At this age I will begin to interact more with my environment. I am

learning to roll over (usually tummy to back first). I have discovered

my hands. I soon learn to put my hands in my mouth, and then I try grasping objects with my

hands. I like to hold rattles and squeaky toys and those with different textures and shapes. I will

start to make different noises with my voice and begin to laugh and drool.

Please remember to:Please remember to:Please remember to:Please remember to:Please remember to:

Always use my car seat. Watch what I can reach or grasp because everything will go to my

mouth and I can choke or eat something poisonous. Give me toys that are unbreakable, have no

small parts or sharp edges, and are too large to swallow. I’ll be able to roll soon, so never leave

me near an edge where I might fall. If I’m in a carrier, put me on the floor or in my crib, because I

will bounce and rock, and I could tip the carrier over. Put me to sleep on my back, and put me

down in my bed when I am still awake so I can learn to put myself to sleep.

My name is . The date is .

I weigh pounds, and I am inches long.

The circumference of my head is inches.

Child Development:

4 Months

03-P

UPDATED 5-21-2013

Child DevelopmentChild DevelopmentChild DevelopmentChild DevelopmentChild Development

4 Months4 Months4 Months4 Months4 Months

Feeding Solid Foods To

Your Baby

SHC-PE-3662-NS

5-21-2013

At four months of age, once your baby has good head control, you can start introducing solid foods.This should be an enjoyable time for you and your baby. Feeding and meals in general should be apleasant time for the whole family, free from tension and conflict. Children, like adults, havevariations in appetite from day to day and variations in taste preference. However if offered abalanced diet, a baby will select a nutritious variety over several weeks (not necessarily each day).This is not true if a baby is being offered empty calories like cookies, sweets, juice, or other junkfood. It is important to remember that food is a source of nutrition and not a pacifier for a crankybaby or a means of quieting an active toddler.

Here are some basic guidelines to help ensure a successful feeding experience:

• At this age, breastmilk or formula shouldstill be your baby’s main source of nutrition.If your baby is due to nurse or have a bottlebefore a solid meal, do that first beforeoffering solids. Continue breastfeedinguntil one year of age or longer; continueformula until one year of age, at which pointyou can offer 2-3 cups per day of wholemilk instead.

• All babies need vitamin D supplementsto protect their bones and electrolytes.Formula companies add it for you, so ifyour baby is taking 32 ounces per dayof formula, he is getting adequate vitaminD from that. If your baby is breastfed,continue daily vitamin D (400 units, or1 dropper of D-Vi-Sol or Poly-Vi-Sol daily).

• Start your baby’s solid food experiencewith a positive attitude. Most babies at thisage are eager to explore new tastes andwill enjoy eating. But if your baby balks onthe first day, don’t try to force the issue orforce-feed your baby. Generally, afterseveral days, your baby will become moreenthusiastic about eating. It may take 10 or20 repetitions of tasting one food beforeyour baby starts to like it, so keep trying!

• Make sure all foods that you offer arepuréed so your baby won’t choke onthem. You can easily make baby food bypuréeing some of what you’re eating; youmay need to add a little water to make theconsistency right for your baby. Start byoffering foods with watery consistency,and gradually thicken as tolerated.

• Offer solid foods 2-3 times per day atfirst, and gradually increase to three solidmeals per day. Start with just a fewspoonfuls of food, and increase theamount over several meals. Do notcontinue feeding if your baby shows signsof resistance. Babies will stop eating whenthey’re full.

• You can start by offering any food, but agood first food is rice cereal, which is apowder that you can find in the baby foodsection of the grocery store. Put anounce of expressed breastmilk, formula,or water in a bowl, then stir in rice cerealpowder until the cereal is the consistencyof watery oatmeal. Most babies like ricecereal because it tastes like somethingthey’re familiar with (breastmilk or formula).

Feeding Solid Foods To Your BabyFeeding Solid Foods To Your BabyFeeding Solid Foods To Your BabyFeeding Solid Foods To Your BabyFeeding Solid Foods To Your Baby

Rice cereal is also fortified with iron, whichmost babies (especially breastfed babies)start to get low on around this age. Offeringrice cereal once a day can be an excellentaddition to your baby’s diet.

