Educational Materials for 4 Month Well-Visit

The topics listed below are based on American Academy of Pediatrics national recommendations about the kinds of things that are important to discuss or get more information about for children your child's age.

Click on the info to get education and tips from pediatric health care experts about each topic.

How you and your family are doing:

Changes or stressors for you and your family More Info
Changes or stressors for you and your family
What is this and why is it important?

What’s happening in your life and your family can have an impact on your  child. Research has shown that children whose parents and families that are under ongoing stress are more likely to have behavioral issues and have physical symptoms such as fevers and illnesses compared to other children. If there are particular difficulties in your family – death, divorce, illness, job loss – acknowledge these and seek help. Your health care provider and your community are likely to have ideas, support and resources – but you may have to speak up to learn what’s available.

Just like adults, infants do best with happy and healthy people around them. Look for parent/baby groups, support groups, or organizations in your community where parents with common interests can meet and get to know each other. If things are not going well in your family, if you need help finding groups in your neighborhood, or if you are worried about your baby, talk with your child’s health care provided. You are not alone; many other parents have these same concerns

You can talk to your child’s health care provider about changes or stressors for you and your family.

What are common questions I can ask my health care provider?
  • Can my child really sense what’s going on in our lives right now?
  • We’d like to get out more but don’t have a good source for childcare. What are some ideas for me/us to have our own time?
  • We’ve recently experienced job loss. I wouldn’t really think our health care provider could help. Should I mention it?
Where can I find more information about this topic?

Parenting: Being supermom stressing you out? (APA)

Fatherhood and healthy behaviors for families (APA)

References

Hagan JF, Shaw JS, Duncan PM, eds. 2008. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, Third Edition. Elk Grove Village, IL: American Academy of Pediatrics.

University of Rochester Medical Center. Retrieved from http://www.urmc.rochester.edu/ April 1, 2010.

Making sure you have somewhere or someone to turn to for emotional support More Info
Making sure you have somewhere or someone to turn to for emotional support
What is this and why is it important?

Parenting is a 24/7 job! At 4 months, your child still relies on you for everything. It can be a challenge to meet the needs of your child and still have time for yourself, your partner and other family members.  Even though infants usually are lovable, most parents have moments of frustration, and even anger, with their baby. Feeling this way is common and normal. Support from family, friends and your health care provider can help you through rough times. It’s important to have someone – friend or professional – who can really listen to you. It’s also important to make time to get out, to resume friendships and the activities you were interested in before the birth of your child.

Your child’s health care provider can talk with you about how you are handling the role of being a parent and ways to balance that role, while also making sure that your own needs are met.

What are common questions I can ask my health care provider?
  • It’s amazing how much time babies take! Any shortcuts?
  • I still feel tired so much of the time. Is this normal and how can I get more rest?
  • How do I balance work and being a parent?
  • I am with the baby most of the time and feel very isolated. Is this normal?
Where can I find more information about this topic?

Healthy start, grow smart (AAP)

How Becoming Parents Can Affect Your Relationship (KidsHealth)

References

Hagan JF, Shaw JS, Duncan PM, eds. 2008. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, Third Edition. Elk Grove Village, IL: American Academy of Pediatrics.

Taking time for yourself, for your partner and your other children More Info
Taking time for yourself, for your partner and your other children
What is this and why is it important?

Everyone in a family has needs that must be met. Finding ways to juggle limited time is a challenge for all families! Just as they say on airplanes – in an emergency, put the oxygen mask on yourself first – you’ll be in a much better position to help others.  Taking care of yourself, physically and emotionally, is good for everyone. So remind yourself of your own interests and needs. And make time to act on them. If you need to, use a calendar to “schedule” a date with your partner or a friend, a fun activity with your other children, a shopping trip with a friend, etc.

If your baby has a big brother or sister, you may start to see increasing signs of rivalry at about this time. As your baby becomes older he may demand more of your attention and therefore you need to ration your time and energy so that you have enough for each child individually as well as all of them together. 

Your child’s health care provider can talk with you about strategies for taking time for yourself, your partner and your other children so that everyone feels cared for. 

What are common questions I can ask my health care provider?
  • My partner wants to go out – but we’ll both worry if our child doesn’t go to sleep for the sitter. Shouldn’t we just wait until he’s older?
  • I know my other children need me – what ideas are there to squeeze in special time with them?
  • I feel like I am the only one that consoles my child and that feels overwhelming. How do I get others to help when my child prefers me?
Where can I find more information about this topic?

Healthy start, grow smart (AAP)

How Becoming Parents Can Affect Your Relationship (KidsHealth)

References

Hagan JF, Shaw JS, Duncan PM, eds. 2008. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, Third Edition. Elk Grove Village, IL: American Academy of Pediatrics.

Balancing responsibilities with your partner More Info
Balancing responsibilities with your partner
What is this and why is it important?

Building and maintaining a strong relationship with your partner is important for both of you—and for your child. Babies learn quickly that different people provide different things in different ways. It’s not just about feeding and changing diapers! Help your partner know how important she/he is your child’s life, too. Discuss your child’s needs and what you each have to offer – divide up tasks and decide which ones you’ll do together. If you’re not sure your partner knows, share what you’ve learned about your child’s likes and dislikes and ideas about activities your child might especially enjoy.

You can talk to your child’s health care provider about your relationship with your partner and sharing childcare responsibilities.

What are common questions I can ask my health care provider?
  • I’m breastfeeding. What are good ways my partner can help with our child?
  • I’m a single parent – how can I encourage my child’s father/mother to enjoy and share in our child’s care?
  • I feel guilty about not spending any time alone with my partner. Is this normal?
Where can I find more information about this topic?

Healthy start, grow smart (AAP)

How Becoming Parents Can Affect Your Relationship (KidsHealth)

References

Hagan JF, Shaw JS, Duncan PM, eds. 2008. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, Third Edition. Elk Grove Village, IL: American Academy of Pediatrics.

Issues related to childcare, such as a nanny, daycare or babysitters More Info
Issues related to childcare, such as a nanny, daycare or babysitters
What is this and why is it important?

Childcare can mean a loving grandparent who cares for your child, a teenager who babysits for you from time to time, or a childcare center or nanny who watches your child while you are at work. It’s likely that you use a combination of the above.  Finding childcare that is best for your child and your family’s needs can be a challenge.

At this age lots of parents are back at work. No one else will provide care exactly the way you do – and that’s okay. When considering different childcare options, think about what is important to you and what your child’s needs are.  Make sure these priorities are met and that the care your child receives is loving, caring and safe.

In childcare, the ratio of babies to adults is absolutely critical – it should not be more than three babies to one adult. Equally important is the caregiver’s ability to understand and respond to each baby as individual. Be sure to check references and spend some time watching caregivers with your child to be sure their styles match what you want for your child before choosing one.  It’s a good idea to have backup plans as well—consider who you can call on if your regular caregiver is unavailable.  There are many resources for finding, screening and choosing high quality childcare for your child.  ChildCareAware has many resources for finding, screening and choosing high quality childcare for your child, learn more at their website.

You can talk to your child’s health care provider about issues related to childcare.

What are common questions I can ask my health care provider?
  • I don’t want to upset our childcare provider by asking too much. What are reasonable duties for a childcare worker?
  • Where can I go to find out how to choose a good sitter or childcare center?
  • My mother has some old-fashioned ideas about child care. How do I ask my mother to respect my childcare wishes?
  • What would happen if my child gets sick while in someone else’s care? How can I make sure my child gets medical care if I’m not there?
Where can I find more information about this topic?

Checklist: Is This the Right Place for My Child? (NACCRRA)

Making Child Care Choices Count for Your Family (AAP)

Choosing a Child Care Center (AAP)

Finding Safe Child Care (AAP)

Parent Publications (ChildCareAware/NACCRRA)

Child Care and Early Childhood Programs (MCH Library)

Choosing and Instructing a Babysitter (KidsHealth)

Childcare - The Right Person and Discipline in Childcare (KidsGrowth)

References

Hagan JF, Shaw JS, Duncan PM, eds. 2008. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, Third Edition. Elk Grove Village, IL: American Academy of Pediatrics.

