4 Months Old Checkup – Questions to Ask Pediatrician?

At four months, your baby might already be smiling, cooing, and laughing. He has grown up fast since he was born, and you can already see changes in his behaviour and feeding. He might have as well doubled his weight (that’s good news), and if you get lucky, you might even hear a chuckle or two if you try to make him laugh. Four months is also the time for his 4th-month checkup at the paediatrician. With a newborn baby, you probably have many questions in your mind that you might want to discuss with a professional. Well, this is the time. If your baby is due for this checkup in the near future, this article has everything you need to know about what to expect during a visit, questions for a 4-month baby checkup, and how to prepare for them.

What Does the Doctor Do in the 4-Month Checkup?

Here are a few things you can expect at the 4-month paediatrician appointment (1):

1. Measure the length, head circumference and weight

You will have to undress your baby completely for this procedure so the doctor can accurately weigh him on a scale. Next, your baby’s length and head circumference will be taken, and, together, all the numbers will be plotted on a growth chart. The growth chart compares how your baby is developing compared to others of his age. What is important about this value is that there must be some development since his last visit regardless of where he places on the percentile.

2. Complete physical examination

The physical examination involves a check-up of all the body parts to look for healthy growth or abnormalities. It will include:

• Heart and lungs: The doctor will listen to your baby’s heart rhythm to look for abnormalities and listen to the breathing to look for problems or blockage.
• Eyes: The eyes will be checked for any congenital disabilities and to ensure proper functionality. The doctor will also look for problems such as blocked tear ducts.
• Ears: Ear examination will involve checking how your baby responds to sounds and if hearing is normal. There will also be a physical exam to look for infections in the ear.
• Mouth: The mouth cavity will be examined for any congenital disabilities and infections such as oral thrush. The gums will also be examined for emerging teeth.
• Head: The head check-up will reveal if the head’s shape is normal or developing a flat spot. The doctor will also check the soft spots (fontanels) for proper development.
• Body: The doctor will check your baby’s body for the development of muscles, his physical reflexes and examine the skin for rashes, allergies, or infections. The baby might also be put on his tummy to check the head and neck control.
• Belly: A belly examination will reveal any internal developmental defects such as a hernia or enlarged organs.
• Genitals: The doctor will open the baby’s diaper to examine the genitals to check for rashes or infections.
• Hips and legs: The hip and leg joints will be checked for proper functioning by moving them around.

3. Discuss other concerns

The doctor will take the time to address any problems that may have been discovered in your baby. If your baby is experiencing constipation or diarrhoea related to bugs, the ways to deal with it will be discussed. Finally, if you are exclusively breastfeeding your baby, Vitamin D drops will be recommended to supplement the deficiency. Babies who drink between 17 to 32 ounces of formula every day will not be given any Vitamin D supplements.

4. Look for development milestones

The doctor will observe your baby for development milestones that should be seen in babies of 4 months age. By this time, your baby should be able to support his head or look up when placed on the bed. He should be able to look at attractive objects, such as toys, and track them when moved in front of him. He should also be able to make an effort o grab the toy if he finds it appealing. He should be able to respond to sounds.

5. Immunisation shots

There are a few immunisation shots for common diseases that your doctor will give at the end of the session. The procedure is usually done by a nurse and is reserved till the end of the check-up, so there will be plenty of time to settle your baby down.

Questions That the Doctor May Ask

Your doctor will ask you a range of questions to assess your baby’s health and development, such as (2):

1. How are your baby’s eating habits?

With this question, the doctor will know how much and how often your baby is feeding. It can give a picture of whether he is getting enough nutrition or he needs to be supplemented with formula. Most babies can’t start on solids at 4 months but now is the time if you wish to talk about it. You could also ask about vitamin supplements.

2. How well does your baby sleep?

At this stage, your baby spends more time sleeping than being awake. Your doctor will want to know if the baby sleeps in a more predictable routine with six or more hours in the night and three to four daytime naps. You could discuss irregular sleep and other concerns you may have at this stage.

3. How is your baby’s bowel movement?

Baby stools can vary depending on how much they are feeding and what goes into their milk. Faeces that are soft indicate your baby is in good health even though the colour might vary. If you have seen that the baby passes stools that are smelly, watery, mucus-filled, and more frequently than usual, it could be diarrhoea. Discuss how to deal with loose stools and stomach upsets.

4. Can your baby sit with support or roll over on one side?

Many babies develop these two skills around this time. They will be able to sit with support and roll over on one side but not both. Your baby can sit without support or rollover on both sides by the time he is 6 months old. These are important developmental milestones.