• The only foods that are off-limits to offer toan infant are honey (which can causebotulism) or foods a baby can choke on.We used to think that withholding the morecommon allergy foods (like eggs, dairy,wheat, strawberries, soy, nuts, peanutbutter, shellfish, etc.) would lead to fewerfood allergies. In fact, delaying theintroduction of these foods seems to leadto more allergies. It’s fine to introduce thesehighly allergenic foods, starting in smallamounts, once other foods like vegetablesand grains are tolerated. New allergenicfoods can be tried every few days. For allother foods, there’s no need to wait severaldays between new foods because delayingintroducing foods just leads to deficientnutrition. Make sure any food you offer ispuréed so your infant will not chokeon it, but otherwise you can and shouldoffer any food other than honey. Foods withmultiple ingredients are fine. Spices arefine, and introducing foods with differentflavors now will help your child like themlater. You can easily make your own babyfood by puréeing some of your own meal ina blender!

• When you start introducing solid foods, youcan introduce water in a sippy cup. Waterhelps rinse teeth, flush the kidneys, andreduce constipation. Using a cup for wateralso teaches a new skill.

• Allow your baby to feed himself. At first hewill not be coordinated enough to get anadequate amount of food into his mouth.But letting him try to self-feed is really goodfor developing fine motor skills and healthyeating habits. You may have to give him abath after meals, but it’s worth it!

• Remember that fruit is healthy, but juice is ajunk food! Please try to avoid giving juice,or limit it to 4 ounces per day. Also avoidother sweets and junk food.

• Avoid hard or compressible food like roundcandies, nuts, popcorn, peas, etc., becauseyour baby can choke on them.

• You can offer your baby organic food,but studies have not yet shown that it’sbetter than regular food. Organic andnonprocessed food (if pasteurized whennecessary and stored appropriately)certainly aren’t worse than regular food,though, so if you have the money and desireto eat organic, go for it!

Teething is an exciting milestone, but it can also be a challenging time. Teething infants tend to drool a lot, chew on everything they can get their hands on, and often become fussy and have interrupted sleep as the teeth are about to erupt.

The Teething Process:All children are different, and there's a great variability in the timing of teething and the symptoms babies feel. As a general guideline, though:

The teething process usually starts at about three months of age. You may notice excessive drooling at this point.

In general the fi rst teeth begin to erupt at approximately six months of age, and babies generally get a couple of new teeth each month, fi nishing teething by about three years of age.

There are twenty primary ("baby") teeth. From middle to back, these are the central incisors (front teeth), lateral incisors, canines, fi rst molars, and second molars. The fi rst teeth to erupt are usually the lower front teeth (central incisors), followed by the upper front teeth (central incisors). Next come the upper and lower lateral incisors, then the fi rst molars, then canines, and fi nally the second molars. Keep in mind that all children are different and timing (and tooth eruption order) for any individual child may vary, so don't worry if your child doesn't follow these steps exactly.

Symptoms of Teething:

Drooling, which may cause chin rash due to excessive moisture

Chewing on or biting fi ngers or toys

Swollen, tender gums

Fussiness (due to gum soreness) and sleep interruption for 3-5 days before teeth erupt

Low-grade fever (not over 101°F, or 38.3°C)

Child Development:

4 Months

SHC-PE-3668-NS

UPDATED 6-25-15

Smile!Your Baby's About ToStart Teething!

How to Relieve Discomfort of Teething: Give your baby something cool to chew on, like a teething ring, a chilled washcloth, or a regular-sized (not baby-sized) chilled carrot. Do not put teething rings in the freezer or give your baby ice to chew on because this can freeze and damage gums.

Use a clean fi nger or cold teething ring to gently rub your baby's gums for a couple of minutes at a time.

If nothing else is working, give your baby a pain relief medicine like acetaminophen (Tylenol) or ibuprofen (Advil or Motrin). Infants should not be given ibuprofen until they are six months old.

