Your Child at 4 to 6 Months

Your Child's Health

The Well Visit

At four months, your baby may have another well visit. Prepare for the visit by observing your baby’s habits and making notes about questions you may have. Bring supplies with you such as books or toys to entertain him, a blanket to keep him warm, and diapers and wipes to change him.

Contact your doctor if issues about your child’s health and development or illnesses arise between visits and always call your doctor if your baby is older than three months and has a temperature of 101˚ F or higher. Your baby’s next visit may be at six months.

Make sure your child’s immunizations are up-to-date. Typical immunizations at this age will include:

• DTaP or DTP
• Polio
• Hepatitis B
• Hib
• Prevnar (pneumococcal)

Nutrition

At this age, breast milk or iron-fortified formula are still the primary forms of nutrition. Although the AAP’s Committee on Breastfeeding recommends waiting to introduce solids until six months, you may begin to introduce single ingredient cereals at around four to six months. Basic strategies for starting solids are:

• Mix single ingredient solids like rice cereal with equal amounts of breast milk or formula.
• Start with one feeding of solids a day (such as single ingredient cereals). Add a second when your baby can eat two to three tablespoons per feeding.
• When your baby becomes used to spoon feedings, add single ingredient smooth or pureed foods, like carrots, peas or apples, or “stage one” baby foods in the jar. To make sure your baby is not allergic to a specific food, be sure to wait for at least two to three days before starting another new food.

Take Note… According to the American Academy of Pediatrics, at four months let your doctor know if your baby:

• Doesn’t seem to respond to loud noises.
• Doesn’t reach for and grasp toys.
• Doesn’t babble or try to imitate any of your sounds.
• Doesn’t push down with her legs when her feet are placed on a firm surface.
• Has trouble moving her eyes in all directions.
• Doesn’t pay attention to new faces, or seems very frightened by new faces or surroundings.

Your Child’s Teeth

Clean your baby’s new teeth daily by brushing with a soft child’s toothbrush and water.

Sleep

At this age, your baby should be sleeping about 15 hours per day. He may be taking either two or three daytime naps and may be waking twice per night for feedings. Although your baby is too young to have a regular sleep schedule, there are steps you can take to help him learn healthy sleep habits:

• Put him to bed between 6 and 8 pm every night.
• Start a bedtime routine that you can follow consistently, no matter where you are. Activities might include giving your baby a bath, singing a song, reading a book, and hugging good night.

Safety Tip… Although your baby can roll over on his own, you should still place your baby to sleep on his back (don’t worry if he rolls over on his own). Also, lower the mattress to its lowest level if your baby can sit up; don’t put toys, pillows and large blankets in the crib with your baby; and keep the temperature in your baby’s room comfortable for an adult.

Your Child's Growth and Development

Between four and six months, you will be able to observe amazing changes in your baby. Your child may:

Physically

• Try to grab things with her hands.
• Wiggle and kick with her arms and legs.
• Sit with support.
• Begin teething.
• Roll over from stomach to back and back to stomach.

Socially and Emotionally

• Respond to a shaking rattle and peek-a-boo games.
• Express herself by laughing when happy, or crying or turning away to show signs of fear, anger or dislike.

Intellectually

• Use eyes and hands together.
• Explore objects with her mouth.
• Use verbal and non-verbal cues to signal her needs.
• Understand that she can reach to touch objects.
• Try to talk to image of self in mirror.

Nurturing your Child

Discipline

Discipline is never appropriate for babies. Since they cannot control their actions, they should not be held accountable for them. At this age, babies simply need your attention and affection. Therefore, you should always pick up your baby when she cries, and try to read and respond to all of her needs. You cannot spoil your baby at this age. Never shake or spank your baby. Shaking can cause brain damage.

Play

Play with your baby! Early exposure to simple toys will activate your baby’s imagination and help him grow. Also, your playful loving care will help you form a strong, secure relationship with your baby. Try activities like these:

• Help your baby hug stuffed animals. Use them to touch and tickle your baby.
• Stack plastic rings and knock them down.
• Place your baby on his tummy to help strengthen his neck, torso and upper body.

Literacy

Your baby has already begun to learn language by listening to you talk, tell stories and sing songs. When she moves her mouth and makes sounds, she is trying to imitate you. Also, the first steps towards writing begin when she learns to grasp at objects. So, even at this young age, there is a lot you can do to help her skills along:

• Let her listen to songs and music with different rhythms.
• Surround your child with books by incorporating reading into your daily routines.
• Give your baby cloth or board books that have pictures with bright contrasting colors, and textures and objects to touch and feel.

Your Child's Safety

In the Bath

• To prevent burns, always check the temperature of the water before setting your baby in the water. Also, never put a baby in a tub with running water since the temperature can quickly change and burn the baby.
• Fill the bath with only two to three inches of water. Never leave your child unattended in water.

In the Car

Your baby must always ride in a car seat that is:

• Properly attached or secured, and rear-facing.
• In the backseat (ideally, in the middle of the backseat).
• For more information go to www.fitforakid.org.

Around the House

• Do not give your child toys with small parts to play with or chew. They present a choking hazard.
• Never leave your baby on a bed, couch or chair where she can roll off and fall. A baby may move faster than you would expect and get seriously hurt.
• Do not drink or carry hot liquids when holding your child or when children are nearby.
• Contact Poison Control immediately if you think your child has eaten or drunk something poisonous: 1-800-222-1222.