How your child is growing and developing:

Behaviors to expect in the next few months More Info
Behaviors to expect in the next few months
What is this and why is it important?

Between four and seven months, your baby may undergo a dramatic change in personality. At the beginning of this period, he may seem relatively passive and preoccupied with getting enough food, sleep, and affection. But as he learns to sit up, use his hands, and move about, he’s likely to become increasingly assertive and more attentive to the world outside. The 4-month-old child is usually delighted with the world and charms those around him . He is interested in what is going on, smiles frequently and is starting to play with toys. You can see there has been a transition from infant to child.
 
Children at this age usually begin to communicate their interests and their likes and dislikes. The more subtle aspects of your baby’s personality are determined largely by his constitutional makeup or temperament. Is he rambunctious or gentle? Easygoing or easily upset? Headstrong or compliant? To a large extent, these are inborn character traits. Just as infants come in different sizes and shapes, their temperaments differ as well.

Their unique character traits include their activity levels, their persistence, and their adaptability to the world around them—and these traits will become increasingly apparent during these months. You won’t necessarily find all of their personal characteristics enjoyable all the time—especially not when your determined six-month-old is screaming in frustration as he lunges for the family cat. But in the long run, adapting to his natural personality is best for both of you. And because your baby’s temperament is real and directly affects you and the rest of the family, it’s important to understand him as completely as possible.

The shy or “sensitive” child also requires special attention, particularly if you have more boisterous children in the household who overshadow him . When a baby is quiet and undemanding, it’s easy to assume he’s content, or if he doesn’t laugh or smile a lot, you may lose interest in playing with him . But a baby like this often needs personal contact even more than other children. He may be overwhelmed easily and needs you to show him how to be assertive and become involved in the activities around him . How should you do this? Give him plenty of time to warm up to any situation, and make sure that other people approach him slowly. Let him sit on the sidelines before attempting to involve him directly with other children. Once he feels secure, gradually he’ll become more responsive to the people around him .

With the new burst of awareness in sight and sounds can affect your five or six month old baby’s readiness to accept strangers. Before this, he may have been happy as he was handed from one person to another, but this is likely to change.  This change can come as a surprise to parents, The acute phase of sensitively may only last a week or two, but the need for a steady caregiver is important.

If your child has established a bedtime pattern for falling asleep, you can expect him to continue to stretch out the amount of time he can sleep without fully waking up at night.  He will have more of an ability to self-comfort and fall back asleep.

Your child will become more and more interactive. Your child’s emerging abilities – holding his head up well, reaching, cooing, laughing – allow him to express himself . Children use their new language and communication skills. They smile and coo back and forth and enjoy babbling, starting with “ohs” and “ahs” and progressing to the sounds of P’s, M’s, B’s and D’s.  When your child babbles, talk and babble back, as if you both understand every word. These early conversations will teach him hundreds of words before he can actually speak any of them.

Place your baby in different positions—on his back, stomach and sitting with support. Each gives him a different view and a chance to move and explore in different ways. Your child might be ready to sit up and start crawling soon – make sure to start childproofing your home for an active child.  Your awareness and responsiveness to your child’s emerging skills and personality enable you to appreciate changes and meet his needs.

You can talk to your child’s health care provider about behaviors to expect in the next few months.

What are common questions I can ask my health care provider?
  • My child loves everyone. Sometimes I feel less important to him . Is this normal or doesn’t he know I am his mother?
  • My child’s personality seems to be staring to come out – what are some things to look for in understanding my child’s temperament?
Where can I find more information about this topic?

The Magic of Everyday Moments: 4-6 Months (Zero to Three)

Healthy start, grow smart (AAP)

References

Hagan JF, Shaw JS, Duncan PM, eds. 2008. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, Third Edition. Elk Grove Village, IL: American Academy of Pediatrics.

Healthy Minds: Nurturing Your Child’s Development from 2 to 6 Months. Retrieved 4/1/2010 from http://www.zerotothree.org/site/DocServer/2-6months.pdf?docID=325.

Establishing consistent daily routines and their impact on behavior and sleep More Info
Establishing consistent daily routines and their impact on behavior and sleep
What is this and why is it important?

By now, your child (and your family) has probably settled into predictable daily routines for eating, sleeping, napping and play time. If not, now is a great time to start! Consistent daily routines have been shown to have a positive impact on a child’s sleep and overall behavior. Continuing to provide regular structure and routines for your child will increase his sense of security.

Many parents want their child to be “sleeping through the night” at this age but most 4-month-old children continue to wake at night for feeding.  Stretches of 5 to 6 hours of sleep are typical. An established daily routine for feedings and naps and a bedtime routine will help establish eventual longer sleeping stretches at night. Knowing these routines and how your baby responds can also help you identify when something is wrong —an illness or injury, for example. It is also important to help your baby learn to put himself to sleep by placing him in his crib when he is drowsy, talking gently to him , and even patting him to sleep.

If you’re not sure about your child’s routines or how to establish them, your health care provider can help you learn your child’s cues and can suggest ways you can help your child settle into routines.  You can talk to your child’s health care provider about strategies for establishing and keeping a consistent daily routine.

What are common questions I can ask my health care provider?
  • Why is a consistent daily routine important?
  • Is it better to have a regular routine or to follow my child’s lead with sleeping and eating?
  • How long before bedtime should I feed my child – so he’ll sleep longest?
  • I’d like to have my child up and active in the evening when we’re both home from work – is that ok?
  • Is it time to move my child into his own room?
Where can I find more information about this topic?

Healthy start, grow smart (AAP)

Emotional and Social Development: 4 to 7 Months (AAP)

How Active is Your Baby? (AAP)

Getting Your Baby to Sleep (AAP)

References

Hagan JF, Shaw JS, Duncan PM, eds. 2008. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, Third Edition. Elk Grove Village, IL: American Academy of Pediatrics.

Night waking and fussing More Info
Night waking and fussing
What is this and why is it important?

No matter how much you love your child, night wakings are a test of your patience and energy and is one of the most common issues families bring up at their child’s well-visit.

At this age many babies have long stretches when they sleep 5 – 6 hours; but some do not and sleep patterns can be hard to predict. Just when they start to settle down to a better sleep pattern, things like awareness of sounds around them, teething and over activity during the day can change their sleep/wake patterns.

As your baby sleeps for longer periods of time, then he will cycle between “quiet” (or non REM sleep) and “active” (or REM sleep), coming up to the REM state roughly every ninety minutes. That means that every three to four hours your baby can come into a more active state that is closer to waking. Four-month-olds have different ways of dealing with night waking. Some infants can easily go back to sleep while others need more help. 

When your baby wakes up more than once a night, there may be something disturbing his sleep. Perhaps other noises in the room are awakening him? If he is still in a bassinet, it may be too small for him . Still another problem may be a room that’s too dark. He needs enough light to reassure himself that he’s in familiar surroundings. A simple solution of a night-light might solve this problem.

Approaching this time with few expectations of a full night’s sleep will help. In the meantime, here are some tips for preventing and dealing with night waking and fussing:

  • Keep a consistent daily routine and do quiet activities to lead up to bedtime.
  • Put him to sleep when he is drowsy but still awake so he can learn to fall asleep on his own.
  • Wait just a few minutes before responding if he is fussing to see if he will go back to sleep on his own, but don’t let him cry for a long time at this age – he is learning to trust that you’re there for him . If he continues to cry, check on him , but don't turn on the light, play quietly with him , or pick him up. If he gets frantic or is unable to settle himself , consider what else might be bothering him . He may be hungry, wet or soiled, feverish, or otherwise not feeling well. As tempting as it may be to calm him down with food or cuddling, he’ll learn and come to expect these responses when he wakes up and night and he won’t go back to sleep without them.
  • Also, don’t feed your child unless you have a reason to believe he’s really hungry (e.g,. if he fell asleep earlier than usual and missed a feeding). If your baby is already feeding at night, gradually decrease the amount (or time at breast) until the feeding can be discontinued.
  • Limit each daytime nap to no longer than 3 hours a day.