Do not use teething gels. They can be harmful because your baby may bite down on or otherwise damage numb gums, causing more pain later on. Also, if excessive amounts of teething gels are swallowed, they can lead to throat numbness causing diffi culty swallowing or breathing.

Don't Forget to Brush!!Once your baby has teeth, make sure to brush them twice a day with a soft infant toothbrush. To prevent cavities in children, the American Dental Association and the American Academy of Pediatrics now recommend that caregivers brush infants' and children's teeth with fl uoride toothpaste as soon as the fi rst tooth comes in. For children under three years old who have not learned to spit yet, just use a tiny smear of fl uoride toothpaste (or an amount about the size of a grain of rice), which is safe to swallow. For children older than three years who have learned to spit out the extra toothpaste after brushing, you can use a pea-sized amount of fl uoride toothpaste. Don't let your baby go to bed with a bottle, because this leads to cavities, and try to wean your baby off the bottle soon after age one year. The American Dental Association and the American Academy of Pediatrics recommend the fi rst dentist visit at one year of age.

1

What Is Fever?What Is Fever?What Is Fever?What Is Fever?What Is Fever?Fever is the body’s normal response toinfections and may be helpful in fighting them.When white blood cells attack germs, theyrelease chemical signals which cause the brainto elevate the temperature. This elevation mayhelp the body kill the germs faster. The usualfevers (100°F to 104°F) that all children get arenot harmful. Most are due to viral illnesses;some are due to bacterial ones.

The symptoms and characteristics offever include a rectal temperatureover 100.4°F (38.0°C), oraltemperature over 100°F(37.8°C), and axillary(armpit) temperatureover 99°F (37.2°C).While the body’saverage temperatureis 98.6°F (37°C), itfluctuates from a low of 97.6°F in the morning toa high of 100°F in the late afternoon. Mildelevations of temperature can be caused byexercise, excessive clothing, hot weather, orwarm food or drink. If you suspect one of thesecauses, retake the temperature after 30minutes.

How Do You Take Temperatures?How Do You Take Temperatures?How Do You Take Temperatures?How Do You Take Temperatures?How Do You Take Temperatures?Use digital, not mercury, thermometersbecause they are safer, faster, and moreaccurate. For children under three years of age,use axillary or rectal measurements. Mostchildren four or five and older are ready for oral

Fever in Children

68-P

Revised 5-21-2013

readings. Ear thermometers may be unreliable,especially in children under one year old. Inyoung children, high ear thermometer readingsshould be confirmed by another method.

Axillary: Place the tip of the thermometer in adry armpit, and close the armpit by holding theelbow against the chest. If you’re uncertain

about the result, check it with arectal thermometer.

Rectal: Place your childstomach-down on your lap, oron his back on a changing

table. Lubricate the end of thethermometer and the opening of

the anus with petroleum jelly(Vaseline or KY Jelly). Carefully insert the

thermometer about one inch, but neverforce it. Hold the child still and rest your handon the buttocks to stabilize the thermometer.

Oral: Be sure your child has not recentlytaken a cold or hot drink. Place the tip ofthe thermometer underneath the tongue oneither side, rather than at the front of themouth. The child should hold it in place withthe lips and fingers (not the teeth), keepingthe mouth closed and breathing through thenose. If the nose is congested, take an axillarytemperature.

You do not need to check your child's tempera-ture if he is not sick, or many times a day whenhe is sick. Remember that the main purposeof temperature-taking is to determine if a feveris present, not to chart its every move.

FEVER IN CHILDRENFEVER IN CHILDRENFEVER IN CHILDRENFEVER IN CHILDRENFEVER IN CHILDREN

2

age can be given acetaminophen (Tylenol®,Tempra®, Liquiprin®, Panadol®) if the fever iscausing discomfort. Acetaminophen will reducethe fever but usually not bring it down to normaland the fever may recur after the aceteminophenwears off. Liquid ibuprofen (Advil, Motrin®) mayalso help improve comfort and reduce thetemperature in feverish children and can begiven to infants six months or older. See chartthat follows for dosing. If your child is sleeping,don't awaken him for medications, and do notuse them for more than three days withoutconsulting your pediatrician.

