Hello, moms and dads, and welcome to Month 4 with your baby and Month 4 with my baby, Bracey. Bracey is now 17 weeks old, but since he was 10 weeks premature, he is only seven weeks old in terms of his corrected age. So in terms of milestones he’s closer to a two-month-old baby than a four-month-old.

Let’s take a look at a full term baby’s growth and development by month 4 and at what should be top of mind in terms of taking care for them. Then, I’ll talk about premature babies and give you an update on Bracey.

Growth and Development of a 4 Month Old Baby

Growth of a 16 Week Old Baby

At 16 weeks old, your baby has likely gained 5-7 pounds from birth (2.3-3.2 kilos) and they’ve grown about 2-4 inches or 5-10 centimeters.

Growth of a 17 Week Old Baby

At 17 weeks old, your baby has likely gained 5.3-7.4 pounds from birth (2.4-3.4 kilos) and they’ve grown about 2.125-4.25 inches or 5.4-10.8 centimeters.

Growth of a 18 Week Old Baby

At 18 weeks old, your baby has likely gained 5.6-7.8 pounds from birth (2.5-3.5 kilos) and they’ve grown about 2.25-4.5 inches or 5.7-11.4 centimeters.

Growth of a 19 Week Old Baby

At 19 weeks old, your baby has likely gained 5.9-8.3 pounds from birth (2.7-3.8 kilos) and they’ve grown about 2.4-4.8 inches or 6-12 centimeters.

Bracey was born weighing 1.490 kilos (3.3 pounds) and he now weighs 3.960 (8.7 pounds) so he has gained 2.5 kilos or 5.5 pounds, which is exactly within the range I just cited. Yeah! Your pediatrician will be measuring your baby’s height and weight against other similarly aged babies most likely based on data provided by the World Health Organization.

Pediatrician Appointment at 4 months.

At four months of age, your baby will return to the pediatrician for a thorough checkup. Your doctor will measure you baby, take their weight, check their reflexes, observe their neck strength and ability to hold up their head and test their vision and responsiveness. Your baby has developed a lot since birth and at four months, you start to really notice the changes.

Vaccine Doses at 4 Months

Your pediatrician will be administering another dose of the same vaccines your baby received at two months of age, including the DTaP, Hib, Polio, Pneumococcal (PCV), and the Rotavirus vaccine via the mouth. Let’s review what these vaccines are immunizing against, along with the suggested calendar according to which they should be administered to your baby.

The DTaP Vaccine for Babies

The DTaP vaccine protects against Diptheria, Tetanus and Pertussis. Diptheria and Pertussis spread from person to person. Tetatus enters the body through cuts or wounds. Diptheria (D) can lead to difficulty breathing, heart failure, paralysis or death. Tetatus (T) causes painful stiffening of the muscles and can lead to serious health problems including being unable to open the mouth, having trouble swallowing and breathing, or death. Pertussis or “whooping cough” can cause uncontrollable, violent coughing which makes it difficult to breathe, eat or drink. In babies, pertussis can cause pneumonia, convulsions, brain damage, or death. It is recommended that babies receive five doses of DTaP, at 2 months, 4 months, 6 months, 15-18 months, and 4-6 years. DTaP may be given as a stand alone vaccination or in combination with other vaccines.

Haemophilus Influenza Type B (Hib)

This vaccine is effective in preventing infections stemming from the bacteria Haemophilus Influenza Type B including: infections of the blood, bone and joints caused by this bacteria; pneumonia; pericarditis (an infection of the membrane covering the heart), and bacterial meningitis (infection of the tissue covering the brain and spinal cord). Bacterial meningitis used to kill about 1000 children in the US (20,000 used to fall ill). Today, less than 50 cases occur each year in children who have not been vaccinated. The CDC recommends that babies receive multiple doses of this vaccine, most commonly at 2 months of age, 4 months of age, 6 months of age (depending on the brand) and 12-15 months of age.

Polio (IPV)

Polio is a disabling and life-threatening disease caused by the poliovirus. The virus spreads from person to person and can infect a person’s spinal cord causing paralysis (the inability to move parts of the body). The CDC recommends that children get four doses of the polio vaccine: at 2 months of age, 4 months of age, 6 through 18 months of age and 4-6 years old.

Pneumococcal (PCV)

The PCV vaccination prevents against infections caused by pneumococcal infections including pneumonia, septicemia (a kind of blood poisoning) and meningitis. The CDC recommends four doses of this vaccine: at 2 months of age, 4 months of age, 6 months of age and 12-15 months of age.

Rotovirus (RV)

Rotavirus spreads easily among young children and causes watery diarrhea, vomiting, fever and abdominal pain. The CDC recommends three doses of the rotavirus vaccine: at 2 months of age, 4 months of age and 6 months of age. Alternatively, your baby might receive two doses at 2 months and one at 4 months. This depends on the brand your pediatrician chooses.

