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# Healthy Start, Grow Smart

**Your Four-Month-Old**

## TITLE PAGE

**Healthy Start, Grow Smart**

**Your Four-Month-Old**

Prepared by:

U.S. Department of Agriculture

U.S. Department of Education

U.S. Department of Health and Human Services

2002

# Acknowledgments

This publication was an initiative of Laura Bush as the First Lady of
Texas and sponsored by the Texas Department of Health. President Bush
and Mrs. Bush have asked that this series of booklets be revised and
distributed by the U.S. Department of Agriculture, U.S. Department of
Education and the U.S. Department of Health and Human Services.

We would like to thank the Texas Department of Health for their
cooperation and assistance in bringing this publication to families
across the United States. In addition, we recognize the contributions
that Susan H. Landry, Ph.D., Craig T. Ramey, Ph.D. and many other
individuals made in the development of this magazine.

# Here's What's Inside

Your Baby Is Four Months Old 1

Feeding Your Baby 2

Taking Care of Your Baby's Gums and Future Teeth 4

Your Baby's Four-Month Checkup 5

Dads Are Important 6

Questions Parents Ask 8

Coping with Stress 9

Helping Your Baby To Fall Asleep 10

What's It Like To Be Four Months Old? 12

Games You Can Play with Your Baby 13

Toy Safety Is Important 14

Helping Your Baby Explore 16

Talking with Your Baby 17

Babies Respond to Angry and Happy Faces 18

Your Baby Learns from Experience 19

Guiding Principles To Help Your Baby Every Day 20

Information Resources for Families 22

# Your Baby Is Four Months Old

When your baby reaches the age of four months, things will really start
to happen fast. She is growing and learning about her world. She is
interested in everything she sees or hears. She is reaching for things
and putting them in her mouth. This is how she learns about them.

When she is feeding, she stops and plays with your clothes, or she looks
at other people in the room.

She may try to roll over. The more she tries, the better she can do it.

She smiles when she sees her parents and other people who care for her.
She may frown when she sees strangers. She babbles. She tries to imitate
your words as she makes sounds.

She may start sleeping at night for longer and longer periods of time.
She will love it when you sit on the floor and play with her. You can
have a lot of fun with your baby at this age.

The more you help her explore, the more she will reward you with smiles,
happy sounds and love. You can help her by playing with her, singing to
her and talking to her. Enjoy your baby as she grows and develops!

# Feeding Your Baby

Make sure your baby is ready for solid food before you give it to her.
Don't rush her into eating solid food. Some babies are ready for it at
four months. Some babies aren't ready until they are older. Your baby's
weight or age alone does not determine her readiness for solid food.

Here are some signs to look for that will tell you if your baby is ready
to

try solid food:

-   She holds her head steady and sits with support.

-   She reaches for and shows interest in food.

-   She opens her mouth when she sees food.

-   She no longer thrusts her tongue out during feeding, so she's able
    to keep food in her mouth and swallow it.

-   She turns her head away when she's full.

Most babies are ready for baby cereal when they're between four and six
months of age. Ask your doctor about the best time to start your baby on
solid food. Rice, oatmeal or barley cereals are OK if they are finely
ground. Use them one at a time.

Mix some infant cereal with breast milk in a bowl. You can also use
formula instead of breast milk. Don't use cow's milk or any other kind
of milk or other liquid. Hold your baby in a sitting position or put her
in a child seat on the floor (Be sure she is strapped in.) so she
doesn't choke. Always use a spoon to feed solid foods to your baby.

See if your baby will take half of a very small spoonful. If she turns
her head away or cries, she's not ready. Try again in a week or two.

When she is ready, she will take small, messy bites. She may roll the
food around in her mouth or feel it repeatedly with her tongue. Making a
mess is part of learning, so just have fun with her. At this age, your
breast milk or infant formula provides all the nutrition your baby
needs.

Give your baby only one new food at a time. You can then see if any one
of the foods causes allergic reactions. Right now, only infant cereals
are a good choice. If one of these types of cereals is a problem for
her, she will vomit or get a rash. She may also have diarrhea. If this
happens, call your doctor or go to your clinic.

# Taking Care of Your Baby's Gums and Future Teeth

It's never too early to start taking care of your baby's future teeth.
Here are some simple things you can do for her:

-   Never put your baby to sleep with a bottle.

-   Once a day, gently wipe her gums with a wet, clean soft cloth. Start
    doing this even before her teeth come in.

-   Some babies show teeth as early as four or five months. Most babies
    show teeth between six and eight months.

-   When her teeth begin to show, you may use a soft toothbrush for
    cleaning. Make sure it is baby-sized. Or you can continue to clean
    her teeth every day with a cloth.