Other Measures To Take:Other Measures To Take:Other Measures To Take:Other Measures To Take:Other Measures To Take:Encourage, but don’t force, extra fluids.Popsicles and iced drinks may help replacebody fluids lost because of sweating.Keep clothing to a minimum because mostheat is lost through the skin. Bundling up yourchild will cause a higher fever. Be especiallycareful of infants, who cannot undressthemselves if they become overheated. If yourchild feels cold or is shivering, use a lightblanket. Discourage vigorous activitiesbecause they produce additional heat. Normalplay, however, is perfectly fine.

A Word of Caution AboutA Word of Caution AboutA Word of Caution AboutA Word of Caution AboutA Word of Caution AboutAspirinAspirinAspirinAspirinAspirinThe American Academy of Pediatrics and otherhealth organizations have recommended thatpatients through 21 years of age not receiveaspirin if they have chickenpox or influenza(any cold, cough, or sore throat symptoms).Several studies have linked aspirin to Reye’ssyndrome, a severe illness that resemblesencephalitis. Many pediatricians have stoppedusing aspirin for fevers associated with anyillness because it has the potential to be so

dangerous.

How Long Does Fever Last?How Long Does Fever Last?How Long Does Fever Last?How Long Does Fever Last?How Long Does Fever Last?Most fevers associated with viral illness rangebetween 101°F and 104°F and last for oneto three days. In general, the height of the feverisn’t related to the seriousness of the illness.What counts is how sick your child acts. Withmost infections, the level of fever bounces aroundfor two or three days. Shivering or feeling coldindicates that the fever has peaked; sweatingmeans it is coming down.

It is important to understand that there isno evidence that fever itself can be harmfulunless the temperature exceeds 107°F.Fortunately, the brain’s thermostat keeps nearlyall untreated fevers below this level. A smallnumber of young children may developconvulsions (seizures) with fever. While theseare frightening, they do not appear to causeharm and are not usually a sign of more seriousillness. Still, call your child's doctor if your child hasa febrile seizure.

When Should I Call?When Should I Call?When Should I Call?When Should I Call?When Should I Call?If your child is under three months old, callus day or night if the rectal temperature is greaterthan 100.4°F. Beyond three months, callimmediately if the fever is over 105°F, your childis crying inconsolably or whimpering, or cries ifyou touch or move him. Also call immediately ifthe child’s neck is stiff, any purple spots arepresent on the skin, breathing is difficult and nobetter after you clear the nose, or a convulsion(seizure) has occurred. Call if burning or painoccurs with urination. Also call if your child isunder two years of age and has a fever of 104°For greater. Call if the fever has been present morethan 72 hours, more than 24 hours withoutobvious cause, or has returned after going awayfor more than 24 hours.

Which Medications Should I Use?Which Medications Should I Use?Which Medications Should I Use?Which Medications Should I Use?Which Medications Should I Use?Check with our office before using medication forchildren under four months of age. Children of any

child’s weight child’s infants’ drops or children’s liquid children’s junior

age 80 mg in each o.8 mL

160 mg in each 5 mL (1 tsp) chewables strength

Kitchen spoons are not accurate measures. 80 mg in each tab 160 mg in each tab

6–11 lbs (2.7–5 kg) 0–3 mos Advised dose* Advised dose*

12–17 lbs (5.5–7.7 kg) 4–11 mos Advised dose* 1⁄2 teaspoon or 2.5 mL

18–23 lbs (8.2–10.5 kg) 12–23 mos Advised dose* 3⁄4 teaspoon or 3.75 mL

24–35 lbs (10.9–15.9 kg) 2–3 yrs 1.6 mL (0.8 mL +0.8 mL) 1 teaspoon or 5 mL 2 tablets

