Your Baby's 4-Month Checkup

Checkups are a way to make sure your baby is growing properly and help you find out if there are any health problems. After the visit, make an appointment for your baby's 6-month checkup.

• Feed your baby when they show signs of hunger. Signs that your baby is hungry include smacking the lips, making sucking motions, looking around for your breast or the bottle, or crying.

• Pay attention to signs that your baby is full, such as turning away from the breast or nipple and closing the mouth.

• For breastfed babies:

  • Feed your baby whenever they're hungry, about 4–6 times in a 24-hour period.

  • Follow your health care provider's advice for giving your baby any vitamins.

  • At this age, it's OK to give your baby a bottle filled with breast milk.

• For formula-fed babies:

  • Offer your baby about 5–6 ounces (150–180 ml) of formula every 3–4 hours.

  • Always hold your baby and the bottle when feeding. Don't prop the bottle.

  • Don't give your baby low-iron formula.

  • Don't add extra water to your baby's formula.

• Most babies are ready to eat solid food at about 6 months of age. If you and your baby's health care provider decide that your baby is ready to eat solid foods sooner, start by giving your baby just one kind of food. Use a baby spoon and only give soft foods. First foods can include:

  • iron-fortified infant cereal mixed with water, breast milk, or formula until thin. Give a variety of cereals, including oat, barley, rice, and multigrain. Do not only give rice cereal.

  • puréed soft meats

  • puréed fruits or vegetables

• After a few days, try another kind of soft food. Each time your baby tries a new food, wait about 2–3 days before adding another one. This helps you see if your baby has problems with a food. Some foods can cause reactions like diarrhea, a rash, or fussiness.

• If your baby has eczema (a red, itchy rash); a food allergy; or a brother, sister, or parent with a food allergy, talk to your health care provider about the best time to give your baby foods with:

  • nuts

  • dairy (such as milk or cheese)

  • egg

  • soy

  • wheat

  • fish and shellfish

• Continue any vitamin supplements as recommended by the health care provider.

• Don't give your baby foods that can cause choking, such as hot dogs, whole grapes, raw vegetables, popcorn, or nuts.

• Don't give your baby honey or unpasteurized food or drinks.

• Don't give your baby cow's milk or soy beverages to replace breast milk or formula. (Kids shouldn't start drinking cow's milk or soy beverages until they're at least 1 year old.) It's OK to give yogurt or cheese.

• Don't add cereal to your baby's bottle unless the health care provider recommends it.

• Don't give juice before 12 months old. It can lead to tooth decay and weight gain.

• Avoid foods and drinks with added sugar or no-calorie sweeteners.

• Babies this age should get about 12–16 hours of sleep in 24 hours, including naps. At night, some babies will sleep 5 or 6 hours straight, but others (especially breastfed babies) may still wake up for feedings.

• 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):

  • Be sure your baby always sleeps on their back.

  • Put your baby in a crib or bassinet 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.

  • Give your baby a pacifier at naptime and bedtime.

  • Don't let your baby get too hot while sleeping. Keep the room at a temperature that is comfortable for a lightly clothed adult. Don't put too many clothes on your baby and watch for signs of overheating, such as sweating.

  • If your baby falls asleep in a car seat, stroller, sling, or baby carrier, move then to the crib or bassinet as soon as possible.

  • Do not allow anyone to smoke around your baby.

  • Make sure everyone who cares for your baby follows these safe sleep practices.

• Babies this age learn best by talking and playing with others and touching things in their world. So it is best to avoid screen time such as videos, video games, TV, and phone apps. Video chatting (such as FaceTime or Skype) 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.

• 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.

• Take an infant first aid/CPR class. Be sure you know what to do if your baby is choking.

• To prevent burns, set your hot water heater lower than 120°F (48°C).

• 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. Keep harmful substances out of reach.

• 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.

• To protect your baby from the sun, keep your baby in the shade and cover the skin with clothing. 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.

• If you are ever worried that you will hurt your baby, put your baby in the crib or bassinet for a few minutes and call a friend, a relative, or your health care provider for help. Never shake your baby — it can cause bleeding in the brain and even death.

• Get all immunizations and tests that your baby's health care 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.

• After feedings, clean your baby's gums with a wet, clean washcloth or soft toothbrush.

• 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.

• Your health care provider can tell you about help that is available in the community or through a social worker. Talk to your health care provider if you're worried that:

  • You don't have enough food for your baby.

  • You don't have a safe place to live.

  • You don't have health insurance.

  • You have a problem with drugs or alcohol.

• Call your health care provider if your baby:

  • has a fever above 102.2°F (39°C) (taken in your baby's bottom)

  • is not eating well

  • vomits (throws up) more than a few times in a 24-hour period

  • has hard, dry poop or trouble pooping

  • does not seem to be growing or developing normally