5. Can he do a mini-pushup?

While this is not a regular ‘push-up’ in the true sense of the word, it still allows baby simple control of the head. By 4 months your baby should be able to lift his head up and look ahead while his arms and shoulders are still on the bed. If your baby still can’t do this or struggles with it, let the doctor know.

6. What sounds can your baby make?

As your baby grows, he will gain more control of his lips and vocal cords to make more sounds than before. You would notice that he smiles, coos and laughs when you tickle him or smile at him. These early movements, squeals, and babbles are important to develop sounds and verbal skills later on. If you notice your baby makes fewer sounds, then report the same to your doctor.

7. How good are your baby’s motor skills?

Like all his other developmental milestones, your baby should be developing motor skills at a noticeable rate. He will be able to reach for and grab things such as attractive toys or even bring both of his hands together in front of him. He should also be kicking with both of his legs and bouncing them up and down when held on the floor or over your lap. If he becomes stiff, instead, report this to your doctor. If he also uses one arm more than the other, report it.

8. Do you notice anything unusual about your baby’s eyes?

Babies should be able to comfortably track objects with their eyes and look at things they are interested in. The doctor check for normal eye structure development on every visit along with the alignment. If you notice anything odd with how your baby struggles to look at things, bring it up at the next visit.

9. How is your baby’s hearing?

At 4 months, babies should be able to respond to sounds by turning around and looking at the source. If your baby takes too long to respond or responds only to loud sounds, it could indicate a problem. Hearing problem treatment success depends on how soon they are discovered.

Vaccination

Your baby will receive these 4-month checkup shots as per the CDC (3):

• PCV (Pneumococcal)
• DTaP
• Hib
• Polio vaccine
• Oran Rotavirus vaccine

Questions You May Have During the Checkup

There are plenty of questions to ask a pediatrician at a 4-month visit; while some seem stupid, some feel urgent. Whatever your question is, feel free to tap your parental instincts and ask away the paediatrician. Here are some sample questions to ask at a 4-month check-up (4):

• Can I start my baby on solid foods, or is it too early?
• Should I cut back on breastfeeding if I start my baby on solid foods?
• Can I shift to infant formula from breastfeeding?
• Should I change my diet if I see signs of allergies in my baby?
• My baby has started to drool a lot. Is he teething?
• When will my baby sit up?
• Should I begin baby-proofing the house?
• How do I know my baby is developing physically and cognitively well?

Other Recommendations By the Doctor

Here are some expert recommendations for a infant 4 month check up:

• If you really want to start with solids, there is no single food that is ideal. You can start with anything that the baby likes. It’s best to start with purees to help them process new foods at first and then transition to fruits, vegetables, and baby cereals.
• If your baby is exclusively breastfed, continue with the Vitamin D supplements.
• When planning to return to work, talk to a lactation consultant about continuing breastfeeding or switching to formula.

FAQs

1. When is the usual following visit schedule for baby checkup?

After the four-month check up, your baby is usually scheduled for a routine checkup in the 6 month (5).

2. What are the 4-month vaccinations baby should ideally receive?

As per the CDC, vaccines given to babies at 4 months include (3):

• DTaP (diphtheria, tetanus and pertussis)
• IPV (inactivated poliovirus)
• Hib (haemophilus influenzae type b)
• PCV13 (pneumococcal disease)
• RV (rotavirus)

Four months is a transition stage when your infant moves from being fussy to developing his own personality. You should be able to see some if not all, relevant development milestones. If you have doubts or concerns, write them down in a diary and take it with you on the visit. Never hesitate to call up the paediatrician if your instincts see some trouble.

References/Resources:

1. Well-Child Visit: 4 Months; Nemours KidsHealth; https://kidshealth.org/en/parents/checkup-4mos.html

2. Bright Futures Previsit Questionnaire 4 Month Visit; American Academy of Pediatrics; https://downloads.aap.org/AAP/PDF/Bright%20Futures/BFTRK_4Month_Visit_EN.pdf

3. Your child needs vaccines as they grow!; CDC; https://www.cdc.gov/vaccines/imz-schedules/child-easyread.html?CDC_AAref_Val=https://www.cdc.gov/vaccines/schedules/easy-to-read/child-easyread.html

4. Checkup Checklist: 4 Months Old; American Academy of Pediatrics; https://www.healthychildren.org/English/ages-stages/Your-Childs-Checkups/Pages/Your-Checkup-Checklist-4-Months-Old.aspx

5. Make the Most of Your Baby’s Visit to the Doctor (Ages 0 to 11 Months); OASH; https://health.gov/myhealthfinder/doctor-visits/regular-checkups/make-most-your-babys-visit-doctor-ages-0-11-months

Also Read:

4 Months Old Baby Activities
How to Take Care of 4 Months Old Baby
4 Months Old Baby Growth and Development

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