36–47 lbs (16.4–21.4 kg) 4–5 yrs 11⁄2 teaspoon or 7.5 mL 3 tablets

48–59 lbs (21.8–26.8 kg) 6–8 yrs 2 teaspoons or 10 mL 4 tablets 2 tablets

60–71 lbs (27.3–32.3 kg) 9–10 yrs 21⁄2 teaspoons or 12.5 mL 5 tablets 21⁄2 tablets

72–95 lbs (32.7–43.2 kg) 11 yrs 3 teaspoons or 15 mL 6 tablets 3 tablets

child’s weight child’s infants’ drops children’s liquid children’s

age 50 mg in each 1.25 mL

100 mg in each 5 mL (1 tsp) chewables Kitchen spoons are not accurate measures. 50 mg in each tab 100 mg in each tab

less than 11 lbs (5 kg) 0–5 mos

12–17 lbs (5.5–7.7 kg) 6–11 mos 1.25 mL Advised dose*

18–23 lbs (8.2–10.5 kg) 12–23 mos 1.875 mL Advised dose*

24–35 lbs (10.9–15.9 kg) 2–3 yrs 1 teaspoon or 5 mL 2 tablets 1 tablet

36–47 lbs (16.4–21.4 kg) 4–5 yrs 11⁄2 teaspoon or 7.5 mL 3 tablets 11⁄2 tablets

48–59 lbs (21.8–26.8 kg) 6–8 yrs 2 teaspoons or 10 mL 4 tablets 2 tablets

60–71 lbs (27.3–32.3 kg) 9–10 yrs 21⁄2 teaspoons or 12.5 mL 5 tablets 21⁄2 tablets

72–95 lbs (32.7–43.2 kg) 11 yrs 3 teaspoons or 15 mL 6 tablets 3 tablets

Choose the proper medicine, and measure the dose accurately.

1. Ask your healthcare provider or pharmacist which medicine is best for your child.

2. Give the dose based on your child’s weight. If you don’t know your child’s weight, give the dose based on your child’s age. Do not give more medicine than is recommended.

3. If you have questions about dosage amounts or any other concerns, call your healthcare provider.

4. Always use a proper measuring device. For example: ■ When giving acetaminophen liquid (e.g., Tylenol), use the device enclosed in the package. If you misplace the

device, consult your healthcare provider or pharmacist for advice. Kitchen spoons are not accurate measures. ■ When giving ibuprofen liquid (e.g., Advil, Motrin), use the device enclosed in the package. Never use a kitchen spoon!

Take these two steps to avoid causing a serious medication overdose in your child.

1. Don’t give your child a larger amount of acetaminophen (e.g., Tylenol) or ibuprofen (e.g., Motrin, Advil) than is shown in the table below. Too much of any of these medicines can cause an overdose.

2. When you give your child acetaminophen or ibuprofen, don’t also give them over-the-counter (OTC) cough or cold medicines. This can also cause a medication overdose because cough and cold medicines often con-tain acetaminophen or ibuprofen. In fact, to be safe, don’t give OTC cough and cold medicines to your child unless you talk to your child’s healthcare provider first.

Medicines and Dosages to Reduce Pain and Fever

Acetaminophen (Tylenol or another brand): How much to give? Give every 4 to 6 hours, as needed, no more than 5 times in 24 hours (unless directed to do otherwise by your healthcare provider).

Ibuprofen (Advil, Motrin, or another brand): How much to give?Give every 6 to 8 hours, as needed, no more than 4 times in 24 hours (unless directed to do otherwise by your healthcare provider).

Immunization Action Coalition n www.immunize.org/catg.d/p4015.pdf* healthcare provider: please fill in the advised dose.

after the shots: what to do if your child has discomfort – page 2

old formulations infants’ new formulation

children’schewables orjunior tablets

or in each 1.0 mL

old formulation

product

discontinued by

manufacturers

product

discontinued by

manufacturers

page 2 of 2

1

sleep. If he is crying, rock him and cuddle him;

but when he settles down, try to place him in

the crib before he falls asleep.

Handle naps in the same way. This is how your

child will learn to put himself back to sleep after

normal awakenings. Don’t help your infant

when he doesn’t need any help.