Hepatitis B (HepB)

Hepatitis B is a liver infection caused by the Hep B virus and is spread when blood, semen or bodily fluids from a person infected with the virus enter the body of someone who has been infected. The CDC recommends three doses of the Hep B vaccine: at birth, at 1-2 months of age and at 6-15 months of age.

Developmental Milestones for a 4 Month Old Baby

Baby’s Neck, Back, Chest, and Leg Strength at 4 Months

At four months, many babies can roll over from front to back, bear weight on their legs (50% can stand on their legs with support), hold up their head and chest, hold up their arms during Tummy Time (which is still recommended at regular intervals during the day) and push up to their elbows when laying on their stomach.

Baby’s Vision and Coordination at 4 Months

At four months, many babies are able to spot something they see, reach for it and grab it. Many babies also can follow objects moving from side to side with their eyes. At four months, your baby likely can tell the difference between different colors (particularly red and green) and see objects at a greater distance, up to several feet away. Babies this age can enjoy more complex patterns and colors so try reading them brightly colored books with large patterns. It’s great to get into the habit of reading to your baby at this stage. Try reading for 5-10 minutes each time you put your baby down to sleep.

How much does a 3 Month Old Baby Hear?

By this point, your baby can go beyond recognizing tone and can pick up on the different sounds you make and on actual words. Within a few months, your baby will respond to the word NO and even to their own name. Imagine!

Four Month Old Baby Brain Development

Your 4 month old baby can recognize facial patterns and mimic smiles or frowns. They can mimic sounds, and they can begin to understand cause and effect. They may show disappointment when playing stops, and you might notice them reacting with different cries to hunger, boredom or fatigue. Real, watery tears are coming at this point. Your baby now will likely be smiling frequently, most likely at the sight of you. And your baby will begin babbling more and using more vowel and consonant combos such as ba-ba-ba and ga-ga-ga.

How do I play with my 4 Month Old Baby?

You don’t need any fancy toys or gimmicks at the point. To play with your baby, walk around the house and point out colors, shapes and functions. Go to different family members and say their names repeatedly, emphasizing consonants, like “Da Da Da”. Look in the mirror together (hopefully it’s a good hair day for you). Encourage your baby to roll around (letting your baby practice going from tummy to back). Spread toys out on the floor to encourage your baby to move to get them and to pivot and turn. Pushing balls towards your baby and encouraging them to push back can help teach your baby about cause and effect since they will learn the relationship between their push and the object moving. Allow your baby to touch and feel different fabrics and textures from clothing, cushions or pillows. Read, encouraging your baby to touch the book. Lift your baby up and down safely, holding them securely under the arm pits. Avoid sharp objects, small objects that could be choking hazards, and never leave your baby unattended in an unsafe place.

And … drumroll please … you can now play peek a boo with your baby. Just make sure they don’t get upset when you go “boo.” Enjoy!

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4 Month Old Sleep Regression

Four month old sleep regression is a very common although little understood phenomenon. I’m actually wondering if I’m going through this right now, even though Bracey’s trajectory is measured differently since he is a premie. At four months, many babies revert to waking up more frequently then they did during month three, as often as every 2-3 hours at night. Some experts blame this on growth spurts. Other cite babies’ increased sensitivity to their environment or new tricks, like rolling over, as the reason why babies do not sleep as soundly as before.  The only thing you can do to battle sleep regression is to maintain consistency: continue to feed every three to three and a half hours during the day if you are nursing, and every four if you are bottle feeding. During the night, get up and give that baby a good feed. Try to go right back to sleep afterwards and to nap when you can. This to shall pass.

Breastfeeding and Sleeping Schedule and Amounts for a 4 Month Old Baby

How Much Breastmilk does my Baby Need

To calculate how much breastmilk your baby needs per feeding and across a day, take your baby’s weight in ounces and divide by 6. That is the amount of breastmilk your baby needs over the course of a day. Then, divide that number by the number of feedings your baby is taking. If you are using milliliters multiply the amount by 30. Bracey’s weighs 8.8 pounds. I multiply that by 16 to get the number of ounces, 140.8 and I divide by 6, resulting in 23.4 ounces. That is what Bracey needs over a 24 hour period. When I divide that by 7, I get 3.35 ounces and for milliliters I get 100. Now, we have been giving Bracey 1-2 bottles a day of 150 milliliters. I checked with my sister in law Eileen who is a pediatrician on this and she said it was fine as long as Bracey is not spitting up or showing signs of overfeeding.

For Month 4, I generally recommend the same breastfeeding schedule during the day. By this point, some babies will have dropped the 2:30-3am feed and will be able to sleep from 11:30pm to sometime in the early morning. This has to do with the increased size of your baby’s stomach and their capacity to hold onto more food.

