4 MONTH CHECK UP

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DIET

Fruits and vegetables may be started at four months. There is a wives tale that says if you feed your child fruits first, then they won't like the vegetables because they have that sweet taste in their mouth. There are no studies on this that I am aware of; therefore, you may feed which ever you wish first. Most people start off with sweet potatoes. There are no rules about how much you should feed, but most start with a tablespoon and move up as tolerated to a small jar a day by 5 months, 2 a day by 6 months, etc. Just give your baby a taste and if he or she likes it, then give more until you find out how much your baby wants. Offer one new food every 3 to 5 days and don't give combinations until you are sure that he or she can take each individual food. If your child reacts to a food, he or she will either have a rash or bloody diarrhea. If your child has bloody diarrhea, then don't give that food again without talking with me first. If your baby has a rash, then don't give any new food for a week and then try that food again. If your baby gets the rash again, then he or she is allergic to it and try it again in a year or two. If your baby does not get another rash, then the rash was caused by something else.

Many parents say that they cannot get their babies to try new foods. If we were in then rain forest 100,000 years ago and you happened to pick a berry and offer it to your baby, it would not be a good idea for the baby to eat it, as it could be poisonous. On the other hand if you offer the same food over and over, then the baby should know that it is not poisonous since you have offered it so many times. Studies show that if you offer a food and push past the initial resistance, then most children will eat a new food after 3 to 7 tries. If you only offer something once or twice and then donít offer it again, you may be sending the baby a message that may result in them only eating a few types of food later.

It is acceptable to start fruit juices at this age, but there are some cautions. First, juice is NOT necessary or nutritious. The amount of calories and vitamins it contains are insignificant. Second, some mothers give so much juice that is suppresses the babyís appetite for real food (breast milk or formula) and the babies start to fail to gain weight and fall off the growth chart. Limit the amount of juice to only a few ounces per day unless directed by the doctor. Third, most babyís cannot tolerate full strength juice and will get diarrhea. If you must give juice, then give half or quarter strength juice. Finally, there is some evidence that citrus juice can induce allergies or upset the stomach, therefore avoid citrus until 1 year of age or directed by the doctor. 

COMMON ILLNESSES & PROBLEMS

                The most common call to the doctor between now and the next check up is for a child pulling on their ear. Please see your last check up sheet as this covers how to tell the difference between teething and an ear infection. Remember that teething will give episodic fussiness, temperatures up to but not over 102, runny nose and some loose stool occasionally. Ear infections will cause fevers over 102 and continuous and worsening fussiness. If you suspect your child has an ear infection and the pain is bad, then call anytime for what to do. If the pain is mild to moderate, give your child Tylenol or Motrin for pain (see newborn booklet for dosing), put a heating pad on the ear and call the office during business hours for what to do. For teething, give Ambisol, Oragel or Numzit as directed along with Motrin for the pain. Thankfully, most children will not have an ear infection before 6 months of age, but that age is rapidly approaching. When your child does get a tooth, you should brush it with your finger or a washcloth just as you would brush your own teeth. Either use less than a split pea size piece of toothpaste or donít use any and too much fluoride is as bad for the teeth as too little. Oral B sells a set of three toothbrushes for each stage of teeth (gum massager, first tooth brush and a tiny regular toothbrush) and they are usually available at Toy-R-Us.

 

SAFETY

        Remember to not use a walker as they cause 3-500 deaths and 30,000 emergency room visits per year. Your safety zone will have to be elevated a little as your baby will be sitting and crawling soon. Crawl around your house again to check for anything that could hurt your baby. As you saw in the developmental evaluation you completed on the computer, some children will be sitting (at least supported) by the next visit and a few might say mama or dada (dada is easier). As children grow, remember to make sure the clothes are not too tight. Infants must face backwards in the car seat until 1 year of age AND 20 pounds in weight and should never ride in the front seat of a car, especially one with an air bag. By now you have probably let more and more people around your baby. That initial fear of getting the baby sick is easing. Please continue to protect your baby by keeping away from sick people, washing hands before touching the baby and after changing the diapers and taking care of yourself as parents often bring illnesses home from work.

NEXT VISIT

The next check up will be a 6 months of age. At that visit, your child should get almost the same vaccines as they did today (most likely one less shot). We will also cover how to start meats and most other foods. We then change to every 3 month check ups and wonít receive another vaccine until 12 months of age. At 9 months, there will be a finger stick to check for anemia unless your child receives WIC. There will also be a lead test by finger stick at the 9 month visit.

 2005 Joe Matusic, MD