ALL patients are seen at our Portsmouth office on Saturday and Sunday for sick visits from 9-12 am




55 High Street
Suite 102
Hampton, NH 03842



330 Borthwick Avenue
Suite 101
Portsmouth, NH 03801

Well Child Visits

The 4 Month Visit

This is perhaps the easiest age of a baby’s life. He may be protected from many infections, has usually gotten over his colic and is happy to see people, but doesn’t demand attention.
Babies at this age enjoy being supported in an upright position and can sit with support. The head no longer lags when they’re pulled to sitting, nor does it bob so much when not supported. They tend to lie more with their head facing forward and may develop a bald spot on the back of the head. Encourage your baby to spend some time on his abdomen, on a firm surface, while supervised. Most will soon be rolling from front to back, and a few from back to front. You’ve probably noticed your baby smiles easily now, squeals, babbles, gurgles and coos in response to sound. He responds to and knows your voice, and can distinguish between people. Crying has decreased, but the baby will now protest when left alone. He is probably reaching for and grasping objects. While he may pay little attention to small objects, objects of moderate size are particularly fascinating for your baby. That’s fortunate, as everything he gets a hold of will eventually be brought to his mouth. Offer objects of different shape and texture, but nothing smaller than 2 inches in diameter to avoid choking.
Your baby will now lift his head and chest off the floor when prone, and can turn his head 90 degrees in each direction. Babies of this age may be self-entertaining. Cradle gyms with bright objects or brightly colored objects scattered about on the floor may provide considerable enjoyment. Babies are fascinated by mirrors; you might place one safely out of reach outside the crib. Continue to stimulate your baby’s language by talking to him. He continues to thrive on attention and affection.
You can encourage development by calling your child by name, telling him what you are doing, naming objects, imitating sounds such as whispering and animal sounds. Continue to expose him to different textures- touch him with silk, feathers, wool, or yarn. Play touching games, such as “this little piggy”. Allow your baby to spend time in different rooms and to look out windows. Use brightly colored sheets, blankets and clothing. Hold him in sitting position for short periods. Toys such as cradle gyms and colorful plastic keys, as well as musical or brightly colored toys, are appropriate at this age. Reading aloud to your baby should be a regular activity.

Breast milk or formula is still all that is needed. Most babies will take 24-30 ounces of formula per day at this age. If your baby does not seem satisfied with breast milk or formula alone, you may introduce solids in the next 2 months. Baby cereals have a readily. absorbed form of  iron that is important at this age. When you choose to start solids, go slowly. Begin with cereals usually best to start with rice, 1 or 2 tablespoons once or twice a day. Vegetables or fruits can be started next (at age 5 or 6 months). Start with yellow vegetables (squash, carrots). Don’t add more than 1 new food a week. Do not give citrus juices at this age. Also, avoid eggs and honey until after
12 months of age. Bowel movements may change in color and consistency when solids are offered.

Your child is probably sleeping 6 to 10 hours at night and taking 2 naps a day. This is a good time for you to be thinking in terms of a more regular schedule, especially in regard to meals and putting him down at night. Your baby should never be given a bottle in bed. The milk can cause decay of developing teeth. It will help with sleep habits later in life if he starts early in learning to soothe himself to sleep. As babies learn to roll over, they may do so at night, and then become unhappy with the position in which they find themselves. Simply put them onto their back. Babies should sleep on a firm surface without any soft or fluffy materials in the crib.

Be careful that very small or potentially harmful objects aren’t within reach of the baby. (Remember, no smaller than 2 inches in diameter!) The baby can’t be left unattended for even a second on anything he might roll off.  Babies are experts at sliding out of or knocking over infant seats at this age. Cribs should be away from the window or window cords. Car seats should be a regular part of car travel.

Common Concerns:
Walkers. It is advised that you do NOT use a walker with your baby. They are especially dangerous near stairs, as children can tumble down the entire flight of steps while in the walker, resulting in serious injuries. Walkers also interfere with the normal progression of development.
Drooling is common at this age, as saliva is produced in large quantities. It does not necessarily mean the baby is teething. However, teething may begin at this time. Teething pain can be decreased by rubbing the gum with a clean finger or ice in a washcloth. Teething rings may help.

The second set of immunizations is given today. If your baby had any problems with previous immunizations, be sure to tell us. There are no new immunizations this visit-each vaccine your child receives has been given before either at birth or at the 2-month visit.

                                                                                    adapted from John Chamberlain
                                                                                                     Rose Boynton,
                                                                                                              Barton Schmidt