Your Baby At 4 Months:

Your baby’s development is flourishing. He or she can lift his/her head and chest off the bed by using the arms. His or her hands are now opened and relaxed when sleeping. After all those months of singing to your baby, he or she is starting to sing back to you with laughing, squealing, and musical cooing. You may notice that your baby is starting to reach out with both arms to things or people. By 4 months you can be certain that your baby hears you when he or she turns to your voice. The baby will follow well with his or her eyes, only crossing the eyes to look at close objects.

Feeding Your Baby:

There is still no nutritional need for solid foods. Breast milk or formula should remain your baby’s main source of calories throughout the first year. Some parents may have been advised to start cereal or other foods for a variety of reasons including feeding schedules, sleeping or weight gain. If we have discussed this with you, and your baby has started solid foods at four to six months of age, do not begin foods such as meat, eggs or wheat until your baby is at least 9 months old. Because these foods can trigger allergic reactions in some babies, it is best to wait until your baby is older. If you have not started solid foods, there is no need to start yet. We’ll discuss this further at an upcoming visit. If your child is formula fed, he/she should already be on a formula containing iron. “Low iron formulas” are not sufficient.

Caring for Your Baby:

Now that your baby is 4 months old, he or she is beginning to understand the concept of a good night’s sleep. Babies at this age should be learning that being put in bed means it is time to fall asleep. Putting an already sleeping baby in bed can inadvertently teach him or her to wake up. Remember not to give your baby bottles in bed. To further develop your baby’s development, respond to his or her vocalizations and allow baby time to respond as you interact. Place him or her on their stomach while awake to help them learn to rollover and crawl.

Your Baby’s Safety:

Do not use a walker. Walkers encourage toe walking and can fall down steps or tip over if caught on the edges of furniture or carpet. Developmentally, walkers encourage toe walking. Although many parents feel that walkers help their babies advance, at best walkers are a steel and plastic baby sitter. Buy only age-appropriate toys with unbreakable parts. Beware of small objects such as coins or small toys that your baby may choke on.

Immunizations:

The immunizations your child may receive at this age have been discussed. By now you have read the information about them that we have supplied you. Most babies do not have a reaction to these immunizations. If there is a reaction, most likely it is a slight fever or fussiness. You may give your baby Tylenol or other acetaminophen products for these symptoms. If you feel the Tylenol has not helped or you are concerned about other symptoms, let us know. If your baby’s temperature exceeds 104 degrees F. rectally, let us know.

Your Next Appointment:

Your baby’s next appointment will be at 6 months. We will continue to evaluate your baby’s development and discuss additional information. He or she will also be due for the next round of immunizations at that time.

Your Baby and Solid/Strained Foods

Age for Starting Solid Foods
The best time to begin using a spoon to feed your child is when he or she can sit with some support and voluntarily move his or her head to engage in the feeding process. This time is usually between 4 and 6 months of age. Breast milk and commercial formulas meet all your baby’s nutritional needs until 4 to 6 months of age. Introducing strained foods earlier just makes feeding more complicated. Research has shown that it won’t help your baby sleep through the night.

Types of Solid Food

Cereals are usually the first solid food introduced into your baby’s diet. Generally these are introduced at 4 months of age in formula-fed infants and 6 months of age in breast-fed infants.
Start with rice cereal, which is less likely to cause allergies than other cereals. Barley and oatmeal may be tried 1 to 2 weeks later.
Strained or pureed vegetables and fruits are the next solid foods introduced to your baby. Although the order of foods is not important, introduce only one new food at a time and no more than three per week.
Between 8 and 12 months of age, introduce your baby to mashed table foods or junior foods (although the latter are probably unnecessary). If you make your own baby foods in a baby-food grinder or electric blender, be sure to add enough water to get a consistency that your baby can easily swallow.
Although there is controversy about them, egg whites, wheat, peanut butter, fish, and orange juice may be more likely to cause allergies than other solids, and should be avoided until 1 year of age (especially in infants with allergies).

Spoon Feeding
Spoon-feeding is begun at 4 to 6 months of age. By 8 to 10 months of age, most children want to try to feed themselves, and can do so with finger foods. By 15 to 18 months of age, most children can use a spoon independently for foods they can’t pick up with their fingers, and the parent is no longer needed in the feeding process.

Place food on the middle of the tongue. If you place it in front, your child will probably push it back at you. Some infants get off to a better start if you place the spoon between their lips and let them suck off the food. Some children constantly bat at the spoon or try to get a grip on it during feedings. These children need to be distracted with finger foods or by having a spoon of their own to play with.

Finger Foods
Finger foods are small bite-sized pieces of soft foods. Most babies love to feed themselves. Finger foods can be introduced between 9 to 10 months of age or whenever your child develops a pincer grip. Since most babies will not be able to feed themselves with a spoon until 15 months of age, finger foods keep them actively involved in the feeding process. Good finger foods are dry cereals (such as Cheerios or Rice Krispies), slices of cheese, pieces of scrambled eggs, slices of canned fruit (peaches, pears, or pineapple) or soft fresh fruits, slices of banana, crackers, cookies, and breads.

Snacks
Once your baby starts eating three meals a day, or at 5-hour intervals, small snacks will often be necessary to tide him or her over to the next meal. Most babies go to this pattern between 6 and 9 months of age. The midmorning and midafternoon snack should be a nutritious, nonmilk food. Fruits and dry cereals are recommended. If your child is not hungry at mealtime, the snacks should be made smaller or eliminated.

Table Foods
Your child should be eating the same meals that you do by approximately 1 year of age. This assumes that your diet is well balanced and that you carefully dice any foods that would be difficult for your baby to chew. Avoid foods such as raw carrots and hot dogs that could be choked on.

Iron-Rich Foods
Throughout our lives we need iron in our diets to prevent anemia. Certain foods are especially good sources of iron. Red meats, fish, and poultry are best. Some young children will eat only lunch meats, and the low-fat ones are fine. Adequate iron is also found in iron-enriched cereals, beans of all types, egg yolks, peanut butter, raisins, prune juice, sweet potatoes, and spinach.

Vitamins
Added vitamins are unnecessary after your child has reached 1 year of age and is on a regular balanced diet. If he’s a picky eater, give him or her one chewable vitamin pill per day.

Instructions for Pediatric Patients, 2nd edition, 1999 by WB Saunders Company. Written by Barton Schmitt, M.D. pediatrician.

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