4 month old baby not feeding

Your Baby at 4 Months | Patient Education

Patient Education A-Z

Development

Babies this age enjoy cooing and laughing as well as seeing and communicating with people. In fact, they are so interested in the world that they often would rather look around than eat. If your baby is not interested in eating, try feeding in a darkened room or use a receiving blanket to gently cover the baby's face. This may encourage the baby to focus on feeding.

Spend lots of time talking, laughing and playing "word games" with your baby. Try making a funny face or noise and see if your baby will copy you. When your baby makes a sound, copy it. In addition to "baby talk," speak to your baby in long sentences to help your baby learn language. This is a great time to begin reading stories and enjoying picture books together.

You may want to try using sign language to help your baby learn to communicate in a different way. Beginning at 6 to 8 months of age, try using a hand signal every time you use a word like "hungry" or "tired. " Babies may use sign language to let you know their needs before they can talk. The book Baby Signs covers how to use sign language with babies.

Sleeping

By 4 months of age, most babies are capable of sleeping at least six to eight hours a night.

Everyone wakes up during the night, but we learn to settle ourselves and go back to sleep. If you respond to every squirm and sound your baby makes, you're not allowing him or her to learn this important skill. If your baby is still waking at night, there are several ways to encourage longer nighttime sleep:

Develop a soothing bedtime routine. Sing or read to your baby or rock your baby at about the same time each evening.
Try to place your baby in bed drowsy but still slightly awake.
Try using a night light.
When your baby awakens, try to settle him or her without feeding. Or, if you are bottle-feeding, try giving your baby some water instead of formula. If you are breast-feeding, try feeding from only one breast. By decreasing the amount of food eaten at night, you will help your baby go longer between feedings.
Try to delay the middle-of-the-night feeding by holding your baby, offering a pacifier or letting your baby suck on your finger. Even if your baby still needs to eat after 10 or 15 minutes, prolonging the period before feeding will help your baby sleep a little longer the next night.

For more information, see the books Helping Your Child Sleep through the Night, by Cuthbertson and Schevill, or Healthy Sleep Habits, Happy Child by Marc Weissbluth.

Feeding

Breast milk or formula has all the nutrition your baby needs now, and you should continue feeding your baby with breast milk or formula for the next two months. Your baby does not need any additional food until 6 months of age. Four-month-olds still have an immature intestinal system and cannot control their muscles for chewing and swallowing, and therefore they are not ready for solid foods.

If your baby is mainly breast-fed, continue taking your prenatal vitamins and give your baby 400 units of vitamin D each day.

Teething

Teeth may appear anytime during your baby's first year of life. It is difficult to know when a tooth is erupting unless you can see or feel the tooth. Most 4-month-olds begin drooling and putting objects in their mouths, but this does not mean they are teething.

Teething makes some babies fussy or irritable. It does not cause a high fever. If your baby appears sick or has a fever, please call your baby's doctor.

If your baby seems uncomfortable due to teething, you can help by:

Letting your baby suck on a cold teething toy.
Giving acetaminophen as directed by your child's doctor. Do not use acetaminophen for more than 48 hours.
Avoiding topical medications like Orojel or Numzit, which may cause later allergies.

Safety

A few extremely important safety tips:

Falls — Your baby is becoming much more active and cannot be left unattended on a high surface like a bed or changing table. If you have to leave your baby alone, put him or her in a safe place on the floor.
Hot Liquids — Your baby can reach and grab objects now, so don't hold hot liquids or sharp objects while holding your baby.
Car Seats — Your baby should always be secured in a car seat when traveling by car or taxi. The car seat should still face backward. Babies who are accustomed to car seats behave better during car trips when they are older. Remember that you need to buckle up too.
Small Objects — As your baby learns how to hold objects and put them in his or her mouth, keep small objects out of reach to prevent choking.
Pacifiers — Don't tie or pin pacifiers to pajamas, as this may cause strangulation.
Cribs — Crib toys that stretch across the crib should be removed as your baby begins to learn how to sit. You may need to lower the mattress so your baby cannot roll out.