You can talk to your child’s health care provider about night waking and fussing and strategies for dealing with it.

What are common questions I can ask my health care provider?
  • What’s the best way to handle things when my child wakes or fusses during the night?
  • When will his night waking stop so I can sleep 6-8 hours without getting up?
  • When my child wakes up at night is it okay to let him “cry it out”?
  • Does night waking mean my child needs more to eat?
Where can I find more information about this topic?

Good Night, Sleep Tight (AAP)

Sleep and Your 4- to 7-Month-Old (KidsHealth)

References

American Academy of Pediatrics (AAP). Getting Your Baby to Sleep. Retrieved 4/1/2010 from http://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/Getting-Your-Baby-to-Sleep.aspx

Hagan JF, Shaw JS, Duncan PM, eds. 2008. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, Third Edition. Elk Grove Village, IL: American Academy of Pediatrics.

“Back-to-sleep” and crib safety - avoiding soft toys and bedding More Info
“Back-to-sleep” and crib safety - avoiding soft toys and bedding
What is this and why is it important?

Your child’s sleep environment needs to be safe to prevent suffocation. Research studies show that the safest sleep position for infants is on their backs. The “back to sleep” campaign has been linked to fewer infant deaths from Sudden Infant Death Syndrome (SIDS) – overall SIDS rates have declined by 50% since this campaign started. 

Cribs and playpens should meet current safety standards (a checklist of standards in the resources listed below). Be especially sure to check if you’re using older equipment – standards have changed.  While soft toys and bedding, including bumpers, seem cozy, they increase the risk for suffocation for babies and are not recommended by experts.

Parents and caregivers often worry about the baby developing a flat spot on the back of the head because of sleeping on the back. Though it is possible for a baby to develop a flat spot, it usually rounds out as they grow older and sit up. There are ways to reduce the risk of the baby developing a flat spot:

  1. Alternate which end of the crib you place your child’s feet. This will cause him to naturally turn toward light or objects in different positions, which will lessen the pressure on one particular spot on his head.
  2. When your child is awake, vary his position. Limit time spent in freestanding swings, bouncy chairs, and car seats. These items all put added pressure on the back of your baby’s head.
  3. Spend time holding your baby in your arms as well as watching him play on the floor, both on his tummy and on his back.
  4. A breastfed child would normally change breasts during feeding; if the baby is bottle fed, switch the side that he feeds on during feeding.

You can talk to your child’s health care provider about sleep and crib safety.

What are common questions I can ask my health care provider?
  • Grandma isn’t sure “back to sleep” is necessary at this age – should I try to convince her?
  • At what age can I safely let him sleep on his tummy?
  • My child’s head looks flat on the back – what can be done about that?
  • What do I do if my child rolls over onto his tummy while he’s sleeping?
  • What do I do if my child will NOT sleep on his back but will if I put him on his stomach?
  • At child care my child sleeps in a playpen – what are the safety requirements for playpens?
  • Are bumpers ok to have in the crib? If not, why do most children’s stores sell them?
Where can I find more information about this topic?

Choosing a Crib (AAP)

Reducing the risk of SIDS (BabyCenter)

Safe Sleep for Your Baby: Reduce the Risk of Sudden Infant Death Syndrome (SIDS) (NICHD)

Preventing injuries: at home, at play, and on the way (SafeKidsUSA)

Baby Safety Basics (SafeKidsUSA)

References

American Academy of Pediatrics (AAP). Back to Sleep, Tummy to Play. Retrieved 4/1/2010 from http://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/Back-to-Sleep-Tummy-to-Play.aspx

Hagan JF, Shaw JS, Duncan PM, eds. 2008. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, Third Edition. Elk Grove Village, IL: American Academy of Pediatrics.

National Institute of Child Health and Human Development (NICHD). Back to Sleep Public Education Campaign. Retrieved 4/1/2010 fromhttp://www.nichd.nih.gov/sids/

Playtime for your baby, including “tummy time” and reading More Info
Playtime for your baby, including “tummy time” and reading
What is this and why is it important?

At 4 months, your child is discovering the world! Newly emerging skills mean that your child can begin to “act” on new interests – stretching and reaching and beginning to sit up. It is important to provide time to play and explore the world safely.

Playtime is key learning time for your child. “Tummy time” helps build strong neck muscles that will be important as your child begins to crawl and walk. Also, varying your child’s location and the sights, sounds, people and toys he has access to helps develop new interests and skills and allows him to build on ones he already has. Allowing your child this time helps your baby to learn how to entertain himself for short periods of time, on the floor or in the playpen. Avoid toys with sharp edges or small parts that can be swallowed. Jumpers and exersaucers are fine, but not for more than 30 minutes a day. You can actually hinder development by overuse. Walkers are not recommended. It is better to let your baby wiggle and learn to crawl and explore.

However, you are his most important playmate – singing, playing games, reading, naming objects - all of these are important for physical and intellectual development and for emotional wellbeing. Reading books to young children is a great way to help them learn vocabulary and language patterns – even before they truly understand all the words and concepts.  Other activities that you and your baby can do together.  1 - Try teaching him peekaboo and patty-cake (they can be stimulating for your baby and will help him develop motor skills).  2- Put him in the stroller and take him for a walk. It’s a good way to expose your child to the world around him , and its great exercise for you.

You can ask your child’s health care provider about playtime that is appropriate for your child at this age.

What are common questions I can ask my health care provider?
  • What kind of play is important for babies at this age?
  • What are good ideas for quiet play? Active play?
  • Why should I read to my 4-month-old if he can’t understand it?
Where can I find more information about this topic?

Healthy start, grow smart (AAP)

The Magic of Everyday Moments: 4-6 Months (Zero to Three)

Healthy Minds: Nurturing Your Child’s Development from 2 to 6 Months (Zero to Three)

Baby Safety Basics: Play Time Basics (Page 4 ) (SafeKidsUSA)

References

Hagan JF, Shaw JS, Duncan PM, eds. 2008. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, Third Edition. Elk Grove Village, IL: American Academy of Pediatrics.

Television – why the experts say no TV More Info
Television – why the experts say no TV
What is this and why is it important?

National recommendations discourage TV, DVD and video watching for children under the age of two.  No study has shown benefits to viewing and several have found that early TV viewing is associated with delayed language and shorter attention spans. Do your best to avoid letting your child watch TV or videos. If others in your household are watching, try to move your toddler to another room or distract him with toys or games.  You can also restrict TV time for others to when your toddler is napping or in bed for the evening.

You can talk to your child’s health care provider about why the experts say no TV watching for your child.

What are common questions I can ask my health care provider?
  • My child seems to like those videos geared for babies. Is this alright? And how much time should we let him watch?
  • My baby is often in the room when my older kids watch tv – is this ok?
Where can I find more information about this topic?

Where We Stand: TV Viewing Time (AAP)

How TV Affects Your Child (KidsHealth)

Treat TV as Guest, Not Resident (KidsGrowth)

References

Hagan JF, Shaw JS, Duncan PM, eds. 2008. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, Third Edition. Elk Grove Village, IL: American Academy of Pediatrics.

How your baby communicates his needs More Info
How your baby communicates his needs
What is this and why is it important?

Your 4-month-old has a definite personality! Figuring out his moods, what makes him happy, what makes him mad and the best ways to soothe him when he’s crying are very important.  Respecting your child’s likes and dislikes help him learn that he is important as an individual.

Your child is beginning to learn that when he does something, something else predictable happens (e.g. he cries and you come to him or he says “mum-mum-mum-mum” or “da-da-da-da” and mom or dad respond in delight).  At about four months, he’ll start to babble, using many of the rhythms and characteristics of his native language. Although it may sound like gibberish, if you listen closely, you’ll hear him raise and drop his voice as if he were making a statement or asking a question. Encourage him by talking to him throughout the day. When he says a recognizable syllable, repeat it back to him and then say some simple words that contain that sound.

