4-month guidance
Introduction
Your baby is now 4 months old. Most of the advice from the 2-month page still applies, but a few things have changed. I will provide all the relevant advice here so you do not need to read through the 2-month page as well, and I will emphasize what is different now that your baby is a little bit older. If you have questions about how any of this should specifically apply to your child, please check with your child's healthcare team.
Helpful websites
Sleep
Now that your baby is 4 months old their sleep pattern may change. It is common for babies to go through a 4-month "sleep regression" and you can read more about this here if it seems like your baby's sleep has taken a step backwards.
Sleep training
Between 4-6 months you can actually start "sleep training" where you help guide your baby to sleep well through the night. I have included several articles that discuss different approaches for this in the box below. If your baby is having difficulty sleeping well, read through them and discuss with your family which approach you would like to take.
Sleep training articles
Regardless of sleep training, you should still practice safe sleep. You can learn more about this below.
Safe Sleep
Please read through this article, which describes how to ensure your infant has a safe sleeping environment. Note that your baby should always sleep alone, on the back, in an empty crib (or other safe sleep device like a bassinet or pack 'n play). Once your baby starts to roll from back to front you do not need to reposition them on their back, but you should always set them down to sleep on their back. You can watch the following two videos for additional information.
Now look at the two images below. One shows a safe sleep environment, and the other shows an unsafe sleep environment. Click the buttons below the images for an explanation of the differences.
Safe sleep
Unsafe sleep
Nutrition
At 4 months your baby should still only drink breast milk or formula; it is dangerous (and unhealthy) to give water, juice, other types of milk, or to put any food in the bottle, unless guided to do so by your child's healthcare team. Breastfeeding has health benefits over formula feeding, so provide breast milk if possible, and consider giving vitamin D and iron supplementation. Otherwise, if your child has no medical conditions, provide an FDA-approved iron-fortified infant formula.
Helpful websites
Foods
If your baby is only receiving breast milk it is recommended to wait until 6 months to start introducing foods. Otherwise, if your baby has good head control and can sit upright in a seat for feeding you can start introducing small tastes of foods if your baby seems eager for them. This is a great article discussing the basics of how to begin introducing foods. I provide a lot more advice on feeding foods starting on the 6-month page.
Breastfeeding
Here are two videos that give several tips for breastfeeding effectively, both from this excellent video series:
Formula feeding
Here are two videos that provide good information about how to prepare formula bottles for your baby:
Feeding with a bottle
These two videos discuss how to practice responsive feeding with a bottle while still breastfeeding, but they also apply to people exclusively feeding with a bottle, regardless if you are providing breast milk or formula in the bottles. "Responsive feeding" means you follow your baby's feeding cues about when they are hungry and full and let them determine how much they will eat.
Peeing/pooping
Now that your baby is 4 months old they will still pee a lot but the pooping habits may change. This is especially true when you start introducing foods, and you may notice specific foods change the way the poop looks. Regardless, you only need to be concerned if:
- the poop is hard or very watery consistently
- the poop is dark black, a shade of red, or pale
- your baby has less than 6 wet diapers in 24 hours
If any of the above concerns occur, let your child's healthcare team know.
Safety
At the age of 4 months your child may start rolling a lot. Make sure they are never alone on a tall object since they may roll off. There are many other things to consider to make sure the home is safe for your child, both now and as they continue to grow. I will go through several of the primary safety concerns for infants and toddlers in the cards below, and you can read through the "Helpful Websites" for more general information.
Helpful websites
*This website is based in Australia so any discussion of laws or what is required may not apply to the United States.
Below are several different safety topics, click on each topic to learn more about them.
General
Car safety
Ingestions
Choking/CPR
Sleep
Toys
Falls
Water/Bath
Burns/Fire
Equipment
Outdoors
Home/Pets
Vaccines
The shots given at the 4-month check-up are typically the same shots that were given at the 2-month check-up. In the USA the vaccines follow the CDC schedule and at this age include:
- Hepatitis B - this protects against a virus that can infect the liver
- Rotavirus - this protects against a virus that can cause terrible diarrhea
- DTaP - this protects against:
- Diptheria (a rare illness)
- Tetanus (a disease from a bacteria that can kill people, has no cure, and can be caught by cutting yourself on certain things in the environment)
- Pertussis (a bacteria that causes whooping cough, an illness that can make babies stop breathing (and thus die) and older people cough for 100 days)
- Hib - this protects against a bacteria that can infect the brain (as well as other places in the body)
- PCV20 - this protects against bacteria that can cause pneumonia, ear infections, and other infections
- IPV - this protects against polio (a rare illness)
That may seem like a lot, but the Rotavirus is given as a liquid, and the other vaccines are usually combined into 2 or 3 shots. These have been given to millions of people and we know that they are safe and effective. If you would like more information, look through the "Helpful Websites" listed below:
Helpful websites
Common questions
Many parents have similar questions about their 4 month old babies. Feel free to look through some of the most common ones below.
FAQ
General topics
Normal things that seem troublesome
Various conditions
Conclusion
Enjoy your time with your baby! As sleep-deprived as you may be, many parents are surprised at how quickly the time flies. If you are unsure about how any of this information should be applied to your child, make sure to check with your child's healthcare team.