What Happens at Baby’s Four-Month Checkup?

Baby’s four-month checkup is coming up. What questions, procedures and immunizations should I expect? 
ByAnisa Arsenault
Associate Editor
Updated
Feb 2017
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Baby’s changing fast, but this appointment is pretty similar to baby’s two-month visit. Baby will get another does of the same exact immunizations as last time. But now, says Preeti Parikh, MD, you can begin conversations about solid foods and sleep training.

Questions the doctor will ask

• How are things going? Are there any concerns? Is there anything new going on?

• What activities is baby doing, and what milestones has she hit? Does she interact with you? Smile? Roll over?

• Are you breastfeeding or using formula? How frequently? How much is baby drinking? (You can start introducing solids at this time, but it’s not really necessary until six months.)

• How many times does baby poop per day, and how many times does she pee?

• 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.

• What kinds of noises does baby make?
 
Procedures the doctor will do

Weight check. Just like every other appointment, the doctor or nurse 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. 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. She’ll also check the  shape of baby’s head and check his  soft spots (fontanels) to make sure they’re developing properly.

Vaccines baby may get

Next dose of the ones she had at last appointment:

• Pneumococcal (PCV)
• DTaP
• Hib
• Polio vaccines
• Rotavirus vaccine (given orally)
 
Recommendations the doctor will make

• If baby is showing interest in new foods and is able to hold her head up, she may be ready for you to start introducing solids. Start with one pureed food a day. Parikh says there is no evidence that one type of food is better than another for the first solid, so it’s really your call whether you want to go with baby cereal, fruits or vegetables.
 
• If baby is still on breast milk, continue with vitamin D supplements. 

Expert: Preeti Parikh, MD, is a pediatrician in New York City and spokesperson for the American Academy of Pediatrics.

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