For example, if his sound of the day is “bah,” introduce him to “bottle,” “box,” “bonnet,” and “Baa, Baa, Black Sheep.” So introduce him to simple syllables and words such as “baby,” “cat,” “dog,” “go,” “hot,” “cold,” and “walk,” as well as “Mama” and “Dada.” Although it may be as much as a year or more before you can interpret any of his babbling, your baby can understand many of your words well before his first birthday.

At this age, it is too early to worry about “spoiling” your child by too much holding, cuddling, rocking or singing.  Learning to read and understand your child’s cues and figuring out strategies to address his needs is an important parental role.  Over the next couple of months, you will need to strike the balance between automatically responding to your child’s cries and signals versus when it’s important for your child’s learning to give him a chance to manage on his own with a more minimal response from you.

You can talk with child’s health care provider about tips for understanding your child’s behavior and temperament and ways to read your child’s verbal and non-verbal cues. Your health care provider can also share ideas about how to help your child relax and to soothe or console him .

What are common questions I can ask my health care provider?
  • Can my child understand any words yet?
  • Our child loves to play with us – we love it too. But how can we help him begin to enjoy a few activities on his own?
  • When our child is fussy, what can we do to help him quiet down?
  • I am worried that if I always pick my child up when he is crying that I am spoiling him and that he will never learn to calm himself down without me picking him up. Can I spoil my child?
Where can I find more information about this topic?

Language Development: 4 to 7 Months (AAP)

Healthy Minds: Nurturing Your Child’s Development from 2 to 6 Months (Zero to Three)

Healthy start, grow smart (AAP)

Good Communication (PBS)

Reading Your Baby's Cues (PBS)

References

American Academy of Pediatrics (AAP). Language Development: 4 to 7 Months. Retrieved from http://www.healthychildren.org/English/ages-stages/baby/pages/Language-Development-4-to-7-Months.aspx

Brazelton, Terry and Sparrow, Joshua. Touchpoints: Birth to Three, 2nd Edition. Massachusetts: Da Capo Press, 2006.

Hagan JF, Shaw JS, Duncan PM, eds. 2008. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, Third Edition. Elk Grove Village, IL: American Academy of Pediatrics.

Your baby’s moods and emotions More Info
Your baby’s moods and emotions
What is this and why is it important?

As you’ve probably discovered already, some infants at this age are “easy,” calm and predictable, while others are much more difficult or are shy and sensitive.  You’re probably also beginning to know what your child likes and what he doesn’t, “what works” and “what doesn’t.” 

Over the next few months, your child may undergo a dramatic change in personality. Currently, he may seem relatively passive and preoccupied with getting enough food, sleep and affection. But as he learns to sit up, use his hands, and move about, he’s likely to become increasingly assertive and more attentive to the world outside. He’ll be eager to reach out and touch everything he sees, and if he can’t manage on his own, he’ll demand your help by yelling, banging or dropping the nearest object at hand. Once you’ve come to his rescue, he’ll probably forget what he was doing and concentrate on you—smiling, laughing, babbling and imitating you for several minutes at a stretch. While he’ll quickly get bored with even the most engaging toy, he’ll never tire of your attention.

This new burst of awareness in sight and sounds can affect your five or six month old baby’s readiness to accept strangers. Before, he may have been happy as he was handed from one person to another, but this is likely to change.  This change can come as a surprise to parents, The acute phase of sensitively may only last a week or two, but the need for a steady caregiver is important.

To be understood by others is a lifelong need and desire. Understanding your child’s personality and being responsive to his moods and needs is important. Whether your child is easygoing or temperamental, it is more important to accommodate your child’s personality rather than to try to change it. 

You cannot "spoil" a baby at this age. They simply have needs and expect someone to satisfy them. You also need to consider your needs and strike a balance. If your baby seems to need to be picked up too often, pick him up briefly and put him down next to you, giving frequent social contact, rather than continuously holding him .

You can talk to your child’s health care provider about his moods and emotions or if you are feeling sad or unhappy.

What are common questions I can ask my health care provider?
  • It seems funny to think of a child having moods! Does my child have moods?
  • Are babies’ personalities “set” this early?
  • If a child seems shy and easily startled, will he always be this way?
Where can I find more information about this topic?

Emotional and Social Development: 4 to 7 Months (AAP)

Healthy start, grow smart (AAP)

Social-Emotional Development: Birth to 12 Months (Zero to Three)

References

American Academy of Pediatrics (AAP) Healthy Children. Emotional and Social Development: 4 to 7 Months. Retrieved 4/1/2010 fromhttp://www.healthychildren.org/English/ages-stages/baby/pages/Emotional-and-Social-Development-4-7-Months.aspx

Hagan JF, Shaw JS, Duncan PM, eds. 2008. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, Third Edition. Elk Grove Village, IL: American Academy of Pediatrics.

Tips for calming and relaxing your baby More Info
Tips for calming and relaxing your baby
What is this and why is it important?

All babies have fussy times. That’s a given!  As you’ve probably discovered already, some infants at this age are “easy,” calm and predictable, while others are much more difficult. Strong-willed and easily-excitable babies require an extra dose of patience and gentle guidance. They often don’t adapt to changing surroundings as easily as calmer babies, and will become increasingly upset if pushed to move or perform before they’re ready. To a large degree, you’ll fare better by accommodating your child’s temperament, not by trying to change it. You can reduce the stresses of parenting an infant by recognizing and acknowledging his temperament rather than resisting or working against it.

Language and cuddling sometimes will do wonders to calm the nerves of an irritable child. Distracting him or changing his surroundings can help refocus his energy. For instance, if he screams because you won’t retrieve the toy he dropped for the tenth time, move him to the floor so he can reach the toy herself.

Here are some basic tips for calming and relaxing your child:

  • Hold him !
  • Turn on a calming sound (such as a white noise device, the humming sound of a fan or the recording of a heartbeat)
  • Walk around with your child in a carrier or holding him
  • Avoid overfeeding
  • If it is not yet time to feed your child, offer the pacifier
  • If food sensitivity is the cause of discomfort, a change in diet may help.
  • Keep a diary of when your baby is awake, asleep, eating and crying so you can identify patterns and red flags.
  • Limit each daytime nap to no longer than 3 hours a day

And remember, if you ever think you might do something in frustration that would hurt the child, discuss this ahead of time with your health care provider. And have numbers nearby to call for help.

You can talk to your child’s health care provider about tips for calming and relaxing your child and how to understand strategies that fit your child’s temperament.

What are common questions I can ask my health care provider?
  • How much fussiness is too much – when should I think there is really something wrong?
  • What number(s) could I call for help if I’m really frustrated?
Where can I find more information about this topic?

Healthy start, grow smart (AAP)

Calming A Fussy Baby (AAP)

Calm Parents . . . Calm Baby (KidsGrowth)

References

American Academy of Pediatrics (AAP). Healthy Children. http://www.healthychildren.org/English/Pages/default.aspx

Hagan JF, Shaw JS, Duncan PM, eds. 2008. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, Third Edition. Elk Grove Village, IL: American Academy of Pediatrics.

How your child is eating and growing:

Your child's growth and weight gain More Info
Your child's growth and weight gain
What is this and why is it important?

Between four and seven months, your baby will continue to gain approximately 1 to 1-1/4 pounds a month. By the time he reaches his eight month birthday, he probably will weigh about two and a half times what he did at birth. His bones also will continue to grow at a rapid rate. As a result, during these months his length will increase by about 2 inches (5 cm) and his head circumference by about 1 inch (2.5 cm).

Your child’s specific weight and height are not as important as his rate of growth. Your child’s health care provider will continue to take his measurements at each visit and will track them on standardized growth charts.   At your child’s well-visit, his health care provider will plot length and weight on the growth chart. They will be checking to see if your child’s weight and growth are consistent and on track.  They are making sure that your child keeps growing at the same rate. If you find that he’s beginning to follow a different curve or gaining weight or height unusually slowly, discuss it with your pediatrician. Healthy babies are often naturally “chubby” at this age and this normal gain in fat mass gives your child energy reserves when he is ill.