Immunizations

Your baby will receive a second set of immunizations at 4 months of age, followed by another checkup at 6 months. Please bring your baby's immunization card to each visit.

Used by permission of Jane E. Anderson, M.D.

UCSF Benioff Children's Hospitals medical specialists have reviewed this information. It is for educational purposes only and is not intended to replace the advice of your child's doctor or other health care provider. We encourage you to discuss any questions or concerns you may have with your child's provider.

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What happens at four months?

After the first three months, many mothers start to settle into a bit of a rhythm with their baby and begin to feel like life has become a bit more predictable. Then around four months (or anywhere between three and six months), babies seem to change all over again, sometimes becoming more fussy, sleeping differently, and often being more distractible when nursing.

These outward differences are a sign of the big developmental changes happening in your baby right now. Sometimes this period lasts a couple of weeks, sometimes longer. Nursing is still very important to your baby and you can find imaginative ways to keep him nursing effectively, even with all the excitement of the world around him. This phase does pass, and babies emerge much better able to multi-task and to nurse while doing other things.

So what happens to a baby at this time?

Every baby is different, and as with so many other developments, every child does things at their own pace. Around four months you might be witnessing the beginning of lots of changes in your baby’s physical abilities. They might have much better head control and they may be able to sit up when supported. You might also notice more social skills developing, such as smiling, cooing or babbling. Babies may also start bringing their hands to their mouth simply to explore and play, so it may not always be a feeding cue, as it was in the past. There are lots of changes on the inside too, as their brain develops: their vision is now much better, and they can more easily pick out different sounds. Sometimes babies may also start teething at this age, which can occasionally lead to temporary changes in nursing behaviour.

Distractibility while nursing

The impacts of these changes can often be felt in the breastfeeding relationship. It may seem as if your baby has started nursing for much shorter periods of time. As babies get older they become much more efficient feeders, and a feed that may previously have lasted around half an hour may now take a significantly shorter time. However, the distractibility that starts at around four months for some babies may mean breastfeeds become more sporadic, especially during the day. Babies might suckle for a few moments, then turn their head at a new sound, go back to nursing, then stop to smile at mum. You may feel worried that your baby isn’t getting full feeds, especially during the day.

You can find ways to help baby to have longer/fuller feeds. For example, some mothers take their baby to a quiet or darkened room to nurse. This helps by reducing the amount of distraction so that the baby can focus on nursing. Similarly, some mums try feeding in a sling, or with a cover like a muslin, so that their baby can be less distracted by what’s going on. Other mothers find that gentle movement, like bouncing on a birth ball or sitting in a spinning chair, help to keep the baby focused.

In some cases, no matter what you do, daytime feeds are just less effective for a while. So, instead, you may want to focus on getting a good feed at nap times when baby may feed to sleep. Night-time nursing becomes really important too. Perhaps because it is already dark and quiet and babies are more sleepy, many mums find that their baby often feeds better at night during this time. While it may be worrying if your baby is taking less milk during daytime feeds, it is often helpful to think about their intake over a 24-hour period. Many babies instinctively take more milk at night anyway (sometimes referred to as reverse cycling) if they are nursing less in the day.

You may find this distractible period hard, because your baby no longer seems comforted by the breast to the same extent, and instead seems eager to do other things. Rest assured, your baby still loves you and enjoys your milk; you are still the centre of their world. It is just that your baby’s brain is changing in wonderful ways and it has not yet matured enough to allow them to multi-task effectively. This phase will pass and your nursing relationship can continue for as long as you wish.

Nursing manners

Sometimes a distractible baby might start to suckle, and then twist their head to look at something interesting, which can be painful! Some mothers find it useful to begin nudging babies towards gentle nursing behaviour at this time. If baby pulls away without unlatching, mothers can gently unlatch baby and remind them that they can’t nurse and turn their head. Even though they can’t speak their understanding is growing all the time, and by repeating these messages babies understand what behaviours are acceptable.

