aap 4 month well child visit

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Bright Futures Guidelines and Pocket Guide

Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, 4th Edition is an essential resource that provides health care professionals​ with updated background and recommendations for pediatric health promotion, health supervision and anticipatory guidance for 31 age-based visits. The 4th Edition builds upon previous editions with thoroughly revised and updated content that reflects the latest research. It presents a new focus ​on the social determinants of health and on lifelong physical and mental health. The Bright Futures/AAP Periodicity Schedule​ presents (in chart form) the screenings, assessments, physical examinations, procedures and timing of anticipatory guidance recommended for each age-based visit in the Bright ​Futures Guidelines, 4th Edition .

​​Bright Futures/AAP Periodicity Schedule: Trusted for its Evidence-informed Content

These recommendations in the Bright Futures/AAP Periodicity Schedule represent a consensus by the AAP and Bright Futures. The AAP continues to emphasize the great importance of continuity of care in comprehensive health supervision and the need to avoid fragmentation of care.

For implementation and coding information for each visit on the Bright Futures/AAP Periodicity Schedule, please see the  Bright Futures and Preventive Medicine Coding Fact Sheet .

The  Bright Futures Guidelines, 4th Edition ​  is available below to download for review and reference purposes only. Visit ShopAAP to purchase it in paperback and eBook formats​​.​​​​​

​This section provides an overview of the comprehensive approach to health supervision, contributors, acknowledgements, In Memoriam and an introduction to the 4th Edition.

• Introduction

This section features an introduction and 12 chapters on key health promotion themes to be aware of in each stage of child development. ​

• Introduction to Themes
• Promoting Lifelong Health for Families and Communities
• Promoting Family Support
• Promoting Health for Children and Youth with Special Health Care Needs
• Promoting Healthy Development
• Promoting Mental Health​
• Promoting Healthy Weight
• Promoting Healthy Nutrition
• Promoting Physical Activity
• Promoting Oral Health
• Promoting Healthy Sexual Development and Sexuality
• Promoting the Healthy and Safe Use of Social Media
• Promoting Safety and Injury Prevention

This section includes an introduction, evidence and rationale and 4 chapters providing detailed health supervision and anticipatory guidance for the 31 age-based recommended health supervision visits.​

• Introduction to the Health Supervision Visits
• Evidence and Rationale
• Infancy Visits
• Early Childhood Visits
• Middle Childhood Visits
• Adolescence Visits

This section includes all of the appendices and the book index.

The Pocket Guide for the 4th Edition summarizes elements of each visit in a handy 7- by 4-inch booklet, ideal for quick reference by providers on the go. With all the essentials, the Pocket Guide summarizes each visit's developmental observation, physical examination, medical screening, immunizations and anticipatory guidance. Preview it in the PDF below.

• Bright Futures Guidelines Pocket Guide

The Bright Futures/AAP Periodicity Schedule presents, in chart form, the screenings, assessments, physical examinations, procedures, and timing of anticipatory guidance recommended for each age-related visit in the Bright Futures Guidelines, 4th Edition. Explanatory notes and a key to the chart provide important details and references that support the recommendations. The Periodicity Schedule can be helpful to many audiences, including state Medicaid agencies, insurance companies, public health clinics and pediatric practices.

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4 Month Visit

Assess risk, age footnotes.

If a child comes under care the first time at any point on the schedule, or if any items are not accomplished at the suggested age, the schedule should be brought up to date at the earliest possible time.

Return to Interactive Periodicity Schedule

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Ages & Stages

Checkup checklist: 4 months old.

Your baby is getting bigger! They're also growing more interested in what you're doing. They may coo to get your attention. You may even hear a little chuckle if you try to make them laugh.

It's time for your baby's next well-child visit . In addition to the standard physical exam and measurements, here's what you can expect at your baby's 4-month checkup.

✅ Immunizations

At the 4-month visit, your baby may receive the second doses of the following vaccines :

Rotavirus vaccine

Diphtheria, tetanus, acellular pertussis vaccine (DTaP)

Haemophilus influenza type B vaccine (Hib)

Pneumococcal conjugate vaccine (PCV)

Inactivated polio vaccine (IPV)

✅ Screenings

• Postpartum depression : Your pediatrician will ask you how you are feeling. If you are having postpartum issues with anxiety or sadness, or anything else, please feel free to discuss it with your baby's pediatrician.
• Hematocrit or hemoglobin screening : If your baby was born preterm or with a low birth weight, they may receive this blood screening that helps detect anemia . Your pediatrician may ask you if your baby is drinking anything other than breast milk or iron-fortified formula, as it is a risk factor for developing anemia.

✅Feeding & development

Your pediatrician will measure and weigh your baby to make sure their growth is on track, observe their development and behavior, and perform a physical exam.