Healthy eating is important for growing bodies and sets the stage for lifelong healthy weight and nutrition.  At this age, 8 to 12 feedings in 24 hours is typical.  However, your child’s feeding patterns might change from day-to-day due to growth spurts or appetite changes. As a result your child’s feedings might change from more frequent to less frequent.  You can learn more about how much and what to feed your child in the “Introduction to solid food”, “Guidance on breastfeeding” or “Guidance on formula feeding ” topics in this section.

You can talk to your child’s health care provider about his growth and weight gain.

What are common questions I can ask my health care provider?
  • What is the meaning of the growth chart? What are you looking for when you plot my child’s height and weight on the chart?
  • Length, weight, and head measurement – is my child where he should be on the growth charts?
  • Does my child’s birth weight affect how you interpret his weight gain?
  • What’s the right amount of weight for my child to gain?
  • Should I worry that my child is too chubby? Too thin?
Where can I find more information about this topic?

How Often and How Much Should Your Baby Eat? (AAP)

Tracking Your Baby's Weight and Measurements (AAP)

Growth Charts (KidsHealth)

Growth and Your 4- to 7-Month-Old (KidsHealth)

References

Hagan JF, Shaw JS, Duncan PM, eds. 2008. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, Third Edition. Elk Grove Village, IL: American Academy of Pediatrics.

Introduction of solid foods More Info
Introduction of solid foods
What is this and why is it important?

There are different opinions about when to start solid foods, but most children are ready between 4 and 6 months. The American Academy of Pediatrics recommends exclusively breastfeeding for a minimum of four months, but preferably for six months, and then gradually adding solid foods while continuing breastfeeding until at least the baby’s first birthday.  The same recommendations apply to children who drink formula.

It is important to wait to begin solid foods until your child is developmentally ready. Be sure to talk with your child’s health care provider about the issues to consider when starting solid foods and which ones your child should eat first. Generally, your child is developmentally ready when he can sit by himself , opens his mouth for the spoon can use his tongue to help move and swallow the food and his thrust reflex (pushing food out of his mouth with his tongue) is starting to decrease.

You may think that when your baby puts his hands in his mouth for chewing and sucking it means he is always hungry and is ready for solid foods.  However, this is just a way he has learned to calm himself .  
When starting solids, begin with easy to digest foods such as baby cereal or soft or pureed fruits and vegetables.   Look for infant cereals that are fortified with iron, which can provide about 30% to 45% of your infant’s daily iron needs. About midway through the first year, his natural stores of iron will have become used up, so extra iron is a good idea.

For your child, the first weeks of solids are a time to learn the new skills involved in eating solid foods. Breast milk or formula continues to provide the most important nutrition - solids should be given in addition to, not instead of, breast milk or formula. In the beginning, feed your infant small serving sizes—even just 1 to 2 small spoonfuls to start.

Foods to avoid that may cause allergies are peanuts and nuts from trees, fish and shellfish.  Although he may be eating more, introduce only one new food every 4 to 7 days so that if your baby has a reaction, you can identify which food caused it. If a rash, vomiting or diarrhea occur, stop the new food and wait at least a month before trying it again. Do not offer mixed foods until you have tried each of the ingredients separately. Babies often act as though they do not like new foods and may spit them out. This is their reaction to new textures and/or tastes. Don’t give up. Try the same food again in a few days. Eating solid foods does not usually mean an infant will sleep through the night.

Be sure to talk with your child’s health care provider about the issues to consider when starting solid foods, which foods your child should eat first and when and how to introduce them.

What are common questions I can ask my health care provider?
  • When should we begin solid foods?
  • Why do some books say you can start at 4 months and other say to start at 6 months?
  • Will my child sleep through the night if he’s more full?
  • How will I know if my child is ready for solids?
  • What are the best foods to begin with?
  • What foods are babies most likely to be allergic to?
Where can I find more information about this topic?

Healthy start, grow smart (AAP)

Getting Started with Solid Foods (AAP)

Feeding Solid Foods (The Children's Clinic)

References

American Academy of Pediatrics (AAP). Getting Started With Solid Foods.. Retrieved 4/1/2010 from http://www.healthychildren.org/English/ages-stages/baby/feeding-nutrition/pages/Getting-Started-with-Solid-Foods.aspx

AAP. Where We Stand: Breastfeeding. Retrieved 4/1/2010 from http://www.healthychildren.org/English/ages-stages/baby/breastfeeding/Pages/Where-We-Stand-Breastfeeding.aspx

Hagan JF, Shaw JS, Duncan PM, eds. 2008. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, Third Edition. Elk Grove Village, IL: American Academy of Pediatrics.

Vitamins your baby may or should take More Info
Vitamins your baby may or should take
What is this and why is it important?

Not getting needed vitamins can negatively affect a child’s growth and development.  Supplementing your child’s diet depends on whether your child is breastfed or formula fed, whether he's full-term and healthy and if he gets any sunshine. If your child was born prematurely or has any health problems, consult his health care provider about the need for special vitamin supplementation. As your child gets older, his intake of solid foods will help determine his need for a multivitamin-mineral supplement.

Children need to be protected from too much sun which does skin damage, but it also means they get less Vitamin D from the sun. Vitamin D is important in preventing rickets which leads to softening and weakening of the bones. The AAP recommends children have 400 IU of Vitamin D per day.  Iron-fortified formula already contains Vitamin D, but for babies who are breastfed, Vitamin D drops are recommended.  Be sure to talk to your child’s health care provider before starting these.

If you breastfeed, don't forget that your diet affects the quality of your breast milk. It is important to eat a balanced diet for adequate nutrition. Be sure to take a multivitamin-mineral supplement while you're breastfeeding. And if you're vegan and breastfeeding, it's important to have a reliable source of vitamin B12 — preferably from a supplement — so that your child's diet will also contain adequate amounts of the vitamin which is critical for development of your baby’s  nervous system and  for prevention of anemia.

While formula-fed infants receive Vitamin D supplementation from the formula, research has shown that the amount consumed may not be adequate to meet the 2008 AAP recommendation of 400 IU per day.  Check the label of your formula to see if you need to give a Vitamin D supplement to your 4-month-old.  Be sure to talk with your child’s health care provider first.

You can talk to your child’s health care provider about vitamins you and your child may or should take.

What are common questions I can ask my health care provider?
  • Isn’t my child getting everything needed from breast milk or formula?
  • If I take vitamins won’t that be enough while I am breastfeeding?
  • Should my child be out in the sun more to get Vitamin D?
  • I am not giving solids yet but would that help my child get enough vitamins?
Where can I find more information about this topic?

Vitamin & Iron Supplements (AAP)

Vitamin D Deficiency (AAP)

References

American Academy of Pediatrics (AAP). Vitamin D Supplementation for Infants. Retrieved 4/1/2010 from http://www.healthychildren.org/English/News/pages/Vitamin-D-Supplementation-for-Infants.aspx?nfstatus=401&nftoken=00000000-0000-0000-0000-000000000000&nfstatusdescription=ERROR%3a+No+local+token

Hagan JF, Shaw JS, Duncan PM, eds. 2008. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, Third Edition. Elk Grove Village, IL: American Academy of Pediatrics.

Swinney, B. Should I give my baby vitamin supplements? Retrieved 4/1/2010 from http://www.childcenter.com/404_should-i-give-my-child-vitamin-supplements_9154.bc

Guidance on breastfeeding More Info
Guidance on breastfeeding
What is this and why is it important?

At 4 months, breast milk is still the ideal way to meet your child’s nutritional needs. Your child’s health care provider can talk with you about any issues you are having with breastfeeding and any supplements, vitamins or herbs you may consider.