Changes in sleep

As well as nursing differently, other things like sleep can be affected. A baby that may have been sleeping longer stretches may start waking more frequently at this time. Brain developments at this stage may mean they spend less time in the deeper phases of sleep. Research shows that sleep is not a linear development and it’s common for babies and children to go through periods of more and less frequent waking. Babies will wake for lots of reasons. Sometimes because they are hungry (especially if they have nursed less during the day), but also because they are processing new experiences from the day, because of separation anxiety, illness, or simply to feel a connection with a caregiver. Teething pain can be another reason: babies may have uncomfortable gums and may wish to nurse more for pain relief, particularly at night when there is less to distract them.

This can be a tiring period for mothers and parents. You may want to make some short-term changes to catch up on rest – perhaps going to bed earlier, finding a chance to nap during the day, or choosing to co-sleep with your nursling.

Not the time to introduce solids

There is a common myth that exclusively breastfed babies who are nursing less and waking more around this time might be doing so because they are hungry and breastmilk is no longer enough for them. This is not true. For the exclusively breastfed baby, breastmilk is the only source of nutrition required until at least the middle of the first year, and well beyond in conjunction with solid food. There is no need to introduce formula milk at this time. There is no evidence that introducing baby-rice or thickeners will help babies to sleep better. In fact, it may be harmful to introduce solid food before your baby’s gut has fully matured.

As babies get bigger and become able to reach and grasp for things, they may start to grab the food that you are eating. Babies also start to use their hands much more to experiment and will frequently put their hands in their mouth. Again, these are not a sign that they are ready for solid food. Getting teeth through is also not a sign that your baby is ready for solids or that he no longer needs to nurse. Evidence suggests it is better to wait until baby is showing other signs of being ready for solids, like being able to sit up unaided for short periods of time. You can read more about starting solid food here.

The UK Department of Health recommends exclusive breastfeeding for the first six months of a baby’s life and states that breastfeeding can continue to benefit your baby along with solid foods for many months after.

The World Health Organization strongly recommends exclusive breastfeeding for the first six months of life and it states that after that breastfeeding should continue, along with complementary foods, for up to the age of two years or beyond and as long as mutually desired.

Distractible older baby

Sometimes babies can also become distractible between around eight and ten months. Again, this is related to normal developments that the child is going through. Sometimes parents think distractible babies at this age are weaning. Research shows that it is very unlikely that a baby under one year will self-wean. Nursing remains very important to your baby. Many of the same tactics that worked for a four-month-old may work again; for example, keeping external stimulus limited when nursing. An eight-ten month old baby will be drinking water and having some solid foods, and you may find they eat more or less during this period. Babies may also wish to nurse more at night for a while.

Summary

For some babies the developmental changes that happen around four months mean that they may become more distractible while nursing. Nursing is still very important to your baby and sometimes you may need to try some imaginative solutions for a short period in order to help your baby get full feeds. Babies may also begin to experiment with their hands in their mouth a lot more, or reach for food. This does not necessarily mean your baby is hungry, or that thickeners, baby rice or solids need to be introduced. Research shows that waiting until at least the middle of the first year is ideal to ensure your baby’s gut has matured.

As with so much else, this is a phase that will pass. If you’re finding it tricky and you’d like some support, or simply to hear from other breastfeeding mothers in similar situations, you might like to join your local La Leche League Group. You can find your nearest group here.

Written by Rhiannon Butterfield, LLL Cambridge, August 2020

If the child does not eat well: what to do and what not to do

What to do if the child does not want to eat.

- Malyusik, well, one more spoon - and that's it! Last! I ate only two, let's have a little more, here's the most delicious piece for you! - says the average mother, offering a spoon with one hand, playing the accordion with the other, showing the trick with the disappearance of the handkerchief with the third, turning the cutlets over with the fourth, while doing somersaults on one leg.

Sound familiar?

Every dad has an instinct to bring home food, and mom has to feed the baby food. And if he refuses to eat, a signal is triggered - "I'm a bad mother" or "the child is sick."

In this case, the most important thing for a parent to understand is whether the child DOES NOT WANT or CANNOT eat?