Hold your baby for all fussy cryingduring the first three months. All new

babies cry some during the day and night. If

your baby cries excessively, the cause is

probably colic. Always respond to a crying

baby; responding to your baby's cries will

actually reduce the amount of crying in the

future. Gentle rocking and cuddling seem to

help the most. Swaddling, pacifiers, and

making "shush" noises also help. Babies can’t

be spoiled. Even colicky babies have a few

times each day when they are drowsy and not

crying. On these occasions, place the baby in

his crib and let him learn to self-comfort and

self-induce sleep.

Carry your baby for at least three hourseach day when he is awake and isn’tcrying. This practice will reduce fussy crying.

Definition:Definition:Definition:Definition:Definition:Parents want their children to go to bed without

resistance and to sleep through the night. They

look forward to a time when they can again have

seven or eight hours of uninterrupted sleep.

Newborns, however, have a limit to how many

continuous hours they can sleep (usually four or

five hours). By two months of age, some 50% of

infants can sleep through the night (which is

actually defined as sleeping six continuous

hours). By four months, most infants have

acquired this capacity. It may not develop,

however, unless you have a plan. Consider the

following guidelines if you want to teach your

baby that nighttime is a special time for

sleeping, that her crib is where she stays at night,

and that she can put herself back to sleep. It is far

easier to prevent sleep problems before six

months of age than it is to treat them later.

NewbornsNewbornsNewbornsNewbornsNewbornsPlace your baby in the crib when he is

drowsy but awake. This step is very important.

Without it, the other preventive measures will fail.

Your baby’s last waking memory should be of

the crib, not of you or of being fed. He must learn

to put himself to sleep without you, so that when

he wakes up he is able to go back to sleep

without you too. Don’t expect him to go to sleep

as soon as you lay him down. It often takes 20

minutes of restlessness for a baby to go to

Sleep Problems:

Prevention

63-P

Prevention of SleepPrevention of SleepPrevention of SleepPrevention of SleepPrevention of SleepProblems in ChildrenProblems in ChildrenProblems in ChildrenProblems in ChildrenProblems in Children

Revised 5-21-2013

2

Do not let your baby sleep for morethan three consecutive hours during theday. Attempt to awaken him gently and feed orentertain him. Waking your infant to feed duringthe day (every 2-3 hours for breastfed infants orevery 3-4 hours for formula-fed infants) will helpensure that the time when your infant sleeps thelongest will occur during the night. (Note: Manynewborns can sleep five consecutive hours andyou can teach your baby to take this longerperiod of sleep at night.)

Consider keeping daytime feedingintervals to at least two hours fornewborns. More frequent daytime feedings(such as hourly) sometimes lead to frequentawakenings for small feedings at night.When your baby shows signs of hunger (pleasesee handout about hunger cues), feed him.But crying does not always mean your babyis hungry. Crying is the only form of comm-unication newborns have. He may be tired,bored, lonely, or too hot. Hold your baby atthese times or put him to bed. Don’t let feedingbecome a pacifier. For every time you nurseyour baby, there should be four or five timesthat you snuggle your baby without nursing.Don’t let him get into the habit of eating everytime you hold him.

Make middle-of-the-night feedings briefand boring. You want your baby to think ofnighttime as a special time for sleeping. Whenhe awakens at night for feedings, don’t turn onthe lights, talk to him, or have other non-essential interactions. Feed him quickly andquietly. Provide extra rocking and play timeduring the day. This approach will lead tolonger periods of sleep at night.

Don’t awaken your infant to changediapers during the night. The exceptions tothis rule are soiled diapers or times when youare treating a bad diaper rash. If you must

change your child, use as little light as possible(for example, a flashlight), do it quietly, anddon’t provide any entertainment.

Make an informed decision about co-sleeping. It's not harmful for your child to sleepwith you as long as there are no smokers in thehome, no one in the bed has had alcohol ordrugs or sedating medicine, and your bedmeets the other SIDS guidelines. Many parentschoose to cosleep so they don't have to get outof bed at night. The problem is that once yourbaby is used to sleeping with you, a move toher own bed will be extremely difficult,becoming more and more difficult as your babygets older. If you don't want your one- or two-year-old to still be in your bed, you may wish toavoid cosleeping from the beginning, andinstead let your baby sleep in a bassinette orcrib nearby your bed instead.

