Recommended Assessments, Screenings, and Treatments for a 4-Month-Old Female Well-Child Visit
At the 4-month well-child visit, comprehensive assessment should include growth measurements, developmental screening, nutritional guidance, immunizations, and anticipatory guidance to ensure optimal health outcomes.
Physical Examination and Measurements
- Measure and plot weight, length, and head circumference on appropriate growth charts
- Calculate and plot weight-for-length
- Perform complete physical examination including:
- Skin assessment
- Fontanelle examination
- Eye examination (red reflex, tracking)
- Heart and lung auscultation
- Hip examination for developmental dysplasia
- Neurological assessment
- Oral cavity examination
Developmental Assessment
- Perform developmental surveillance using standardized tools 1
- Assess age-appropriate milestones:
- Social: smiles spontaneously, enjoys social play
- Language: coos, babbles, turns to sounds
- Cognitive: follows objects 180 degrees
- Motor: good head control, pushes up on arms when prone, reaches for objects
Nutritional Assessment and Guidance
- Assess feeding patterns and growth
- Support exclusive breastfeeding through 4-6 months 1
- For formula-fed infants, ensure use of iron-fortified formula only 1
- For breastfed infants who were preterm or had low birthweight, recommend iron supplementation (2-4 mg/kg/day up to 15 mg/day) 1
- Discuss introduction of solid foods at 4-6 months when developmentally ready 1
- Recommend iron-fortified infant cereal as first solid food 1
Immunizations
- Administer age-appropriate vaccines per CDC schedule:
- DTaP (2nd dose)
- IPV (2nd dose)
- Hib (2nd dose)
- PCV13 (2nd dose)
- Rotavirus (2nd dose)
- Review potential vaccine side effects and management
Screening
- Universal screening for iron deficiency is not recommended at 4 months 1
- Assess risk factors for lead exposure 1
- Screen mother for postpartum depression 1, 2
- Perform hearing assessment if not completed or if concerns exist
Safety and Injury Prevention
- Reinforce proper use of rear-facing car seats
- Discuss fall prevention as infant mobility increases
- Review safe sleep practices (back to sleep, firm mattress, no co-sleeping)
- Discuss water safety and never leaving infant unattended
- Review home safety measures (smoke detectors, water temperature)
Follow-up Planning
- Schedule next well-child visit at 6 months
- Ensure mechanism for addressing parental concerns between visits
- Verify plan for obtaining emergency services if needed 1
Special Considerations
- For infants discharged from hospital before 48 hours after birth, ensure appropriate follow-up was completed 1
- For infants at high risk for developmental delay, consider more frequent developmental monitoring 1
- For infants with feeding difficulties, consider referral to lactation consultant or feeding specialist
Common Pitfalls to Avoid
- Missing maternal postpartum depression: Screen all mothers through infant's first 6 months 2, 3
- Introducing cow's milk too early: Discourage use of cow's milk, goat's milk, or soy milk until 12 months 1
- Overlooking iron needs: For breastfed infants who were preterm or low birthweight, iron supplementation is essential 1
- Inadequate developmental surveillance: Formal screening tools are more effective than informal observation alone 1
- Insufficient anticipatory guidance: Address sleep, feeding, and safety concerns proactively
By following these comprehensive recommendations, healthcare providers can ensure optimal health outcomes for 4-month-old infants during well-child visits.