If the baby is running around, having fun and looking good, without showing any signs of illness, then most likely he does not want to eat. There can be many reasons:

A breastfeeding child prefers milk and dairy products, intuitively understanding that he needs calcium, and now milk is healthier for him than soup.
The child wants a cookie, not vegetables.
He really wasn't hungry. For example, his metabolism is slow, breakfast has not yet been digested, and lunch is already being offered. Or the child was sitting in front of the TV after breakfast and his appetite had not yet had enough time to play out. Compared to the boy next door who was outside all day.
If a child is not genetically destined to become Uncle Styopa, then he can eat much less than his peer, who has tall parents.
Psychological problems. If earlier you accidentally gave your child a bitter cucumber, then he may refuse any green food. Or you yell at the child during the meal, and for him the food is perceived as a trauma.

If your child is lively, but at the same time he has a "bad appetite", then this is not his problem, but yours - the psychological problem of an unsatisfied instinct. If a child jumps, jumps, he has healthy nails, hair, etc., think less about what he lacks. Better think about something nice))

An active child = not a hungry child.

Wait for the natural desire and correctly distribute energy costs - take a walk more often, give the child to the sports section, or simply say: “If you don’t want to, take a walk, dinner is not earlier than seven and no snacks.” That is, if your child simply does not want to eat, normalize feeding - strictly at a certain time and without snacks. The body will get used to secrete gastric juice strictly according to the schedule.

And one more thing. There are no rules about how much a child should eat. He can eat a kilo (and make you very happy) and 9Send 00 grams to the toilet. Or eat 100 g and learn everything.

But it is much more difficult if the child CANNOT eat.

Causes:

If you are breastfeeding, you may have “tight breasts”, when it is very difficult for the baby to suck milk.
The child has a runny nose, and when he eats, he begins to choke.
Food hot, cold, sour, bitter.
He has sores in his mouth (for example, from toys), and they hurt when food gets on them.
Teeth are cut, gums hurt.
Bowel problems. The stomach starts to hurt while eating.
The child simply fell ill (cold, SARS, poisoning, influenza, etc.). If the child is sick, and he is not dystrophic, then you should not force him to eat. The body fights infections better when it's hungry. But be sure to drink.

If a child at first shows appetite and interest in food, but refuses to eat through a spoon or two, then, most likely, the process of eating causes him certain difficulties.

If the baby CANNOT eat and you can't identify or eliminate the cause, the best thing to do is contact your pediatrician. The doctor will accurately determine the problem and give the necessary recommendations.

Our clinic has a wonderful pediatrician Yuliya Vladimirovna Sinyagina with 17 years of experience! You can sign up to her))

Bon appetit everyone! As well as strength, patience and satisfied instincts!

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What to do if the baby began to eat little

— Anastasia Ivanovna, how do you know if a child is malnourished and lacks breast milk or formula?

- Mom will immediately know everything - it will be screaming, crying or not gaining weight (in the first year of life, the baby is weighed and measured every month). As soon as the mother sees that the behavior of the baby changes and the weight does not increase, she can conclude that the baby has begun to eat less, he does not have enough breast milk or formula.

— At what age does food refusal most often begin?

- Babies start eating little and sleeping a lot around six months of age. 4-6 months is the main period, because at this time the child's teeth begin to erupt, sleep and wakefulness patterns change, food interest and a need for a product of a different consistency appear. The child sees adults at the table: how mom and dad eat, knock on plates, and, naturally, he has the same need, he can refuse to breast at this moment. In addition, on artificial feeding, in addition, the mixture may not be suitable for age.

— What are the dangers of early childhood malnutrition?

- Mom and the doctor will immediately see that the child is malnourished, due to the lack of body weight. With malnutrition, there are not enough kilocalories that the child absorbs from food for energy. A lack of vitamins and minerals can cause a malfunction of the whole organism: underdevelopment of internal organs, malnutrition and brain supply (cognitive disorders) will occur.

— Are babies really more likely to refuse breast milk than infant formula?

— Several factors influence a baby's refusal to breastfeed. One of them is that a nursing mother has changed her diet. If the composition of food changes in macronutrients (proteins, fats, carbohydrates), it is possible that breast milk will become more fatty, and a small amount of food will be enough for the baby to get enough. Therefore, the mother must definitely keep track of what she eats and in what quantity. The best way is to keep a food diary, by which it will be possible to judge why the child begins to refuse to eat or eat less in volume.

