106 - 4 Months Old

Your baby is now super cute at 4 months old and are laughing, smiling, and doing happy feet. In this episode, Dr. Carole Keim MD talks about weaning your baby and the difference between the traditional purees method and baby-led feedings. With new foods comes how to handle food allergies and brushing your baby's teeth. She also talks about protecting your baby while outside and safely using sunscreen or bug spray. Bookmark this episode! This information will apply for the next two months.

Just like previous episodes Dr. Carole Keim MD will go into detail about your baby’s development, sleep patterns, peeing and pooping, skin care, and what to expect at their 4-month check-up. As a new parent, you should be feeling a lot more confident about the overall care of your baby. Also a reminder those little hands are stronger than they look so if it is in grabbing distance be prepared.

Parents: (00:24)

• Feeling more confident overall
• Baby is laughing and babbling, really interacting - this is when most parents fall in love with the baby
• Start wearing hair up / no jewelry - baby can grab objects!

Development: (01:32)

• Social smile / laugh / happy feet
• Consoles self
• Babbles
• Different types of crying
• Indicates happy/sad
• Responds to affection
• Lift chest when prone, roll (typically front to back)

Sleep: (03:02)

• Variable at this age; some have sleep regression, others are sleeping better than ever
• Safe sleep: alone, on their back, in a crib. (Time to move to a crib!)
• Crib should be in parents’ room until 1 year of age, new studies show babies sleep better in their own room starting at 4mos but it’s not an official recommendation yet
• No blankets until 1 year, no pillows til age 2 - very high risk at this age - starting to roll
• Start a bedtime routine; feed, brush teeth/gums with water, read, sing, set down awake but drowsy
• Things that can help, but only if they need it: blackout blinds, white noise machine, music

Eating: (06:27)

• Primarily breastmilk or formula; starting to consider solids
• 6-8x per 24 hours, 24-30oz per 24h
• Can take 4-6oz at a time and be full 4-6 hours
• Signs of food readiness: showing interest in food, good head control while seated supported, loss of extrusion reflex
• How to start solids:
  • Baby-led weaning vs. purees (traditional)
  • rice/oat cereal optional (pros/cons)
  • progression green veggies - orange veggies - fruits; ok to give anything other than honey and cow’s milk (dairy products are ok)
  • one new food every 3-4 days
  • signs of food allergy: rash, vomiting
• When to start water (ounce per ounce with foods)

Peeing/pooping: (17:11)

• They have found their pattern: typical 1-2x per day, the rule of 7’s still applies (until they start solids): once per week up to 7x per day is normal; after starting solids should be 1-3x per day
• Peeing about 6x per 24h

Skin: (17:54)

• Bathing 2-4x per week; wipe skin folds a few times per day
• Can use lotion or cream or ointment after baths
• Sunscreen, insect repellant: any baby sunscreen is ok but not fully protective til >6mos, citronella works for insects and is safe
• Diaper rash and drool rash - might be infected if it lasts more than 2-3 days despite normal diaper cream (zinc-oxide-based like Desitin or petroleum-based like Vaseline or Aquaphor)
  • Candida (yeast/fungal) - solid pink area with tiny pinpoint-sized pink dots around it (satellite lesions). Can try mixing apple cider vinegar and water 1:1, OTC antifungal cream, or call a doctor for a prescription for Nystatin.

Teething: (22:25)

• Teeth can appear anytime; brush 2x per day with water
• Teething toys, frozen washcloths, frozen fruit/breastmilk/formula in mesh bags
• Medicines: tylenol (ask your doctor for the dose), topical teething gel like orajel

4-month check up: (26:19)

• baby should have gained about 2-3lbs since last checkup, or should be about twice their birth weight (avg weight 14lb)
• Second round of vaccines: DTaP, Polio, Hib, PCV, rota (2 shots, one oral)
• Anticipatory guidance:
  • Safety: never leave baby on high surfaces, use rear-facing car seat until age 2, avoid secondhand smoke, set water temp to 120'F to avoid scald burns
  • Development: tummy time (30 mins twice a day), anticipate rolling, laughing, babbling. Can inspire rolling with toys placed just out of reach. They’re not sitting on their own yet or crawling (those are at 9 mos).
  • Next WCC in 2 mos; same vaccines as the 2mo visit
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