Bright Futures

4 Month Visit

Here are some suggestions from Bright Futures experts that may be of value to your family

Learn if your home or drinking water has lead and take steps to get rid of it. Lead is toxic for everyone.
Take time for yourself and with your partner. Spend time with family and friends.
Choose a mature, trained, and responsible babysitter or caregiver.
You can talk with us about your child care choices.

For babies at 4 months of age, breast milk or iron-fortified formula remains the best food. Solid foods are discouraged until about 6 months of age.
Avoid feeding your baby too much by following the baby’s signs of fullness, such as
- Leaning back.
- Turning away.

Providing only breast milk for your baby for about the first 6 months after birth provides ideal nutrition. It supports the best possible growth and development.
Be proud of yourself if you are still breastfeeding. Continue as long as you and your baby want.
Know that babies this age go through growth spurts. They may want to breastfeed more often and that is normal.
If you pump, be sure to store your milk properly so it stays safe for your baby. We can give you more information.
Give your baby vitamin D drops (400 IU a day).
Tell us if you are taking any medications, supplements, or herbal preparations.

Create routines for feeding, nap time, and bedtime.
Calm your baby with soothing and gentle touches when she is fussy.
Make time for quiet play.
- Hold your baby and talk with her.
- Read to your baby often.
Encourage active play.
- Offer floor gyms and colorful toys to hold.
- Put your baby on her tummy for playtime. Don’t leave her alone during tummy time or allow her to sleep on her tummy.
Don’t have a TV on in the background or use a TV or other digital media to calm your baby.

Go to your own dentist twice yearly. It is important to keep your teeth healthy so you don’t pass bacteria that cause cavities on to your baby.
Don’t share spoons with your baby or use your mouth to clean the baby’s pacifier.
Use a cold teething ring if your baby’s gums are sore from teething.
Don’t put your baby in a crib with a bottle.
Clean your baby’s gums and teeth (as soon as you see the first tooth) 2 times per day with a soft cloth or soft toothbrush and a small smear of fluoride toothpaste (no more than a grain of rice).

Information About Car Safety Seats: www.nhtsa.gov/campaign/right-seat | Toll-free Auto Safety Hotline: 888-327-4236

Use a rear-facing–only car safety seat in the back seat of all vehicles.
Never put your baby in the front seat of a vehicle that has a passenger airbag.
Your baby’s safety depends on you. Always wear your lap and shoulder seat belt. Never drive after drinking alcohol or using drugs. Never text or use a cell phone while driving.
Always put your baby to sleep on her back in her own crib, not your bed.
- Your baby should sleep in your room until she is at least 6 months old.
- Make sure your baby’s crib or sleep surface meets the most recent safety guidelines.
- Don’t put soft objects and loose bedding such as blankets, pillows, bumper pads, and toys in the crib.
Drop-side cribs should not be used.
Lower the crib mattress.
If you choose to use a mesh playpen, get one made after February 28, 2013.
Prevent tap water burns. Set the water heater so the temperature at the faucet is at or below 120°F /49°C.
Prevent scalds or burns. Don’t drink hot liquids while holding your baby.
Keep a hand on your baby when dressing or changing her on a changing table, couch, or bed.
Never leave your baby alone in bathwater, even in a bath seat or ring.
Keep small objects, small toys, and latex balloons away from your baby.
Don’t use a baby walker.

We will talk about:

Consistent with Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, 4th Edition