At this age, 8 to 12 feedings in 24 hours is typical.  However, your child’s feeding patterns might change from day-to-day due to growth spurts and appetite changes. As a result your child’s feedings might fluctuate from more frequent to less frequent. Over the next two months, you will likely begin to see your child mature and can expect that he will soon be ready to begin learning how to eat solid food. Read the “Introduction to solid food” topic within this section to learn more about complementary foods.

You might begin to experience issues with breastfeeding around this time.  As your child’s brain develops, a spurt in his awareness of his surroundings occur around 4 ½ to 5 months and this will likely interfere with smooth feedings. He will begin noticing everything around him – shadows on the wall, a light through the window, everything except the breast or bottle. Because of this development, some breastfeeding moms think their baby is “ready to wean” but it just means that your baby is more aware of his surroundings which is a normal and exciting stage of development.  You can try to cut down on the distractions during feeding by dimming the lights and providing a calm atmosphere.  If you continue to have issues, keep a lactation specialist’s contact information handy and get their help.

If you are soon returning to work you may be thinking about changing feeding choices or your patterns of feeding. Once you have learned how to express your breast milk, you will want to teach your baby to drink it from a bottle.  Be sure to store breast milk in clean containers. Try to use screw-cap bottles, hard plastic cups with tight caps or special heavy nursing bags that can be used to feed your child. Make sure to keep it stored in a refrigerator. Freeze the breast milk if you do not plan to use it within 24 hours.  Frozen breast milk is good for at least one month.  You can learn more at the links below as well as by asking your child’s health care provider for written guidelines.

You can talk to your child’s health care provider about breastfeeding and bottle feeding your child.

What are common questions I can ask my health care provider?
  • How can I tell if my child is getting enough milk?
  • How many times a day should my child be eating?
  • What are the advantages/disadvantages of switching from breast to bottle feeding at this age?
  • Is it ok to breastfeed and bottle feed?
  • What supplements – vitamins, iron, herbs – should we consider along with breast milk?
  • What’s the best way to store breast milk for daily use or when we’re traveling?
Where can I find more information about this topic?

Breastfeeding (AAP)

An Easy Guide to Breast Feeding (U.S. Dept. of Health and Human Services)

Feeding Your Newborn (KidsHealth)

References

Brazelton, Terry and Sparrow, Joshua. Touchpoints: Birth to Three, 2nd Edition. Massachusetts: Da Capo Press, 2006.

Hagan JF, Shaw JS, Duncan PM, eds. 2008. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, Third Edition. Elk Grove Village, IL: American Academy of Pediatrics.

Guidance on formula feeding More Info
Guidance on formula feeding
What is this and why is it important?

At 4 months, iron-fortified formula still provides all the nutrition your child needs.  Generally babies need to be fed 8 – 12 times in a 24-hour period. This is about 30 to 32 oz per day, but anywhere between 26 to 36 oz is normal. You child will clearly show you when he is hungry or full and it is not unusual for him to want different amounts of formula at different times of the day.  Holding your baby during feeding also helps you understand the meaning of his behaviors and will reduce fussiness.  It will even help him learn as he watches you and listens to your voice.

You might begin to experience issues with feeding around this time.  As your child’s brain develops, a spurt in his awareness of his surroundings occur around 4 ½ to 5 months and this will likely interfere with smooth feedings. He will begin noticing everything around him – shadows on the wall, a light through the window, everything except the breast or bottle. This development should be seen as normal and exciting.  You can try to cut down these distractions during feeding by dimming the lights and providing a calm atmosphere.

It is important to hold your baby for all bottle-feedings to reduce the risks of choking and to ensure that your baby gets enough of the formula.  To reduce the risk of developing cavities, do not prop the bottle in his mouth.   It also deprives you of the closeness and interaction you get with your child when you hold him to feed him – feeding your child builds and strengthens the emotional bonds you have and is “quality time” for the two of you.

While formula (or breast milk) is all your child needs right now, as he grows and develops, his body systems are maturing and he will soon be ready to begin learning how to eat solid food.

You can talk to your child’s health care provider about formula feeding.

What are common questions I can ask my health care provider?
  • How can I tell if my child is getting enough formula when he still spits up often?
  • Should we be offering water in bottles too?
  • How many times a day should my child be eating?
  • What supplements – vitamins, iron, herbs – should we consider?
Where can I find more information about this topic?

Choosing a Formula (AAP)

Amount and Schedule of Formula Feedings (AAP)

Feeding Your Newborn (KidsHealth)

Infant Formula Feeding (USDA)

References

Brazelton, Terry and Sparrow, Joshua. Touchpoints: Birth to Three, 2nd Edition. Massachusetts: Da Capo Press, 2006.

Hagan JF, Shaw JS, Duncan PM, eds. 2008. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, Third Edition. Elk Grove Village, IL: American Academy of Pediatrics.

Your child’s dental health - even before teeth:

How to avoid spreading bacteria that causes cavities from parent or caregiver to child More Info
How to avoid spreading bacteria that causes cavities from parent or caregiver to child
What is this and why is it important?

Even if your baby doesn’t have teeth (and most don’t at 4 months) oral health is already important!  One interesting fact  - the germs (bacteria) that cause tooth decay (cavities) can pass from a parent or caregiver to the child through saliva (spit).  Of course, all adults should brush and floss daily and see a dentist regularly - especially any who are in close contact with your child.

It’s important not to clean a pacifier, spoon or anything that goes in to your child’s mouth in your mouth – use clean water instead.  More than a quarter of young children have been found to have cavities. Maintaining your own oral health not only sets a good example for your child, but also improves his chances for good oral health as well. Whether or not your child’s teeth are showing – they’re growing beneath the surface. Avoiding cavities and the infections that cause them is important- especially since they are preventable.  Keep your child's mouth clean by gently brushing the gums and teeth with water and a soft infant toothbrush or gauze.

You can talk with your child’s health care provider about how to avoid sharing germs that cause cavities can be passed from the parent/caregiver to the child.

What are common questions I can ask my health care provider?
  • Can cavities (the bacteria that cause them) be passed on to my child, the way a cold can?
  • Why can’t I clean my child’s pacifier with my mouth?
  • Can bacteria or germs from my mouth cause cavities in my child’s teeth later?
  • Do I need to clean my child’s gums if he doesn’t have teeth yet?
  • Do children’s “baby” teeth even matter – aren’t they going to fall out anyway?
Where can I find more information about this topic?

A Healthy Smile for Your Baby (MCH Oral Health)

How to Protect Your Baby's Teeth from Cavities (AAP)

Dental Care for Your Baby (AAPD)

References

Center for Disease Control and Prevention (CDC). Preventing Cavities, Gum Disease, Tooth Loss, and Oral Cancers: At A Glance 2010. Retrieved 4/1/2010 from http://www.cdc.gov/chronicdisease/resources/publications/AAG/doh.htm

Hagan JF, Shaw JS, Duncan PM, eds. 2008. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, Third Edition. Elk Grove Village, IL: American Academy of Pediatrics.

Teething and drooling – what’s important to know and what to expect More Info
Teething and drooling – what’s important to know and what to expect
What is this and why is it important?

Teething usually starts during the next few months. The two front teeth (central incisors), either upper or lower, usually appear first, followed by the opposite front teeth.  Timing of teething varies greatly among children. If your child doesn’t have any teeth yet, don’t worry.

Teething occasionally may cause mild irritability, crying, a low-grade temperature (but not over 101 degrees Fahrenheit or 38.3 degrees Celsius), excessive drooling and a desire to chew on something hard. Often, the gums around the new teeth will swell and be tender. To ease your baby’s discomfort, try gently rubbing or massaging the gums with one of your fingers or giving him a cold, damp washcloth to gum. Teething rings are helpful, too, but they should be made of firm rubber. Some teethers that you freeze tend to get too hard and can cause more harm than good.

Pain relievers and medications that you rub on the gums are not necessary or useful since they wash out of the child’s mouth within minutes. Some medications you rub on your child’s gums can even be harmful if too much is used and the child swallows an excessive amount.

