4 Month Old Check-up: What to Expect

Congratulations Mama! Together you have made it past the fourth trimester! Isn’t it amazing how much both you and the baby have grown. Your baby has changed quite a bit and rather quickly, right? Here’s how to prepare for that four month check-up! This appointment is pretty similar to baby’s two-month visit. Baby will get another does of the same exact immunizations as last visit (I have linked my 2 Month Check-Up post below). You and your doctor may begin conversations about solid foods and sleep training.

Questions the doctor will ask

• How are things going? Are there any concerns?

• Does your baby interact with you and smile? Does he/she Roll over when on their tummy? Can they do a mini-pushup? What kinds of noises does baby make?

Your baby’s language may include babbling, squealing, and even laughing. Aria has been testing the volume of her voice lately. She also likes to hum herself to sleep. She is exploring objects, drooling, and blowing bubbles. Her fingers are always in her mouth! She has definitely begun teething, but we may not see a little tooth for another few months. (We are constantly changing her wet shirts these days! – I’ve got myself a serious drooler!)

*If your baby is making fewer sounds than she did before, you should tell your pediatrician.

• Are you breastfeeding or using formula? How frequently? How much is baby drinking?

• How many times times a day does your baby have wet stools? How often does baby go #2?

* Soft feces are best, but color can vary. If your baby has ever passed frequent, smelly, watery, mucus-streaked stools, it’s probably diarrhea. Ask the doctor about the best way to treat it.

• What is baby’s sleep schedule like? You can start thinking about sleep training around the four-month mark, if you’re interested and ready.

• You can start introducing solids at this time, but it’s not really necessary until six months.)

Procedures the doctor will do

Weight check. Just like every other appointment, they will measure and weigh baby and plot weight, height, and head circumference on a growth chart that indicates the average height and weight for boys and girls.
The chart enables you to see how your baby compares with other children the same age and gender. But it doesn’t matter whether he/she is in the 5th or the 95th percentile, as long as his or her rate of growth is steady from one visit to the next is important. They’ll check that baby stays within the same percentile range from checkup to checkup.

Physical. The doctor will check baby’s heart, lungs, genitals, reflexes, joints, eyes, ears and mouth. (SuePerMom – 2 Month Visit)

Your pediatrician will also check the shape of your babes head and check the soft spots (fontanels) to make sure they’re developing properly. The fontanel at the back of head closes by about 2 months old and the fontanel at the top takes about 7-19 months.

*Because babies tend to favor one side over another, so it is important to try and turn their heads often, also to avoid flat head syndrome.

Whether you choose to vaccinate your child or not I have listed the recommended vaccinations for this time. Based on the Centers for Disease Control and Prevention (CDC) your baby is recommended to receive the following at this visit:

Rotavirus Vaccine (given orally). This disease is spread by mouth. The vaccine is given to prevent severe dehydration caused by diarrhea, vomiting and fever.

Pneumococcal PCV13 vaccine protects against pneumococcus. Spread by air or direct contact. There may be no symptoms, pneumonia (infection in the lungs). Disease complications: Bacteremia (blood infection), meningitis (infection of the covering around the brain and spinal cord), death

DTap DTaP* vaccine protects against diphtheria. Spread by air or direct contact. Symptoms include: Sore throat, mild fever, weakness, swollen glands in neck. Disease complications: Swelling of the heart muscle, heart failure, coma, paralysis, death.

HIB Hib vaccine protects against Haemophilus influenzae type b. Spread by air or direct contact. Symptoms may include bacteria in the blood. Disease complications: Meningitis (infection of the covering around the brain and spinal cord), intellectual disability, epiglottitis (life-threatening infection that can block the windpipe and lead to serious breathing problems), pneumonia (infection in the lungs), death.

Polio IPV vaccine protects against polio. Spread by air, direct contact, through the mouth. Symptoms may include sore throat, fever, nausea, headache. Disease complications: Paralysis, death.

These vaccines are combined in two shots.

He/she will be getting the second dose at this point of Hepatitis B if you chose to opt out in the hospital.

HepB vaccine protects against hepatitis B. Spread by contact with blood or body fluids. Symptoms may include fever, headache, weakness, vomiting, jaundice (yellowing of skin and eyes), joint pain. Disease complications: Chronic liver infection, liver failure, liver cancer

I’ve provided a link to the CDC website at the end of this post.

*Due to recent measles outbreaks in America – My doctor has recommended an early dosage of the MMR Vaccine at Aria’s 6 month visit. We have declined but I thought this was important to mention.

Your doctor will continue to recommend giving Vitamin D <- (Link to the drops we use) to breastfed babies. (Formula fed babies get enough vitamin D.)

Be prepared for a sleepy baby that wants to cuddle. Call your pediatrician should your baby develop a fever or if you notice any unusual behavior. Please feel free to click the links I provided on the vaccines for additional information.

Recommended Immunization Schedule

CDC Immunization Schedule – 0-6years

Feel free to check out one of my previous posts on organizing paperwork for your children.

Children’s Folders – Organizing Paperwork and Health Information