your baby is not already doing so, this is also the time for him or her to be falling asleep on his or her own.
• You should discuss child care options and suggestions with your doctor.
• Your baby might be able to roll from back to stomach now, so you might want to be cautious about leaving him or her unattended on a high surface, like a changing table.

• DTP series (#2)
• Hib (#2)
• Hepatitis B virus (HBV) vaccine (#2) (1-4 months)
• Polio vaccine (#2)
• Pneumococcal 7-valent (#2) (optional)

Today’s Report For Your 4-month-old

Child’s name  

Examined by Dr.  

Weight  

%

Length  

%

Head  

%

Hepatitis B

Hib (#2)

Polio vaccine

DTP series (#2)

Pneumococcal 7-valent (#2)

Feeding your baby

Is my baby ready for solid foods?
You might be getting a lot of advice regarding when you should start giving your baby solid foods. That decision is determined by your baby’s development. Signs that indicate your baby might be ready for solid food include:

• Your baby is able to hold his or her head up independently.
• Your baby no longer has the reflex to thrust out food with his or her tongue.
• Your baby can move his or her tongue back and forth, and up and down.
• Your baby reaches for and shows an interest in a spoon and cup.
• Your baby can draw in his or her lower lip so food can be taken from a spoon.

When your baby is ready for solid food, the first step is to mix a small amount of rice cereal with breast milk, formula, or water. Feed him or her with a spoon, not from the bottle (cereal in bottles has been shown to cause choking). Never force your baby to eat. If he or she turns his or her face away, stop feeding.

Gradually introduce other cereals, and strained fruits and vegetables. By introducing only one food per week, you will ensure that your baby is not allergic to specific types of foods. This also gives your baby time to adapt to new flavors and textures.

Avoid foods like hot dogs, popcorn, peanuts, grapes, apple chunks, carrots, and celery sticks, and other hard, raw fruits and vegetables. These foods can cause choking. Always watch your baby while he or she eats, and make sure you know what to do if your baby chokes.

Developmental milestones
Keep in mind that children develop at their own rates. These milestones are common to infants at this age, but it is completely normal for your child to reach some milestones quickly and others at a slower rate. Common milestones can include the following.

• Babbles and coos
• Is able to fall asleep on his or her own
• Smiles and giggles at people
• Reaches for and bats at objects
• Controls his or her head well
• Can grasp objects, such as a rattle
• Rolls from stomach to back
• Recognizes parents by their voices and their touch
• Is able to sleep for at least six hours

Selecting a babysitter
By this time, you might be ready, or it might be necessary, to spend time away from your baby. In that case, you will need to select a babysitter. Here are some important steps to remember when choosing your child’s alternate care provider:

• Ask friends and family if they know any qualified candidates. If not, place an ad in a local community or religious newspaper, making sure to be specific about what your needs are (i.e. housework, age of child, hours needed, etc.).
• Expect to pay for what you get, anywhere from $6.00 to $9.00 for a college student or mature woman.
• Check references. Be cautious of references given from friends or relatives.
• Conduct a personal interview, so you can see how the babysitter interacts with your child and you can get an overall impression.

• How do you feel about this sort of work? What do you like about babysitting
• What kind of activities will you do with my child?
• What is your method of discipline?
• How will you keep me informed about my child’s day?
• What would you do if my child becomes ill? Do you know CPR or first aid?
• What pay are you expecting?
• Do you expect to be paid if the child is sick or we are on vacation?
• Do you have a back-up sitter in the event that you would be unable to baby-sit that day?

• What do you feel is a suitable notice if you cannot baby-sit?

• Make sure smoke detectors are in good working order by testing them once a month. Change batteries every six months.
• Many states mandate the use of car seats. Make sure the car seat is properly positioned in the back seat of the car.
• A playpen is a safe place for your baby to play and learn to amuse himself.
• Walkers are unsafe at any speed and at any age. Never put your infant in a walker.
• Never leave your infant alone with siblings or pets.
• Never leave your infant alone on a bed, couch, changing table, or infant seat from which he or she can fall.
• Install guards on electrical outlets. Infants can roll across the room quickly. Use electrical tape to secure electrical cords along baseboards.
• Keep small objects, knick-knacks, and poisons out of reach or in a locked cabinet. Infants love to taste things and can easily choke or be poisoned.
• Make sure that your infant cannot pull lamps or other electrical objects on himself or herself by the cords. Secure cords on blinds and drapes to prevent accidental strangulation.
• Adjust the hot water to less than 120 degrees Fahrenheit to avoid burns.
• Inspect toys for small parts that can be pulled off and swallowed.
• Never leave your infant alone in the bath water; not even for a second. Store small appliances, such as hair dryers and radios, away from bathing areas.
• Keep a flashlight in your bedroom in case of a power outage.

Should I call the doctor?
Yes. If your baby:

• Becomes sluggish or inactive
• Will not eat
• Cries more than usual
• Develops an unusual rash (not prickly heat or diaper rash)
• Has a fever at any age 
• Vomits repeatedly (not just spitting up)
• Has frequent loose, watery bowel movements
• Has apnea spells (times when baby stops breathing)
• Breathes rapidly, wheezes, or has any difficulty breathing

Before you call your child's doctor or nurse, write down your child’s symptoms. Take his or her temperature. Have your pharmacy’s phone number on-hand to tell the doctor and notepad on hand to write down any instructions.