Your baby’s four month well visit: What to Expect

Is it hard to believe that 4 months have already gone by since your baby was born?  She should already be starting to be more alert and interested in what is going on around her.  Well-child visits are an essential part of keeping your baby healthy and safe.  Here is what to expect at this visit.

What’s NEW at this visit

  • Evaluating your child’s risk of anemia

At every well visit we check:

We will examine your baby’s growth, making sure she is growing at a normal rate for her age. We check weight, length, and head circumference. This is a very important part of making sure children are healthy and are getting the proper nutrition.  Babies grow very fast but continue to slow down a little at this age.

We will ask what kind of things he is doing now to be sure her brain, nerves and muscles are developing properly.

Your baby should be doing the following things.  If not, please let us know:

  • Smiling back at you and responding to your voice.
  • Raising her head and chest when lying on her stomach.

At every well visit, we do a full head-to-toe exam and check every part of your baby’s body. At every age we do pay special attention to certain key areas:

  • Head: We are checking head shape, soft spots, and any flattening from sleeping on his back.
  • Eyes: We check babies at every well visit for a red reflex when shining a light in the eye (like a red eye in a picture). Babies can have cataracts or eye tumors, and since the brain is still developing, it is critical to correct vision problems immediately. Eye crossing is normal at this age and should go away by 4 months old.
  • Neck: We check for any cysts in the neck that babies can be born with, plus any thyroid enlargement.
  • Heart: We listen for any murmurs or irregular heart rhythm or rate.
  • Abdomen: We check for tumors, swollen organs, and the belly button.
  • Genitals: We check for any new problems, and in boys, that the testicles are descended. In circumcised boys, we check for healing and to be sure the skin is being pulled back so no scars or problems develop.
  • Hips: We push and pull on your baby’s hips to be sure the hip joint has developed properly.
  • Skin: Cradle cap is common at this age. Seborrheic dermatitis and eczema can also appear at this age.
  • Nervous system: We check your baby’s reflexes and development to be sure their brain and nerves are working and developing properly.

As your child’s medical home, we want to know about any new developments since the last visit, including

  • changes in family health history
  • changes or challenges at home, family, and living situation
  • ER and urgent care visits and hospitalizations
  • Visits to any specialists or therapists or any other health care providers
  • Injuries

Ask how your baby is doing

  • We will ask about what you are feeding your baby, and be sure he is getting the proper nutrition at this age.
  • We will check on how he is sleeping because this is important for her health (and for the whole family!).
  • Celebrate your baby’s strengths, growth, and development!
  • Learn about any challenges your baby is having

Ask how mom and family are doing

  • We will ask some questions about mom’s health to screen for postpartum depression (see below).
  • Fourth trimester
  • Resources, enough to eat

Address any questions or concerns you have

You may find it helpful to download and complete our planning guide for this visit, which has an area for you to write down your questions.

FAQ at this age:

  • spitting up
  • drooling/chewing/teething

Parenting guidance we discuss

  • Change in sleep patterns
  • Feeding changes
  • Helping your child develop

Risk factors & screenings

Measuring your baby’s risk factors

At every well visit, we evaluate your child’s risk of certain conditions. Children at higher risk usually need additional screening or testing.

Screenings

  • We will screen your baby for anemia if he/she is at risk. Screening may be done by measuring hemoglobin level in our office with a finger or heel stick, or send your baby to the lab for more extensive tests.

Vaccines usually given at this visit

These are the vaccines we usually give at this visit. The vaccines given today are in most cases exactly the same as those given at the two-month visit. These same vaccines are also given at the six-month visit. Georgia requires all of these vaccines, except rotavirus, for school and daycare attendance unless you refuse to give the vaccines for religious reasons.

Your child’s schedule may differ from the usual schedule. You can view your child’s vaccine record on the portal and compare it with the standard schedule.

Vaccines are among the most researched and safest treatments for children (and adults). They are highly effective at preventing severe illness and death and save hundreds of thousands of children’s lives every year. For centuries, these diseases were the most common cause of death in children, and all of them are still present and a threat to the health and lives of infants and children. Visit our Vaccine Center for more information.