-   Gently brush her teeth with water only. Toothpaste is not needed
    until your baby is around three years old. She should be old enough
    to spit out the toothpaste after brushing.

# Your Baby's Four-Month Checkup

Your baby needs regular health checkups. She needs the checkups even if
she's not sick. Checkups can keep her healthy. She will have her vision,
hearing, weight and length checked.

Your baby will receive shots. Ask your doctor or nurse what to look for
and what you should do if your baby has any reaction to these shots,
like fever or fussiness. Shots will keep her from getting sick and keep
her healthy.

The doctor will also make sure your baby is developing as she should.
The doctor will ask you if your baby is reaching for toys. He will ask
if your baby smiles and coos.

Before the checkup, write down questions you have about your baby. Bring
the questions with you to the checkup. This is a good time to ask any
questions you have about your baby. This is a good time to ask the
doctor or nurse questions like, "What are the symptoms a baby has when
she has a cold? How should I treat her if she has a cold? What kinds of
problems should I call you for? What temperature should I call you for?"

Always ask the nurse or doctor for a copy of your baby's checkup
results. It's a good idea to keep the copy in a notebook or safe place.
If the doctor tells you to give your baby any medicines, write down the
names of the medicines and directions. Using a notebook will help you
keep track of your baby's health and development. Make an appointment
for your baby's six-month checkup.

Your baby may get her first cold or ear infection. As your baby explores
her world and plays with other children and adults, she will have more
contact with germs. If you don't know what to do about her symptoms,
call your doctor or clinic. They will be able to tell you if she needs
to see a doctor.

# Dads Are Important

Dad, it's never too early for you to get involved with your baby. You
have an important role to play in your baby's life. She wants to play
with you and learn from you. Showing your baby that you care about her
will help her. It will make taking care of her more fun for you and her
mom.

Babies learn from all the adults around them. It's good for your baby to
have someone besides her mom to learn from.

Taking care of your baby is important and can be fun. Be very gentle
when you play with your baby. Use a calm voice.

If you do these things for your baby, she will reward you with smiles,
happy sounds and love. She will smile when she sees you, and she will
reach for you when she wants to play. The bond you make now with your
child will last a lifetime.

You and your baby's mom can learn more about how to care for your baby.
Look in the Yellow Pages of your phone book. There may be a "community
service" section near the front of the book. Look under "support groups"
for parenting help.

Here are some things you can do with your baby:

-   You can hold her.

-   You can talk to her.

-   You can sing to her.

-   You can show her toys.

-   You can bathe her and dress her.

-   You can comfort her when she's fussy.

-   You can help teach her how to talk.

-   You can take her to child care.

-   You can take her to health checkups.

-   You can help feed the baby. If your baby's mom is breastfeeding she
    can pump some of her milk into bottles, and you can give this breast
    milk to your baby. As your baby learns to eat solid food, you can
    feed her with a spoon.

# Questions Parents Ask

"Whenever my baby cries, I pick her up. My friend says I'm spoiling her.
Is my friend right?"

No, you don't have to worry about spoiling your baby. When you pick your
baby up, you are doing the right thing.

By reacting to her needs, you are teaching your baby that she can trust
you. Holding her brings her comfort. It shows her that you care when she
is hungry, in pain, afraid or unhappy.

Meeting your baby's needs makes her feel safe and loved.

It's good to respond quickly when your baby is crying. Her needs are
immediate. When your baby is hungry, she wants to be fed. When your baby
is wet, she wants a dry diaper. When she is uncomfortable or scared, it
helps her to be held.

It's not good to ignore your baby. She depends on you to respond to her
needs. She learns to trust because you respond to her needs. Your baby
needs a lot of love from you.

# Coping with Stress

Taking care of a baby may cause stress. It's a big job. It's normal to
have moments of sadness, fear, frustration or anger.

These feelings can be powerful. When you are angry, you may feel like
hitting someone. You may feel like breaking things or saying hurtful
things.

But there are other ways to deal with strong feelings. Here are some
tips:

-   Talk about these feelings with someone you trust. The worst thing
    you can do is keep these feelings to yourself.

-   Talk to your spouse or a family member.

-   Talk to a friend, a doctor or a member of the clergy.

-   Try to exercise. Put your baby in a stroller or in your arms, and
    take a walk. Exercise at home while your baby sleeps. Being active
    can make you feel better. Exercise can give you more energy to take
    care of yourself and your baby.

-   Take time to relax. Take a moment for yourself while your baby naps.
    Do something that calms you down. Take a break from your chores.
    Take a moment to talk to a friend, read, listen to music, just be
    still or enjoy a hobby.

