FOUR MONTH VISIT

FOUR MONTH VISIT

Height _________Weight ________   Head Circ ________

 FEEDING

1)    Breast or Bottle feeding: Continue Breast feeding as long as you are able. Formula is recommended until 1 year of age and then switch to whole milk. 

2)    Introduce Baby Food between 4 – 6 months of age.

It will be a learning experience for you both.  Start with a small amount of rice cereal and gradually advance to 1-2 Tablespoons 2 -3 times a day.  You can start a new food every 3 to 7 days. Once a food has been tolerated, you may continue it and blend in a few teaspoons of a new food to “blend” flavors as you introduce a new food then gradually increase the amount of this new food as your baby tolerates it.

It doesn’t really matter what order you go in for fruits and vegetables, but if your baby has hard stools, adding peaches, pears and prunes to the diet really loosens the stool. The goal is 1-3 soft stools per day with no hard lumps. 

ORAL DISCOVERY AND TEETHING:This is the age for putting everything in the mouth.  Use the “toilet paper roll” rule. Check the area around your baby for anything small enough to fit through a toilet paper roll as these would be small enough to be a choking hazard.

Formula feeding: Formulas have been researched extensively and are made to be very similar to breast milk.  Cow’s milk is much harder to digest and has too much of a salt load for young infants.  Plan to wait until after the first birthday to give your baby cow’s milk.

Adding rice cereal:  You may receive well-intended advice to add cereal to your baby’s bottle to help him sleep longer. While not harmful, this may not be the best choice.  How long your baby sleeps actually depends on the maturity of the brain and length of sleep cycles.   Think of the nutritional value of rice cereal which is made of chains of sugar molecules linked together compared to formula which has the protein, fats, and carbohydrates needed for good nutrition.

Baby food:  We will plan to introduce baby food at 4-6 months of age.  Your breast milk and formula have everything your baby needs for excellent nutrition at this age.

SLEEPING

By 3 months of age most babies are sleeping through the night (7-8 hours). Your infant may need encouragement to do this by keeping her awake longer in the afternoon and later evening.  Keep her in with the family and talk and play with her.  Increase the amount of feeding right before bedtime, so that she will not wake up early to feed.

If you have an early bird, who likes to wake up early at the crack of dawn, you may need to work at keeping her up an hour later at night and help her to eventually adjust her schedule.  If this doesn’t work, you may have little choice but to adapt to her schedule.   Try putting heavy curtains on the window. 

SIDS RISK

Always put your baby down to sleep on her back.  The “Back to Sleep” program has tremendously decreased the incidence in SIDS. Since we still don’t know what causes SIDS, we should be aware of the risks and do everything we can to avoid them.  Don’t expose your baby to cigarette smoke; avoid soft bedding and soft objects in the infant’s sleeping area. Death scene analysis stresses the hazards of adults sleeping with an infant in the same bed. Some studies have shown that risk of SIDS may be reduced by having infants sleepin the same room as adults and with using pacifiers at the timeof sleep. 

SAFETY

Choking: As soon as your baby develops control of his hands, you can expect him to put anything he happens to be holding right into his mouth. Make sure everything he holds is clean, doesn’t have sharp edges or anything that can break off, and that it is too big to fit entirely in his mouth.

Car Seats:  Motor vehicle crashes are the number one cause of death for children and adolescents ages 1 to 21. Infants should face the back of the car until 2 years of age..  Knowledge of common errors that are made in the installation of car seats may help to prevent injury in a crash: 1. Car seat not secured to vehicle seat 2. Harness and crotch straps too loose 3. Car seat is not appropriate for child’s age and size 4. Car seat facing in the wrong direction 5. Car seat placed in front seat especially with an active front passenger seat air bag 5. Improper fit of vehicle safety belt across child in belt-positioned seat.

Falls: can happen in a second with you being just a step away. Please be sure to never leave your infant on a changing table, sofa, or your bed.  Place him on a blanket on the floor or in his crib.    CIGARETTE SMOKE EXPOSURE: Maternal smoking has been associated with excessive crying in infants. Smoke exposure has been linked to Gastric Reflux Disease and SIDS – sudden infant death syndrome. 

DEVELOPMENT:

Talk to your baby while she’s reaching out for things. Cheer her on. Even at this age, she loves to know that you appreciate her efforts. When your baby babbles to you, don’t just babble back. Talk to him as though he understands every word you’re saying. Long before he utters his first real word he’ll understand hundreds of them as a result of these early conversations.

Watch your child’s development. By 3 Months your baby should be able to:

  • Suck and swallow well with feedings
  • Smile and coo in response to voices
  • Turn head in direction of sound
  • Follow moving objects with her eyes
  • Reach and start to grasp toys
  • Support her head well
  • Occasional crossing of the eyes is normal in the first few months but shouldn’t be prolonged or frequent.

 Vaccines have literally transformed the landscape of medicine over the course of the 20th century. Before vaccines, parents in the United States could expect that every year:

  • Polio would paralyze 10,000 children.
  • Rubella (German measles) would cause birth defects and mental retardation in as many as 20,000 newborns.
  • Measles would infect about 4 million children, killing 3,000.
  • Diphtheria would be one of the most common causes of death in school-aged children.
  • A bacterium called Haemophilus influenzae type b (Hib) would cause meningitis in 15,000 children, leaving many with permanent brain damage.
  • Pertussis (whooping cough) would kill thousands of infants.
  •  Vaccines have reduced and, in some cases, eliminated many diseases that killed or severely disabled people just a few generations before. For most Americans today, vaccines are a routine part of healthcare. However, the disappearance of many childhood diseases has led some parents to question whether vaccines are still necessary. Further, a growing number of parents are concerned that vaccines may actually be the cause of diseases such as autism, hyperactivity, developmental delay, attention deficit disorder, diabetes, multiple sclerosis, and sudden infant death syndrome (SIDS) among others. These concerns have caused some parents to delay vaccines or withhold them altogether from their children. Medical studies have not shown any relationship of these with vaccines. For more specific information on these concerns, visit vaccine.chop.edu.

Vaccines given: DTaP = Diphtheria, Tetanus,    Pertussis (Whooping Cough),   Hib = Hemophilus Influenza B,       IPV = Injectible Polio,  Prevnar = Pneumococcal

Acetaminophen (Tylenol) Dose:   6-11 lbs=0.4 cc    12-17 lbs=0.8 cc