Pediatric Group

4 Month Well Child Visit

Vaccines:

DTaP:  (Diptheria, Tetanus, whooping cough)

HiB: Haemophilus Influezae Type B

Prevnar: Pneumonia Vaccine

Rotavirus: Prevents rotavirus diarrhea – Given by mouth

    Side effects: Some side effects include low grade fever  (100- 101 F), fussiness, excessive crying, vomiting, sleepiness & swelling at injection site.

            Ask for CDC vaccine information sheet if you need more information. 

            Give about 0.6 ml (3/4 dropper of Tylenol Infant drops) every 4 hours twice if needed.

            Feeding

·         Babies at 4 months can be started on solids / baby foods

o         Start with rice or oat cereal, then vegetables & fruits.  Meats are last at about 7 months of age

o        Give 5-7 days in between starting new foods to ensure baby does not have allergies those foods

            General care / Safety  

·         Babies tend to spit up a lot at 4 months; however this will get better by 6 months. If excessive or not gaining weight, it may need to be treated

·         You can take baby out of house to places such as church or shopping

·         Although generally not recommended at 4 months sun block lotions or bug sprays may be used if needed

·         Place baby on his back to sleep

·         Do not use soft bedding, pillows or stuffed toys in crib

            Colic

·         Babies tend to be fussy a lot and may cry for hours.

o        Try to rock baby gently, wrap up snug, take for car ride, or try placing baby in a vibrating chair.

o        If all else fails, take a break and have some one else take care of baby.

NEVER SHAKE A BABY!

DEVELOPMENTAL MILESTONES

  PHYSICAL & MOTOR SKILLS

• Weight gain slows to approximately 2/3 ounce per day

• Loses infant reflexes (Startle, fencing & rooting reflex)

• Has almost no head lag while in a sitting position

• Is able to sit up straight if propped

• Raises head 90 degrees when placed on stomach

• Is able to roll from front to back

• Tries to reach objects with hands (may miss)

• Plays with rattle when placed in the hands, but won't be able to pick it up if dropped

• Is able to grasp rattle with both hands

• Is able to place objects in mouth

SENSORY & COGNITIVE SKILLS

• Has well-established close vision

• Has beginning hand-eye coordination

• Babbles and coos

• Laughs out loud

• Anticipates feeding when able to see bottle or breast

• Begins to show memory

• Demands attention by fussing

• Recognizes parent’s voice or touch

PLAY

You can encourage development through play:

• Place the baby in front of a mirror

• Provide bright-colored toys to hold

• Repeat sounds the infant makes

• Help the infant roll over

• Use a swing or stroller

Developmental Health Watch

Although babies develop at different rates, failure to reach certain milestones may signal a problem.  If you notice any of the following warning signs in your infant, discuss them with your pediatrician.

* Head falls back when pulled to a sitting position

* Infant does not follow people with his eyes

* Moves one side of the body more than the other

* Babbles less than he used to

* Still has Moro / Startle reflex after 4 months

* Doesn't reach for and grasp toys by 3 to 4 months

* Doesn't babble by 3 to 4 months

* Doesn't bring objects to her mouth by 4 months

* Doesn't try to imitate any of your sounds by 4 months

* Doesn't push down with her legs when her feet are placed on a firm surface by 4 months

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