-   Don't take your stress out on your baby by yelling at her or
    avoiding her. Get someone to help you for a while so that you can
    calm down or get rest.

If you want to know more about how to cope with stress or groups that
help parents cope with stress, ask your doctor or clinic.

# Helping Your Baby To Fall Asleep

Many four-month-old babies sleep through the night. They go between deep
and light sleep several times.

-   A baby in light sleep may cry out. She may move around in bed. This
    may wake her up. As she cries and moves around, she gets upset. She
    will settle herself if she has a way to comfort herself. She may
    comfort herself by sucking her thumb or holding a blanket. Or she
    may get into a comfortable position, which will also settle her
    down.

-   Some babies have more trouble settling down than others do. Going to
    bed at the same time each night will help her settle down. Keep the
    house quiet. Loud TV or music may keep your baby awake.

-   To help your baby to relax, you can give her a warm bath, massage
    her or rock her. Reading or singing to her may also help her settle
    down. Don't rush to her if she starts to cry. She may calm down
    after a few minutes and fall asleep on her own. If she continues to
    cry, pick her up.

-   Always place the same baby-safe soft doll or stuffed animal in your
    baby's crib when it is time for sleep. She will learn to connect the
    stuffed toy with falling asleep.

-   You can sing to your baby at bedtime. Put her to bed before she is
    completely asleep. Then stay beside her and pat her calmly. This can
    help set a good pattern for going to sleep.

-   What your baby does during the day can affect her at night. If she
    had too much excitement during the day, she may not sleep through
    the night. It may take several days for her to get back to her usual
    sleeping pattern.

# 

# 

# What's It Like To Be Four Months Old?

How I grow

-   When I lie on my tummy, I may roll from side to side. I may even
    roll over onto my back.

-   I may be able to sit with support.

-   I can hold my head up on my own. I can turn my head from side to
    side.

-   I use both hands to grab toys and other objects.

-   When I'm in the bathtub, I like to splash in the water. I always
    need to be held firmly so I don't slide into the water.

How I understand

-   I may get excited when I see people I know. Sometimes I don't like
    strangers.

-   I like some toys better than others.

How I talk

-   When you talk to me, I smile and squeal and coo.

-   I like to imitate sounds. I like for you to talk to me and make
    sounds to me.

-   I babble now. I make lots of different sounds.

-   When I am happy, I coo, squeal, gurgle, giggle, grin and laugh out
    loud.

How I respond

-   I like to look at myself in the mirror. Sometimes I smile at myself.

-   I like to be touched and held.

-   I may fuss if I am left alone. I get bored.

-   I may cry when you take a toy away from me. I may cry when you stop
    playing with me.

# Games You Can Play with Your Baby

Babies learn by playing. Here are some games you can play with your
four-month-old:

-   Play peek-a-boo. Place a sheet or baby blanket over your head, lift
    it up and softly say, "Boo!" Your baby will enjoy many ways of
    playing this game.

-   Sing simple songs to your baby. You can sing nursery rhymes, or you
    can make up your own songs.

-   Lay your baby on her back and sing a song while you gently move her
    arms in a big circle. You can also gently move her legs and raise
    her arms.

-   Slip a colorful scarf through a plastic bracelet and tie the scarf
    to the arm of a chair. Lay your baby next to the plastic ring. Your
    baby will grab the ring and move the scarf around on the chair arm.

-   After a bath, sprinkle baby powder into your hands. Do not sprinkle
    it directly on your baby or near her face. Instead, gently massage
    your baby's body with the powder. Talk to her or sing a song while
    you're massaging her.

-   Put a brightly colored sock on your baby's foot. Your baby will
    notice her foot. In time she will be able to grab it with her hands.
    Make a game out of it by helping her reach for the sock and helping
    her pull it off.

# Toy Safety Is Important

Babies put things into their mouths. So it is important to make sure all
toys you give your baby are safe. Here are a few things to look for when
choosing toys:

-   Make sure toys that you buy for your baby are labeled "non-toxic."

-   Toys should have no sharp edges or points.

-   Inspect toys often to make sure there are no loose parts. Older toys
    may break and have sharp edges.

-   Make sure small toys, such as squeak toys, rattles and teethers, are
    large enough so that your baby can't put the whole toy in her mouth.
    Smaller toys can get stuck in your baby's throat.

-   Don't give your baby toys with strings or ribbons. If you have toys
    like this, just remove the strings.

-   Don't hang toys or a pacifier around your baby's neck.

-   Don't give your baby toys that have small parts. The parts can come
    off and she could choke on them. Check for small parts such as
    buttons and eyes that are glued on.

