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Parents often wonder about their child’s health, leading to the frequently asked question: “Is my baby healthy and growing normally?”

These information sheets outline normal and healthy growth and developmental milestones, and common health topics for your baby.

Due to space constraints, some messages are repeated at several ages while others appear once only. Read the complete set of sheets to obtain the entire information.

The Rourke Baby Record (RBR) is a guide that many Canadian doctors and other healthcare professionals utilize for well baby and child visits for babies and children from 1 week to 5 years of age.

photo of a baby

4 Months

Feeding & Growth

  • Breastfeed your baby on-cue when he seems hungry. If your baby is taking breastmilk, give him Vitamin D drops (400 IU/day or 800 IU/day in Northern communities). You should also take a standard multivitamin with at least 400 – 600 IU Vitamin D daily while breastfeeding.”
  • When breastmilk is not available, give commercial, not homemade, formula, when your baby seems hungry. At this age, she will likely drink about 750 to 1080 mL (25 to 36 oz) formula per day.
  • The bowel movements (stools) of your breastfed baby may now be firmer and pasty rather than wet and seedy and can occur up to several times daily or only once or twice a week.
  • Starting solids depends on your baby’s readiness, from a few weeks before to just after 6 months. Your baby is ready to try solids if she can hold her head up and sit with little help and open her mouth when food is offered. She can accept food from a spoon and swallow it and can turn her head to refuse food.
    • Stir a little pureed food into some breast milk, formula or water, and give off a spoon.
    • Start with iron-containing foods like meat, wild game, fish, legumes, tofu, whole eggs, iron-fortified infant cereal. Then you can add vegetables and fruits. Offer these foods at least twice a day.
      • Talk with your health care provider about the best time to start allergenic foods like eggs and peanut products.
    • Leave 2 days between starting new foods to tell how the first is tolerated.

Keeping Baby Safe

  • Childproof your home. Lock away all medications and cleaning products. Cover electrical outlets and tape down cords. Find the hazards before your baby does. Have Emergency numbers handy.
  • To prevent falls, never leave your baby alone on his change table or other high surface. Use window guards and stair gates. Baby walkers on wheels are banned in Canada and should never be used.
  • To prevent drowning, never leave your baby alone in the bath. Do not use baby bath rings or bath seats.
  • Never shake your baby. This can cause serious brain damage or death. If your baby will not stop crying, and you feel like you are losing control after trying to comfort her, lay your baby in her crib and take a moment to collect yourself before trying to soothe her again.
  • Stop swaddling your baby once he is trying to roll.
  • Never leave a child unattended in a vehicle

Other Advice

  • Let your doctor know if you are giving your baby any complementary or alternative medicines, especially if your baby has any health problems.
  • Spitting up (reflux) is common: almost half of healthy 3-4 month old babies spit up at least once daily and almost all stop by 1 year of age. Most require no treatment. Talk to your doctor if your baby is not gaining weight adequately, or cries or coughs during feeding or when spitting up.
  • Your baby may begin teething. The first tooth normally appears on the bottom gums when he is about 6 months old, but this can range from before 3 months to after 12 months. To help soothe your baby, do not give any over-the-counter gels, but you can rub his gums with a cold damp cloth. When your baby’s teeth appear, clean them twice daily with a soft bristle baby toothbrush using water.

Development

  • At 4 months, your baby should:
    • Lift his head and chest up while lying on his tummy.
    • Holds an object briefly when placed in her hand.
    • Follow a moving toy or person with his eyes past the midline.
    • Responds to you with excitement. She may move her legs, pant, or make cooing sounds.
  • Play with your baby by giving him a variety of things to hold. Also have quiet time with rocking and cuddling. Try to keep the same bedtime routine.
  • Read, sing and tell stories to your baby.
  • Report any concerns about your baby’s development, including her hearing and vision, to her physician or other healthcare professional.

Vaccinations

  • Pain when the vaccine needles are given is less when your baby is breastfeeding, held and hugged, given a sweet liquid, or if a local anaesthetic cream is applied before the needles are given.
  • After the vaccinations, your baby may have no reaction, or may be fussy or sleep more or less than usual. He may have a mild fever or a little redness or swelling where the needle was given. If needed, you can give him acetaminophen. Call your doctor if his fever reaches 40oC (104oF), if he is crying/fussy for more than 24 hours, is unusually sleepy or unresponsive, or has swelling at the needle site that is worsening.

Resources

For more information on your baby’s health, the top 5 websites cited by the RBR Parent Resources are:

  1. Canadian Pediatrics Society – Caring for Kids (www.caringforkids.cps.ca)
  2. Hospital for Sick Children – About Kids Health (www.aboutkidshealth.ca)
  3. Parachute - (www.parachutecanada.org)
  4. Dietitians of Canada – UnlockFood (www.unlockfood.ca/en/default.aspx)
  5. Health Canada (www.hc-sc.gc.ca)

Support and Acknowledgements

Financial support for the Rourke Baby Record has been provided by the Government of Ontario. In-kind support from the Canadian Paediatric Society, College of Family Physicians of Canada, and Dietitians of Canada. 2024 brochure revisions by Dr. Anne Rowan-Legg. As information is constantly changing, the Rourke Baby Record and these brochures should be used as a guide only.

August 2024