As a parent, you want to ensure that your child is growing and developing normally. One way to do this is through regular wellness checks with your pediatrician. The 4-month wellness check is a critical milestone in your child's development, as it marks the transition from the newborn to the infant phase. During this visit, your pediatrician will check your child's growth and development, provide vaccinations, and offer guidance on how to support your baby's health and well-being. Here's what you can expect during the 4-month well child check.

Physical Exam

Your pediatrician will perform a thorough physical exam to assess your baby's growth and development. The exam is performed with your baby undressed while you are present. This may include measuring your baby's length, weight, and head circumference to ensure that they are growing at a healthy rate. Your pediatrician will also check your baby's muscle tone, reflexes, and overall physical development. They will do an eye exam, listen to your baby's heart and check the pulse, check your baby’s hips, and observe your baby's movements. They’ll also take a look inside your baby’s mouth to see how you’re cleaning their gums and whether they’re teething. 

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Vaccinations

Your baby will likely receive second doses of several important vaccines during the 4-month-old well-child check, including rotavirus (RV); diphtheria, tetanus, whooping cough (DTap); polio (IPV); influenza type B (Hib); and pneumococcal disease (PCV). Your pediatrician will discuss the vaccines with you and answer any questions. These vaccinations protect your baby from serious illnesses so it’s essential to get them at the proper time. Immunization schedules can vary slightly from office to office, so talk to your doctor about what to expect.

Feeding and Nutrition

Your pediatrician will ask about your baby's feeding habits, including how often they are feeding and whether they are breastfeeding or formula-feeding. At this age, breast milk or formula is still all your baby needs. Most infants are ready to try solid foods at around six months, though some may be ready sooner. Your pediatrician will provide guidance on introducing solid foods and discuss any concerns you may have about your baby's nutrition. If you’re nursing, your pediatrician may inquire about whether you’re giving your baby vitamin D and iron supplements. (The American Academy of Pediatrics advises supplementing breastfed infants with 1 mg/kg/day of a liquid iron supplement until iron-containing solid foods are introduced around six months of age).

Sleep

Your pediatrician will ask about your baby's sleep habits, including how many hours they are sleeping and whether they are developing a regular sleep schedule. At 4 months old, infants sleep between 12 to 16 hours each day, including naps. Most infants have a longer stretch of sleep for 5 or 6 hours at night, though some babies, especially those who are breastfed, may wake more frequently. The doctor may ask about how your infant falls asleep and whether you give them a bottle. They will also discuss any concerns you may have about your baby's sleep.

Developmental Milestones

Your pediatrician will ask about your baby's development, including whether they are reaching important developmental milestones such as rolling over, sitting up, and babbling. Your pediatrician may also perform developmental screenings to assess your baby's motor skills, language development, and social interaction. For most 4-month-old babies, this includes the following milestones:

• pivot their head to the sound of your voice
• smile and giggle (not quite a full laugh yet)
• make noises like "ooh" and "aah" (cooing)
• make sounds back to you when you talk
• keep their head steady when held
• watch you, move, or make noises to get or keep your attention
• grasp a toy when placed in their hand
• observe their own hands with curiosity
• use their arms to bat at toys
• push up onto their elbows/forearms while on their tummy

Safety

Your pediatrician will discuss important safety considerations, such as car seat safety, safe sleeping practices, and childproofing your home. Always place your baby in a rear-facing car seat in the back seat of the vehicle. To minimize the risk of sudden infant death syndrome (SIDS), always place your baby to sleep on a firm, flat mattress on their back, and not on the stomach or side, in a crib or bassinet with no crib bumpers, blankets, quilts, pillows, or plush toys. Consider room-sharing with your baby until their first birthday, or for at least 6 months, when the risk of SIDS is highest. Keep small objects and toxic substances out of reach. Avoid any exposure to secondhand smoke or secondhand vapor from e-cigarettes, which increase the risk of heart and lung disease. Limit or avoid sun exposure by covering your infant and staying in shaded areas when possible. (Sunscreen is not advised for infants younger than 6 months.)

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The Takeaway

Overall, the 4-month wellness check is an important milestone in your baby's development. By providing vaccinations, assessing growth and development, and offering guidance on feeding, sleep, and safety, your pediatrician can help ensure that your baby is healthy and thriving. Be sure to bring any questions or concerns you may have to your pediatrician, as they are there to support you and your baby's health and well-being.

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