Questions your pediatrician may ask

How does your baby fall asleep ? Are you giving them a bottle?

Do you have questions about cleaning your baby's gums and teething?

If you are breastfeeding , are you giving your baby an iron supplement ? (The AAP recommends giving breastfed infants 1 mg/kg/day of a liquid iron supplement until iron-containing solid foods are introduced at about six months of age).

Questions you may have

How do I know if my baby's physical development is on track ?

When do I start my baby on solid foods ? Which foods do I start with?

My baby drools and blows bubbles a lot. Is this normal?

When can I start reading to my baby ?

Where does your baby sleep at night? A safe sleep space is crucial.

Are you placing baby in a rear-facing car seat ?

Is your home's water heater set so the temperature at the faucet is at or below 120 degrees Fahrenheit (59 degress Celsius)?

How do I help calm my baby when they get fussy ?

Is it safe for my baby to be near someone who is vaping ?

Is it safe to use amber teething necklaces ?

✅ Communication tips

Never hesitate to call your pediatrician's office with any questions or concerns—even if you know the office is closed. If your pediatrician is unable to see you but believes your baby should be examined, they will advise you on the most appropriate place for your baby to receive care and how quickly your baby should be seen.

More information

AAP Schedule of Well-Child Care Visits

AAP Bright Futures Previsit Questionnaire: 4 Month Visit

Catch Up on Well-Child Visits and Recommended Vaccinations

Many children missed check-ups and recommended childhood vaccinations over the past few years. CDC and the American Academy of Pediatrics (AAP) recommend children catch up on routine childhood vaccinations and get back on track for school, childcare, and beyond.

Making sure that your child sees their doctor for well-child visits and recommended vaccines is one of the best things you can do to protect your child and community from serious diseases that are easily spread.

Well-Child Visits and Recommended Vaccinations Are Essential

Well-child visits and recommended vaccinations are essential and help make sure children stay healthy. Children who are not protected by vaccines are more likely to get diseases like measles and whooping cough . These diseases are extremely contagious and can be very serious, especially for babies and young children. In recent years, there have been outbreaks of these diseases, especially in communities with low vaccination rates.

Well-child visits are essential for many reasons , including:

• Tracking growth and developmental milestones
• Discussing any concerns about your child’s health
• Getting scheduled vaccinations to prevent illnesses like measles and whooping cough (pertussis) and  other serious diseases

It’s particularly important for parents to work with their child’s doctor or nurse to make sure they get caught up on missed well-child visits and recommended vaccines.

Routinely Recommended Vaccines for Children and Adolescents

Getting children and adolescents caught up with recommended vaccinations is the best way to protect them from a variety of   vaccine-preventable diseases . The schedules below outline the vaccines recommended for each age group.

See which vaccines your child needs from birth through age 6 in this easy-to-read immunization schedule.

See which vaccines your child needs from ages 7 through 18 in this easy-to-read immunization schedule.

The  Vaccines for Children  (VFC) program provides vaccines to eligible children at no cost. This program provides free vaccines to children who are Medicaid-eligible, uninsured, underinsured, or American Indian/Alaska Native. Check out the  program’s requirements  and talk to your child’s doctor or nurse to see if they are a VFC provider. You can also find a VFC provider by calling your  state or local health department  or seeing if your state has a VFC website.

COVID-19 Vaccines for Children and Teens

Everyone aged 6 months and older can get an updated COVID-19 vaccine to help protect against severe illness, hospitalization and death. Learn more about making sure your child stays up to date with their COVID-19 vaccines .

• Vaccines & Immunizations

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The 4-Month Well-Baby Visit

Medical review policy, latest update:, the physical checkup, developmental milestones, read this next, 4-month shots, questions to ask your doctor.

As always, don’t forget to make the next appointment — this time for  baby’s 6-month visit — before leaving the doctor's office.

What to Expect the First Year , 3rd edition, Heidi Murkoff. WhatToExpect.com, Thumb-Sucking Baby: Is It Okay for Newborns to Suck Their Thumbs? , March 2020. American Academy of Pediatrics, Movement Milestones: Babies 4 to 7 Months , March 2021. American Academy of Pediatrics, Language Development: 4 to 7 Months , August 2009. American Academy of Pediatrics, Pediatrics , Incorporating Recognition and Management of Perinatal Depression Into Pediatric Practice , January 2019. Centers for Disease Control and Prevention, Recommended Vaccines by Age , November 2016. KidsHealth From Nemours, Your Child’s Checkup: 4 Months , April 2021. National Institutes of Health, National Library of Medicine, Developmental Milestones Record — 4 Months , January 2022. Stanford Children’s Health, Infant Sleep , 2021.

Go to Your Baby's Age

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