The DTaP vaccine protects against three diseases: diphtheria, tetanus, and pertussis (whooping cough). These germs infect infants and often cause severe illness or death. Infants in our area are at risk; tetanus lives in the dirt and is always around. Diphtheria outbreaks occur in other countries and may travel here. We still see cases of whooping cough in our area. Children should not delay getting this vaccine.

Children usually receive five doses of DTaP, usually at the following ages:

  • Two months
  • Four months
  • Six months
  • 15–18 months
  • 4–6 years

More information

The Hib vaccine protects against a bacteria called Haemophilus influenzae type B. This bacteria causes meningitis and other infections in infants, leading to serious illness, brain injury, and death. It was quite common in infants and toddlers before the development of the vaccine. Children should not delay getting this vaccine.

More information

The IPV (polio) vaccine protects against the poliovirus, which can cause paralysis. It can occur at any age. The paralysis can be permanent and affect only the arms or legs affect the chest, causing breathing difficulty. These patients have to live inside an iron lung for the rest of their lives.

More information

The PCV13 (pneumococcal) vaccine protects against a common bacterial infection in children. It causes common conditions, such as ear infections, and more severe infections, including sepsis and meningitis. The vaccine prevents severe illness and has also made ear infections much less common. It is the most common cause of serious bacterial infections in infants and toddlers. Infants should not delay getting this vaccine.

More information

The rotavirus vaccine is an oral vaccine, not a shot, that protects against an extremely common virus. Almost all children caught it before the vaccine. Rotavirus causes vomiting and diarrhea and is a leading cause of death in children worldwide due to dehydration.

More information

Hepatitis B is a virus that causes liver disease. Hepatitis B often stays in the liver and never goes away, causing chronic liver disease and liver failure. It can also cause liver cancer. It spreads through blood and body fluids. Babies can get it during birth if their mother is infected. Infants and children can get it through close contact with body fluids from someone with it. Unfortunately, if babies catch it, it is often much more severe than in adults. The first dose is given at birth to prevent transmission from the mother, who may not know she is infected. Children receive two more doses in the first two years of life.

More information

Giving medication for fever or pain before the vaccines is not recommended, and it is not needed for fever after the vaccines either. Fever will not harm your child, and it helps the vaccines work. You only need to treat discomfort. If your child is cranky, fussy, or uncomfortable, give some pain medication (acetaminophen or ibuprofen). See After Vaccine Care for more information.

You can learn more about each vaccine from the CDC Vaccine Information Statements (VIS). There is a link above for each vaccine and a copy in a notebook in your exam room. You can also ask for a paper copy at your child’s visit.

Postpartum depression screening

Most moms experience the “baby blues” to a certain degree, with symptoms of exhaustion, moodiness, crying, and sadness. However, between 10-20% of moms will experience postpartum depression, a more serious condition. Since moms see pediatricians far more often than their OB/GYN or other doctors, pediatricians now screen moms for symptoms of postpartum depression. Learn more.

Vaccines for parents and family members

  • To protect your baby, it is recommended that parents, siblings and household members get a flu vaccine a during flu season. Babies cannot get a flu vaccine until 6 months old.
  • We do offer flu vaccines to parents and family members who need them.

Handouts you will receive today

  • Guidelines on caring for your four month old baby.
  • Guide to Starting Your Child on Solid Foods.
  • Your Four Month Old’s Development.
  • Please let us know if you need a vaccine record/GA 3231 Form for daycare.

Next visit

Visit the portal

  • All your child’s information is available on the portal: growth charts, vaccines, medications, and more!
  • Use the portal to contact us, schedule your next appointment, and much more!

Learn more about the portal and how to get started.

Related Information

Additional resources for this visit

  • Four Month well visit planning guide
  • Caring for your Four Month Old
  • Four-Six Month Development
  • Starting Solids
  • Understanding well visit billing

References