-   Don't give her toys with beads that can be pulled off. Toys that are
    stuffed with small pellets can come apart, and your baby could choke
    on the pellets.

-   Don't let your baby play with a plastic bag. It can choke or smother
    her.

-   Don't give your baby balloons to play with. The balloon can break
    and create a choking hazard. Don't give pieces of popped balloons to
    children of any age. Babies and children can choke on balloon
    pieces.

-   Don't let your baby play with plastic wrapping from toys or other
    items.

-   Older children should be told not to use loud toys around the baby.
    Such loud noises can damage her hearing.

# Helping Your Baby Explore

By the time your baby is four months old, she is beginning to learn to
move around. She may even roll from her stomach to her back.

Your baby can sit up if you prop her up with pillows. She is also able
to grab an object with both of her hands.

Since she can now hold toys, your baby spends more time playing.

At this age, babies need time to explore the world around them. It is
important to give them time on a flat surface. Place your baby on a
blanket on the floor. If you are outdoors, place a blanket on the
ground. Make sure the blanket is out of the hot sun. Do not put it near
objects or insects that can hurt her. Let her wear clothing that allows
her to move easily. Watch her very carefully. Do not walk away leaving
her on the blanket, even for moment.

Here are some activities to try:

-   Place toys just out of reach so your baby will reach for them. She
    will learn that she has to wiggle and reach to get the toys. If she
    can't reach a toy in a few seconds, place it within her reach so she
    doesn't get frustrated.

-   Spread a cloth on the grass and lay your baby on her stomach at one
    edge of the cloth. Gently raise the edge of the cloth so she will
    roll onto her back. Reward her with a hug and a kiss.

-   Place an unbreakable mirror next to your baby's blanket so she can
    look at herself. Make sure the mirror cannot fall and break.

# Talking with Your Baby

At four months of age, your baby is already putting together ideas about
speech and sounds. She does this even though she cannot speak.

Even without speech, your baby already knows how to "talk" with you. She
"speaks" by being fussy or with happy giggles. She will learn more ways
to let you know her needs, even before she learns to speak. She has
learned to coo and laugh.

Not all sounds and gestures are for communication. Learning to make
sounds is fun for a baby. Hearing the sounds she makes is also fun for
her.

Taking turns is part of language. When your baby coos or gurgles, be
sure to listen to her. Then respond. Talk to your baby often. Use both
familiar words and sounds and new words and sounds. This will get her
attention and hold it.

Babies start to learn to talk at different ages. They also learn in
different ways. Talking to your baby a lot helps her learn.

# Babies Respond to Angry and Happy Faces

A baby's social skills start to develop long before she can talk. So do
her emotions. Babies quickly come to know emotions and to show them.

A four-month-old baby can tell a happy face when she sees it. And she
can tell an angry face when she sees it. She is also aware of a face
with no expression.

If there is a lot of yelling and screaming in the house, the noise and
emotion will affect your baby.

Another step in learning social skills is that your baby will show when
she is angry or sad. She'll do this when she doesn't get what she wants.
Anger and sadness are normal. Even so, you don't want your baby to have
any negative experiences that last a long time. Babies should have far
more positive experiences than negative experiences.

Always be sure to comfort your baby quickly. It does more than provide
relief. It also builds up the bond between you and your baby.

Babies differ in how social they want to be. Some babies want almost
constant time with others. Other babies want more "alone" time. However,
it can be very harmful to a baby to leave her alone too much or ignore
her.

You should always respond to your baby's needs. This attention will make
her happier. Her ability to think and know is tied to her emotions.
Babies who feel good are more alert. They are also more attentive and
responsive. They learn better. They remember better, too.

Learning about other people starts at an early age. Relating with people
also starts early. It is a good start when your baby learns to trust and
enjoy her parents and others who take care of her.

# Your Baby Learns from Experience

Each brain, like each child, is unique. Here are some things you should
know about your baby:

-   The brain grows fastest in the first three years of life.

-   It's hard to describe how a child's brain develops. It depends on
    traits that come from the parents. It also depends on the child's
    experiences. You can influence the part that depends on experience.

-   Babies cannot see well when they are born. At four months, your
    baby's vision has improved. Now she may show interest in objects all
    the way across the room. Show your baby bright and colorful objects.
    Move them slowly to help her stay interested in them.

-   A baby's hearing develops early. Talk to your baby often. A baby can
    remember patterns of sounds. She can remember the sounds of a story
    that you read over and over. She can also remember the sounds of a
    song. Tell her a rhyme over and over for several days. Read her a
    story over and over for several days. Or sing the same song for
    several days with your baby. Watch how she responds.