• 7am — sleep 8:30-10am.
• 10am – sleep 11:30-1pm. 
• 1pm — sleep 2:30-4pm.
• 4pm — sleep 5:30-7pm. 
• 7pm — sleep 8:30-10pm. 
• 10pm — sleep at 11:30pm. This can be called the “top off” feed.  
• (2-3 am or when baby wakes up). *I’m putting this feeding in brackets as some babies will have dropped this feed at this point or it might happen later at 4-6am.  

Try to pump for 10-15 minutes after every feed or at least after the morning, mid-morning, and 4pm feed. The first two because you will have more milk and the afternoon feed because, like me at this time of day, you might have less so you want to stimulate more.

Bottle Feeding a 4 Month Old Baby 

The calculation for formula feeding amounts remains the same from months 0-6 and I will pop it up here for your convenience. Over a 24 hour period, you want your baby to consume 2-2.5 ounces of formula multiplied by their body weight. To see how much to give per feeding, divide that by the number of feedings per day. For example: 15 lb. baby x 2-2.5/6 feedings = /6 = 5-6 ounces of formula per feeding. Of course, you’ll be playing this by ear and giving your baby an amount that leaves them satiated and rejecting more food after they have burped. You’ll start to recognize what this looks like with your baby.

Overfeeding a Baby

Overfeeding a baby is uncommon, especially with regard to breastfed babies. Overfeeding happens when caregivers do not follow closely enough the signs coming from babies, focusing instead on certain markers such as how many ounces a baby should drink or finishing a bottle. Babies hunger and weight gain varies and you have to allow them to feed at their own pace. If your baby has burped and is rejecting more food by turning away from the breast and bottle, closing their mouth, appearing disinterested or falling asleep, you can safely assume they are full for a while and can stop. If they then cry after a short time, do not assume they are hungry. They might be gassy or tired. Try burping them or settling them down for nap. If they are full, they should be able to make it to the next feeding 3-4 hours later without an issue and you can wait to see signs of hunger before beginning that feeding.

Formula Feeding and Sleeping Schedule for a 4 Month Old Baby

• 7am — 9am nap
• 11am — 1pm nap
• 3pm – 5pm nap
• 7pm – 8pm bedtime
• 11pm – right back to sleep
• (3-4am or when baby wakes up – right back to sleep). I am putting these 3-4am feeding in brackets now because between 4-6 months most babies will drop this feed. I hope yours already has!

Over time your baby will give up the 11pm feeding, as well.

Premature Babies and Milestones

I’ve spoken in prior shows about how to assess milestones when to comes to premature babies: subtract the number of weeks by which your baby was premature from their age. Bracey was born 10 weeks early and is now 17 weeks old, so I subtract 10 from 17 weeks  and get 7 weeks. Meanwhile, there are some things Bracey does that seem beyond a seven-week-old. He smiles alot. He chirps back at us when we say hi. He holds his head up and turns it. He’s our little miracle just as your baby is yours.

One other thing to note with premies is that the newborn phase inevitably gets extended. I’ve been getting up every three hours to pump or feed now for almost four months yet my baby is really a 7 week old. So on the plus side, we’ve had more time with him but on the minus, we’re tired. But still loving every moment.

Bracey Update

Bracey had a terrific month. He weighed 3.960 kilos at his doctor’s appointment on Wednesday and was told he did not need to come back for a whole month. This good news came, however, after an intense three week struggle with my personal demon, nipple confusion, which I have been battling since we took Bracey home 11 weeks ago. And I have followed Winston Churchill’s mantra (and I am paraphrasing) : Never, never give up. It’s been very tough. We had a couple weeks during which he did not gain enough weight and I was advised to top off each feed with a bottle (which my pediatrician told me would effectively end the breastfeeding) or to stop nursing from the breast entirely and pump and give bottles. Having nursed my other babies for over seven years, I knew that over time this also would mean the end of the breastfeeding as in my experience, I do not get as much milk from just pumping. I got so depressed over this. During one particularly grueling day when Bracey was very reluctant to nurse from the breast knowing he was going to get the bottle, I hatched a new plan. I decided to feed getting the let down and doing my best to make sure Bracey was awake, burped and rejecting more food. This took alot of energy especially during the night when I had to force myself to get up and feed him properly versus having him nurse in the side lying breastfeeding position. It worked, and Bracey gained the weight. Now, for me at this stage, two bottles is the tipping point and if I go beyond that, Bracey gets lazy about the breastfeeding.

Apart from feeding, Bracey enjoyed hugs and kisses with his siblings, a cozy Christmas in a red tin soldier outfit and travels in his cozy white polar bear outfit.

His constipation has gotten better as he’s gained weight and last night he gifted us with an enormous explosive diaper that went all the way up his back, resulting in a warm bath at 10pm!

Thanks so much for reading and watching and see you back soon for Month 5 with your baby!

Melissa

Resources

VeryWellFamily

WebMD

Parents.com

Whattoexpect.com

Kidshealth.org