4 Month Well Child Visit 

Immunizations Today:

  __    DTaP (diphtheria, tetanus, and pertussis vaccine)

  ___  IPV (injectable polio vaccine)

  ___  Prevnar (pneumococcal vaccine)

  ___  Hib (Haemophilus Influenza type B vaccine)

  ___  Rotavirus vaccine

Next Visit:    

   __ at 6 months of age

NUTRITION

¨      Continue breast or formula feeding, usually 4-6 times a day.

¨      4 to 6 months old is a good age to begin solids.  Most physicians recommend starting with rice cereal, then introducing a new fruit or vegetable once or twice a week.  Physicians may differ with one another on the timing and order of introducing the various foods, since there is little scientific evidence that one system of feeding is better than any other.

¨      Juice is not a substitute for formula or breast milk.

¨      It is not necessary to give your infant water at this age.  Do not give your infant honey until after his/her first birthday to prevent infant botulism.

SLEEP

¨      Begin to establish a regular schedule for naps (2-3 a day) and bedtime.  Work at putting your baby in the crib awake, ready to fall asleep on his/her own.

¨      Many babies can sleep all night at this age (8-10 hours).

¨      Continue back and/or side sleeping.  Continue to alternate the side your baby’s head rests to avoid flattening on one side.

HEALTHY HABITS

¨      Use an infant car seat, rear facing, until one year old.

¨      Avoid falls: Rolling off the couch or bed

                        Pitching forward out of the infant seat (belt them in)

                        Falling down the steps in a walker

¨      Exersaucers and other stationary-type seats are okay if the baby can support his/her body in an upright position.  These should be used with supervision.  Walkers are not safe.

¨   Keep small objects out of reach.  Remember that their hands go quickly to the mouth.  Ask us about first-aid for choking infant and consider taking CPR course.

¨     Avoid exposure to tobacco smoke.  Use smoke detectors, fire extinguishers and carbon monoxide testers and make sure they work properly.

¨   A small amount of sun exposure (15 minutes a day) is important for breast-fed babies (to get vitamin D). Avoid prolonged sun and bright mid-day sun if possible.

¨     Poison Control can be reached at: 275-3232 (local) and 1-800-222-1222 (national).

SUGGESTED READING

The First Three Years of Life, by Burton White

The Magic Years, by Selma Fraiberg

Caring For Your Baby and Young Child, by AAP

Infants and Mothers, by T. Berry Brazelton

Your Baby and Child, From Birth to Age Five, by P. Leach

Baby and Child Care, by B. Spock

Guide to Your Child’s Symptoms, by American Academy of Pediatrics

Sleeping Through the Night, by Jodi Mindell, Ph.D.