If your child seems particularly miserable or has a fever higher than 101 degrees Fahrenheit (38.3 degrees Celsius), it’s probably not because he’s teething and you should consult your pediatrician.

You can talk to your child’s health care provider about teething and drooling and what to expect.

What are common questions I can ask my health care provider?
  • How soon will my child’s teeth come in?
  • What can I do to help him be more comfortable while teething?
Where can I find more information about this topic?

Dental Care for Your Baby (AAPD)

Teething: 4 to 7 Months (AAP)

References

American Academy of Pediatrics (AAP). Teething: 4 to 7 Months. Retrieved 4/1/2010 from http://www.healthychildren.org/English/ages-stages/baby/teething-tooth-care/Pages/Teething-4-to-7-Months.aspx

Hagan JF, Shaw JS, Duncan PM, eds. 2008. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, Third Edition. Elk Grove Village, IL: American Academy of Pediatrics.

Why to avoid bottles in bed More Info
Why to avoid bottles in bed
What is this and why is it important?

Decay in baby teeth is on the rise among 2 to 5-year-olds, according to the Centers for Disease Control. Tooth decay develops when a child's teeth and gums are exposed to any liquids or foods other than water for long periods. The most common way this happens is when parents put their children to bed with a bottle of formula, milk, juice, sugar water or other sugared drinks. In addition to being at risk for cavities, babies who develop the habit of going to bed with a bottle may harm their teeth when they do come in.  It can also put your child at risk for ear infections and choking.

Habits begun early can be hard to change later – try to avoid the bottle in bed issue by not even starting it.  Always hold your child for bottle feeding and use a pacifier at sleep time.

You can talk to your child’s health care provider about the importance of not putting your child to bed with the bottle and tips for weaning your child from this habit.

What are common questions I can ask my health care provider?
  • A bottle in bed really helps him go to sleep – what would be a good substitute?
  • Is just the milk/juice in the bottle that’s harmful or is it okay to give him a bottle in bed that has water in it?
Where can I find more information about this topic?

A Healthy Smile for Your Baby (MCH Oral Health)

Dental Care for Your Baby (AAPD)

References

American Academy of Pediatrics (AAP). Preventing Tooth Decay. Retrieved 4/1/2010 from http://www.healthychildren.org/English/ages-stages/baby/teething-tooth-care/Pages/Preventing-Tooth-Decay.aspx

Hagan JF, Shaw JS, Duncan PM, eds. 2008. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, Third Edition. Elk Grove Village, IL: American Academy of Pediatrics.

Your child’s safety:

Childproofing for your baby on the move (rolling over/crawling) More Info
Childproofing for your baby on the move (rolling over/crawling)
What is this and why is it important?

Your 4-month-old is on his way to being mobile – it is critical to childproof your home to avoid falls, burns, drowning, choking and other safety hazards.  Soon your baby will learn to scoot and roll. Never leave your child unattended on high places, such as changing tables, beds, or sofas and keep a hand on your child when changing him . Use gates on stairways. Close doors to keep your baby out of rooms where he might get hurt. Install operable window guards on all windows above the first floor.

Never carry your baby and hot liquids, such as coffee, or foods at the same time. You can’t handle both!  Your baby can easily get burned. To protect your child from tap water burns, the hottest temperature at the faucet should be no more than 120°F. In many cases you can adjust your water heater.

Babies explore their environment by putting anything and everything into their mouths. Never leave small objects in your baby’s reach, even for a moment. Never feed your baby hard pieces of food such as chunks of raw carrots, apples, hot dogs, grapes, peanuts, and popcorn. Be prepared if your baby starts to choke. Learn how to save the life of a choking child. Ask your doctor to recommend the steps you need to know.

To prevent possible suffocation and reduce the risk of sudden infant death syndrome (SIDS), your baby should always sleep on his back. NEVER put your baby on a water bed, bean bag or anything that is soft enough to cover the face and block air to the nose and mouth.

Plastic wrappers and bags form a tight seal if placed over the mouth and nose and may suffocate your child. Keep these away from your baby.

You can talk with your child’s health care provider about what you can do to prevent the most common injuries for children this age.

What are common questions I can ask my health care provider?
  • My child isn’t turning over or moving much yet – when is the right time to think about child proofing the house?
  • Our child spends some time with his grandparents – how much child proofing should we do there?
Where can I find more information about this topic?

Preventing injuries: at home, at play, and on the way (SafeKidsUSA)

Home Safety: Here's How (AAP)

Changing Table Safety (AAP)

Baby Safety Basics (SafeKidsUSA)

References

American Academy of Pediatrics (AAP). Safety for Your Child: Birth to 6 Months. Retrieved 4/1/2010 from http://www.healthychildren.org/English/tips-tools/Pages/Safety-for-Your-Child-Birth-to-6-Months.aspx

Hagan JF, Shaw JS, Duncan PM, eds. 2008. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, Third Edition. Elk Grove Village, IL: American Academy of Pediatrics.

Installing and using the car seat correctly More Info
Installing and using the car seat correctly
What is this and why is it important?

Car seats, when correctly installed and used, are extremely effective in saving children’s lives, reducing the risk of death by as much as 71 % for infants. However, they can be complicated to install and use, making mistakes extremely common. In fact, studies have found that as many as 4 out of 5 car seats are installed or used incorrectly.

A correctly installed, rear-facing safety seat in the backseat of the car is the safest place for your child. It’s best to keep the car seat rear-facing until your child reaches the highest weight and height specified by the manufacturer. At the earliest, do not switch your child to a forward-facing safety seat before he is at least one year and weighs at least 20 pounds.  New recommendations are coming out about this, however, and some experts are saying that children should not face forward until 2 years old.  This is an important topic to discuss with your child’s health care provider.

This is also a good time to double check the manufacturer’s instructions. Or perhaps even better, contact the Child Safety Seat Inspection Station locator to find the nearest certified inspector who can check the installation and make any corrections needed.   You can find this information at www.seatcheck.org or by calling 1-866-SEAT-CHECK.

You can talk to your child’s health care provider about how to install your car seat correctly, in what position the car seat should face, and where you can go to have someone check the installation of your car seat.

What are common questions I can ask my health care provider?
  • When can we switch to a forward-facing seat?
  • My mother only has a forward-facing seat – is it ok when the child’s with my mother to use it?
  • The small infant seat is so easy to carry, why do I have to transition to a bigger seat?
Where can I find more information about this topic?

Car seat safety: The biggest mistakes parents make, and how to avoid them (BabyCenter)

Car Seats for Your Infant (Children's Hospital of Philadelphia)

Child Safety Seat Inspection Station Locator

Car Safety Seats: Information for Families for 2012 (AAP)

References

Hagan JF, Shaw JS, Duncan PM, eds. 2008. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, Third Edition. Elk Grove Village, IL: American Academy of Pediatrics.

Safety issues with wheeled baby walkers More Info
Safety issues with wheeled baby walkers
What is this and why is it important?

Although many of us used baby walkers and many parents think walkers will help their children learn to walk, research has shown that they are not safe and that walkers can actually delay when a child starts to walk.  They are no longer recommended for young children. In fact, the American Academy of Pediatrics has called for a ban on the manufacture and sale of baby walkers with wheels.

Children are not recommended to be in wheeled baby walkers because they can:

  • Roll down the stairs — which often causes broken bones and severe head injuries. This is how most children get hurt in baby walkers.
  • Get burned — a child can reach higher in a walker. It is now easier for a child to pull a tablecloth off a table and spill hot coffee, grab pot handles off the stove, and reach radiators, fireplaces, or space heaters.
  • Drown — a child can fall into a pool or bathtub while in a walker.
  • Be poisoned — reaching high objects is easier in a walker.

Most walker injuries happen while adults are watching. Parents or caregivers simply cannot respond quickly enough. A child in a walker can move more than 3 feet in 1 second! That is why walkers are never safe to use, even with an adult close by.