-   Touching your baby gently can help to quiet her or to stimulate her.
    It depends on how you do it. Massaging your baby gently can help her
    relax.

-   Your baby learns more when you respond to her needs.

-   Most infant memories do not last long. Even so, your baby's memory
    is active.

# Guiding Principles To Help Your Baby Every Day

Here are some important things you can do that will help your baby every
day:

-   Be your baby's teacher. Babies learn when they have many good
    experiences with someone who loves them. Give your baby a rattle.
    Say, "Shake, shake," as you move it and make sounds together. Name
    things for your baby. For example, say, "Look at the tree. Let's sit
    under the tree." This helps your baby develop language.

-   Encourage your baby to explore. Your baby is at an age when she
    likes to be held up to look at things. Looking at things is
    important for her. Look at something together, and move it around.
    Your baby now is holding on to things and putting them into her
    mouth. This helps her explore. It also helps her develop movement
    skills. Find things she can play with like unbreakable spoons or
    plastic cups, and get down on the floor and play with her.

-   Get excited about your child. Show your excitement when she does
    something. Make sure you act immediately. Your baby will connect
    your pleasure with what she has just done. For example, when your
    baby sits up as you hold her, say, "Look at you! You are sitting
    up!"

-   Repeat things with your baby. Babies learn by doing the same thing
    over and over. Your baby may learn faster when she has lots of time
    playing and talking with you.

-   Communicate. Talk and sing to your baby. She has been learning about
    language since birth. Talking to her helps her to learn.

-   Do not treat your baby harshly.

-   Babies do not know right from wrong.

-   They should not be punished.

-   They should not be teased in a rough manner.

-   Never shake or hit your baby. Never allow anyone else to shake or
    hit your baby. This can cause injuries, brain damage or even death.

# Information Resources for Families

Families who are enrolled in the WIC program (Special Supplemental
Nutrition Program for Women, Infants and Children) can get information
on breastfeeding, formula feeding and nutrition at their local WIC
office. Families eligible for WIC receive nutrition counseling and
supplemental foods such as baby formula, milk and cereal. To find the
WIC office nearest you, call your state health department or visit the
WIC Web site at www.fns.usda.gov/wic/. Many public libraries offer free
access to the Internet and provide help for first-time users.

For information about early childhood education initiatives, you may

contact the U.S. Department of Education at 1-800-USA-LEARN or visit the
Web site at www.ed.gov/offices/OESE/teachingouryoungest/.

To learn about child care options, you may contact the U.S. Department

of Health and Human Services, Child Care Aware by phone at

1-800-424-2246 or visit their Web site at www.childcareaware.org/.

For more information and resources on postpartum depression,

breastfeeding and many other women's health issues call The National
Women's Health Information Center (NWHIC) at 1-800-994-9662

(1-800-994-WOMAN). You can visit their Web site at www.4woman.org/.

To learn more about breastfeeding, you may call La Leche League at

1-800-LALECHE or visit their Web site at www.lalecheleague.org/.

To learn more about free or low-cost health insurance for children, you
can call the U.S. Department of Health and Human Services' Insure Kids
Now program at

1-877-KIDSNOW. You can also visit their Web site at
www.insurekidsnow.gov/.

The American Association of Poison Control Centers' (AAPCC) poison
control hotline, 1-800-222-1222, should be on your list of emergency
numbers. To learn more, you can visit the AAPCC Web site at
www.aapcc.org/.

Families who cannot afford a car safety seat can contact the National
Highway Traffic Safety Administration. They can provide information on
resources that help low-income families purchase or borrow child car
seats. You may call them at 1-800-424-9393 or visit their Web site at
www.nhtsa.dot.gov/.

To learn more about safety, you can call the Consumer Product Safety
Commission at

1-800-638-2772 or you can visit their Web site at www.cpsc.gov/.

# Coming Next Month

Is Your Baby Teething?

Your Baby's Sleep

Stimulating Your Baby with Toys

Interacting and Playing

...and much more!

This pamphlet is distributed by the U.S. Departments of Agriculture,
Education

and Health and Human Services, and is in the public domain.
Authorization to reproduce it in whole or in part is granted. While
permission to reprint this publication is not necessary, the citation
should be: U.S. Department of Agriculture, U.S. Department of Education
and U.S. Department of Health and Human Services*, Healthy Start, Grow
Smart, Your Four-Month-Old*, Washington, D.C., 2002.

To order copies of this publication,

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This publication is available to download on the Department of
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available in Spanish on the Department of Education's Web site in
September 2002.

On request, this publication is available in alternate formats, such as
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