You can find my post on the 2 month well baby appointment here. Please note that in Ontario, the 2 and 4 month immunizations are the same, so I will not be covering them again in this post. Please refer to my last post for the immunizations.

Disclaimer: this blog is not medical advice. It is for informational purposes only. Please seek medical advice from your trusted healthcare provider.

What to Expect at the 4 Month Appointment

The 4 month visit is the second well baby check for your baby. Ideally, they should have been seen at 2 months as well by their primary care provider (PCP) – it could be your family doctor, nurse practitioner, or paediatrician. You may have been seen in-between if your baby required weight checks or other follow ups, or visits to address other concerns.

Well baby or well child visits usually include a physical examination; growth check (including weight, length and head circumference); a check in on developmental milestones, nutrition/feeding, and health teaching as needed.

Your provider will ask you questions about your little one and examine them. Some questions you might be asked and topics that might be discussed with you include (and this is not exhaustive or necessarily exact, but just an overview of what may be asked or what you can think about if you have concerns to bring up during your visit):

• How are you feeding your baby?
  • They should then ask specifics depending on how you are feeding your baby, such as: are you giving vitamin D (breastfeeding) supplement or how much/which formula are you using?
• Solid introduction may be mentioned at this appointment, but it will be reinforced at the 6 month visit. This is a good time to ask any early questions you may have.
• Your provider may also review things like child safety and injury prevention; typical behaviours and sleep; the importance of tummy time; and more. Some topics may be based on questions you ask. It’s good to make a note on your phone over time if you have questions that are non-urgent for your provider, then you can ask them during the appointment (because mom or parent brain is real and we forget!).
• They will ask about development. Questions such as:
  • Is your baby visually tracking people/objects?
  • Does your baby get excited when they interact with people? Excitement would be demonstrated through sounds and movement (legs kicking) for example.
  • How is their head control when being held in a sitting position or supported at the waist?
  • Do they grasp objects (even if brief)?
  • Are they smiling and laughing in response to you?
  • Do you have any concerns about your child’s development?

The physical examination at this visit is similar to the last one. Red reflex (eyes) will be checked again. They may also check baby’s anterior fontanelle (the soft spot at the front of the skull) and maybe also the posterior fontanelle (bacon the head) – however, it should be closed by around 2 months, whereas the anterior one does not close until at least 7 months but may not until up to 18 months. They may double check that your baby has completed their hearing test (most already have before the 2 month appointment). They may also assess your baby’s neck and hips; muscle tone; and abdomen/lungs/heart with a stethoscope and palpation (using their hands to assess).

And last but not least – the immunizations! As I mentioned, these are the same in Ontario as the 2 month visit so you should already be familiar with what is being administered. Your provider or nurse should review with you after care, and when to call if there are any issues.

I wrote a post recently on immunization aftercare which you can find here.

Your next visit will be at 6 months (barring any off schedule/follow-up visits in the interim). At 6 months, there will be a slight change in the immunizations offered, new topics of discussion/teaching and new questions regarding your baby’s development & feeding as they start their journey with solids around that time! How exciting!

You can read about our experience with the 4-month visit here.

See you all at 6 months!