Bottle-fed formula is easier for a baby to suckle and uses less energy to feed, so it is natural for him to need less food. Everything is interconnected.

- Will the use of special nipple covers help a mother?

— Each specific case will have its own recommendations. Nipple shields are needed by a very small percentage of women whose breasts are not physiologically adapted for suckling. When breastfeeding, it is important to properly express and attach the baby to the breast - and this work begins in the hospital. The task of the mother is to help the child grasp the nipple correctly, and nature will do the rest.

- Another common problematic question of young parents is why the baby began to eat less on complementary foods. What could be the reasons for this?

— With the introduction of complementary foods, the acidity of the products may not be the same. In addition, acidity can be reduced in the gastrointestinal tract of the child himself - then the food is not digested. In such a situation, you need to take medical tests. And it is better not to engage in self-diagnosis and self-treatment, but purposefully, together with the doctor, find out the causes of the failure.

But there is another extreme - overeating associated with leptin resistance. When the hormone leptin does not work in the body, the child does not receive information to the brain that he is full, and continues to eat-eat-eat. This is a very rare occurrence, but mom will immediately understand that you need to see a doctor.

— Anastasia Ivanovna, what to do if the child eats little? How to restore the child's appetite?

— The simplest thing is to create conditions for the baby to get hungry faster, which means that he spends more energy, play outdoor games, walk more and more often in the fresh air, go to the pool if possible. All this greatly affects digestion, and if the child spends energy, he will replenish it by eating more breast milk or formula.

- Can a lack of interest in food go away naturally?

- The active phase of food interest falls on four to six months (everyone is different). And during this period it is better to have time to give the first complementary foods, because later the food interest begins to decline. If a child completely refuses any products, it is advisable not to force him to eat by pushing a spoon into his mouth or persuading him to swallow another spoon, because it is after such persuasion that babies most often appear. A child without conviction should understand that he is hungry and it is time to sit down and eat, not play.

— What can force-feeding turn into and is it possible to restore a child's interest in food without psychological pressure?

— From practice, I can say that the mother puts psychological pressure on the child, realizing that he must now eat, but the child is picky instead of eating, he has no appetite. The mother begins to panic that the child is hungry. In fact, a hungry child will let everyone around know about himself and will definitely eat. At the same time, he will eat a portion of food according to his needs, based on his energy costs. Mom just needs to calm down and remember the so-called intuitive baby food, when the child eats as often and in as much quantity as he needs. If he runs and jumps more, he will eat more, and if he sleeps off after vaccination, when the body is recovering, then perhaps you should not load him with food.

— If the baby refuses breast milk, will formula help?

- Mix is one of the alternative feeding options. If the child refuses breast milk, you need to choose something else, taking into account the age of the child and the situation in the family. After 6-7 months, often the rejection of breast milk comes with the start of the introduction of complementary foods, which the baby likes more. There are also cases when a mother carries a second pregnancy: the quality of milk changes - and the baby does not want to eat it. The inclusion of formula in a child's diet is always an individual decision to be made with your doctor.

— How to choose infant formula if the baby refuses breast milk?

— When choosing a mixture, it is necessary to understand what the mother wants from the mixture - either this is the main food or supplementary food. It is important for yourself to decide which mixture you need, read the compositions of different types of food from manufacturers. There can be many recommendations - both by weight, and by the age of the child, and by filling with minerals. Tasks can also be different. If the child refused one mixture, a new milk or sour-milk mixture is selected. In case of an allergic reaction, you need to look for a therapeutic mixture without components that provoke allergies. There are times when a child does not like the taste, color, smell or texture of food. And if the child rejects food for the second or third feeding, then the diet should be reviewed and other options should be looked for, but after consulting a doctor.

- Can MAMACO ^® Premium formulas be used to replace breast milk? What is special about baby food based on goat milk?

- Goat and cow milk proteins are slightly different. It is generally accepted that cow's milk protein is coarser and larger, while goat's milk is softer and its protein molecules are smaller, therefore, they are easier to digest and assimilate, so digestion will be more comfortable.