What you can do

  • Throw out your baby walkers! Also, be sure that there are no walkers wherever your child is being cared for, such as child care centers or in someone else's home.
  • Try something just as enjoyable but safer, such as:
    • Stationary activity centers—they look like walkers but have no wheels. They usually have seats that rotate, tip, and bounce.
    • Play yards or playpens—these are great safety zones for children as they learn to sit, crawl, or walk.
    • High chairs—older children often enjoy sitting up in a high chair and playing with toys on the tray.

You can talk to your child’s health care provider about safety issues with using wheeled baby walkers and alternatives for your child.

What are common questions I can ask my health care provider?
  • My sisters used a child walker with their kids and nothing happened – aren’t they ok?
  • What are safe alternatives to child walkers?
  • Why don’t child walkers help my child learn to walk?
Where can I find more information about this topic?

Safer Baby Walkers (Consumer Product Safety Commission)

Baby Walkers: A Dangerous Choice (AAP)

Baby Safety Basics (SafeKidsUSA)

References

American Academy of Pediatrics (AAP). Baby Walkers: A Dangerous Choice. Retrieved 4/1/2010 from http://www.healthychildren.org/English/safety-prevention/at-home/Pages/Baby-Walkers-A-Dangerous-Choice.aspx

Hagan JF, Shaw JS, Duncan PM, eds. 2008. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, Third Edition. Elk Grove Village, IL: American Academy of Pediatrics.

Bathtub, water, and pool safety More Info
Bathtub, water, and pool safety
What is this and why is it important?

Drowning is a leading cause of injury-related death in children and is a risk even for your 4-month-old.  Keeping your child safe in the bath and around water takes extra attention. Always have at least one hand on your child and try to keep two hands at this age when they are getting more wriggly.

Children love water whether it is in toilets, pails or in the tub. But they can drown in only an inch or two of water.  Because you will have a crawling child in the next couple of months, it is important to take precautions to reduce drowning risks: put safety locks on toilets, bathroom doors and hot tubs. Never be more than a few inches from your child in the tub, ready and able to grab him .

Think ahead. Learn infant CPR and know how to get emergency help.  Remember that even though your child may not be able to reach the toilet or tub now, crawling and climbing to stand are just around the corner. Taking these actions can prevent a tragedy.

You can talk to your child’s health care provider about keeping your child safe around water.

What are common questions I can ask my health care provider?
  • Is it safe to give my 4-month-old a bath in the bathtub?
  • Can I take my child into a pool at this age?
  • Is there a list of safety concerns we should be thinking about, for home and child care?
Where can I find more information about this topic?

Safety Guide (Home Safety Council)

Pool Safety (Home Safety Council)

Baby Safety Basics (SafeKidsUSA)

References

Hagan JF, Shaw JS, Duncan PM, eds. 2008. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, Third Edition. Elk Grove Village, IL: American Academy of Pediatrics.

Preventing burns and how to change hot water heater temperature More Info
Preventing burns and how to change hot water heater temperature
What is this and why is it important?

Burns are one of the leading causes of death among children, with most of these fatalities occurring in home fires. Even more often, fire-related deaths are caused by smoke inhalation. Your family's best protection against fire-related injuries is to equip your home with smoke detectors and to have an emergency escape route. To protect your baby from house fires, be sure you have a working smoke alarm on every level of your home, especially in furnace and sleeping areas. Test the alarms every month. It is best to use smoke alarms that use long-life batteries, but if you do not, change the batteries at least once a year.

Most non-fatal burns are caused by scalds from hot liquids—for example, when a child turns over a cooking pot upon himself , or turns the knobs on a bathtub faucet so that hot water flows on him . Children also sometimes suffer burns by touching a hot iron, a coil on an electric stove, a curling iron, hot barbecue charcoal, or fireworks.

To avoid scalding burns, reduce the temperature of your water heater so the water is never hotter than 120 degrees Fahrenheit. Keep hot irons out of children's reach and keep children away from the stove when food is cooking. Also, keep hot-steam vaporizers away from a child's reach, and keep portable heaters away from children and from flammable materials, such as curtains, as well. Teach your child not to play with matches.

You can talk to your child’s health care provider about preventing burns.

What are common questions I can ask my health care provider?
  • How do I find out what the hot water temperature is set at in my home?
  • How can I change the water temperature?
  • We live in an apartment – will the landlord let us change the temperature?
  • Is there a good checklist of possible dangers at home?
Where can I find more information about this topic?

Scald Prevention (Home Safety Council)

Preventing injuries: at home, at play, and on the way (SafeKidsUSA)

Baby Safety Basics (SafeKidsUSA)

References

American Academy of Pediatrics (AAP). Keeping Safe from Burns. Retrieved 4/1/2010 from http://www.healthychildren.org/English/safety-prevention/all-around/Pages/Keeping-Safe-From-Burns.aspx

Hagan JF, Shaw JS, Duncan PM, eds. 2008. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, Third Edition. Elk Grove Village, IL: American Academy of Pediatrics.

Preventing choking, common hazards More Info
Preventing choking, common hazards
What is this and why is it important?

Choking is a very common cause of unintentional injury or death in children under age one, and the danger remains significant until the age of five. Food is responsible for most choking incidents. Never feed your baby hard pieces of food such as chunks of raw carrots, apples, hot dogs, grapes, peanuts, and popcorn.

Because young children put everything into their mouths, small non-food objects are also responsible for many choking incidents. Look for age guidelines in selecting toys, but use your own judgment concerning your child. Also be aware that certain objects have been associated with choking, including uninflated or broken balloons, baby powder, items from the trash (e.g., eggshells, pop-tops from beverage cans), safety pins, coins, marbles, small balls, pen or marker caps, small and button- type batteries. If older siblings are playing with toys with small parts, make sure they are picked up after playing and put in a safe place, out of your baby’s reach. 

If you are unsure whether an object or food item could be harmful, you can purchase a standard small-parts cylinder at juvenile products stores or test toys using a toilet paper roll, which has a diameter of approximately 1¾ inches.

You can talk to your child’s health care provider about how to prevent choking and minimize choking hazards.

What are common questions I can ask my health care provider?
  • What are the most common things babies choke on?
  • What types of foods are choking hazards?
  • Is there a list of safety concerns we should be thinking about, for home and childcare?
Where can I find more information about this topic?

Prevent Airway Obstruction (Home Safety Council)

Baby Safety (Home Safety Council)

Baby Safety Basics (SafeKidsUSA)

References

American Academy of Pediatrics (AAP). Choking Prevention. Retrieved 4/1/2010 from http://www.healthychildren.org/English/health-issues/injuries-emergencies/Pages/Choking-Prevention.aspx

Hagan JF, Shaw JS, Duncan PM, eds. 2008. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, Third Edition. Elk Grove Village, IL: American Academy of Pediatrics.

How to check for lead in your home More Info
How to check for lead in your home
What is this and why is it important?

As your baby grows and begins exploring by putting things in his mouth, lead poisoning becomes a concern.

Lead is toxic and it is important to be aware of any sources of lead in your home. Talk to the doctor about the ways that lead can hurt your baby and other family members.

Most people think that lead is only found in old paint. However, lead can also be found in:

  • Children’s toys (for a listing of products known to have lead, see http://www.cpsc.gov)
  • The paint of older homes (built before 1978)
  • Pottery
  • Pewter
  • Folk medicines
  • Insecticides
  • Certain industries
  • Hobbies

You can learn more from the Environmental Protection Agency website.  You can also talk to your child's health care provider about how to check for lead in your home.

What are common questions I can ask my health care provider?
  • How do I check for lead in my home?
  • Is lead only found in old paint? What are other sources of lead I should be concerned about?
Where can I find more information about this topic?

Infant Safety: Protecting Your Child’s Health (AAP)

Lead Poisoning (AAP)

Lead Poisoning Dangers May Lurk in Your Spice Rack (AAP)

References

Hagan JF, Shaw JS, Duncan PM, eds. 2008. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, Third Edition. Elk Grove Village, IL: American Academy of Pediatrics.