Give the last feeding at your bedtime(10:00 or 11:00 p.m.). Try to keep your babyawake for the two hours before this last feedingso the baby's longest sleep period will be atime when you're asleep too. Also, going tobed at the same time every night helps yourbaby develop good sleeping habits.

Two-Month-Old BabiesTwo-Month-Old BabiesTwo-Month-Old BabiesTwo-Month-Old BabiesTwo-Month-Old BabiesMove your baby's bassinette so she

can't see you when she awakens at night. Ifshe can't see her parents when she awakens,she may forget that they're available and put

herself back to sleep.

Try to delay middle-of-the-nightfeedings. By now, some babies are down toone feeding during the night. Before feedingher, briefly try other means to comfort your baby(patting her back, making "shushing" noises, orholding her) to see if that will satisfy. If you dofeed her, try one or two ounces less formula

3

than one minute. If he continues crying, he mayneed to be held for a few minutes, or even fedquickly. This brief contact usually will not beenough to encourage your baby to keep wak-ing up every night. As your child is older, if yourchild is standing in the crib, don’t try to makehim lie down. He can do this himself.

Make an informed decision about sleeptraining. Sleep training _ where you let yourbaby cry for progressively longer periods of

time each night during nighttimeawakenings _ can help your

infant learn to sleep throughthe night. Some parents arenot comfortable with this

type of parenting,but other parentsfind they are better

parents overall whenthey have had a restful sleep, and sleep

training can help with this. There is limiteddata about sleep training, but one study showsno negative effects on babies who underwentsleep training. There are lots of differentmethods and lots of books that can help guideyou through sleep training, and you candiscuss this with your baby's doctor. Onemethod is to let your baby cry for one minutebefore you go to comfort her the first night, twominutes the second night, three minutes thethird night, and so on. Sleep training is usuallysuccessful within about two weeks, but often issuccessful after just a few nights.

Six-Month-Old BabiesSix-Month-Old BabiesSix-Month-Old BabiesSix-Month-Old BabiesSix-Month-Old BabiesConsider providing a friendly soft toy

for your child to hold in her crib. At theage of six months, children start to be anxiousabout separation from their parents. A stuffedanimal, doll, or blanket can be a securityobject that will give comfort to your child whenshe wakes up during the night. Make sure thisobject is not something your child can getcaught around his neck or suffocate on.

than you would during the day. If you are breast-feeding, try nursing for less time at night. Asyour baby gets close to four months of age, trynursing on just one side at night. Never awakenyour baby at night for a feeding except at yourbedtime.

Four-Month-Old BabiesFour-Month-Old BabiesFour-Month-Old BabiesFour-Month-Old BabiesFour-Month-Old BabiesTry to discontinue the 2:00 a.m. feeding

before it becomes a habit. Every child isdifferent, but by four months of age, a bottle-fedbaby often does not need to be fed more thanfour times per day and a breastfed baby oftendoes not need more than five nursingsessions per day. If you do nottry to eliminate thenight feeding at thistime, it will becomemore difficult tostop as your childgets older. Use the tips above fordelaying middle-of-the-night feedings. Forexample, if your child cries during the night, firsttry to comfort him with a back rub and somesoothing words before feeding. Remember togive the last feeding at 10:00 or 11:00 p.m.before you go to sleep.

Don’t allow your baby to hold his bottleor take it to bed with him. Babies shouldthink that the bottle belongs to the parents.A bottle in bed leads to middle-of-the-nightcrying because your baby will inevitably reachfor the bottle and find it empty or on the floor.

Make any middle-of-the-night contactsbrief and boring. Comfort your child as littleas possible between 10:00 p.m. and 6:00 a.m.All children have four or five partial awakeningseach night. They need to learn how to go backto sleep on their own. If your baby cries, visithim but don’t turn on the light, play with him, ortake him out of his crib if possible. Comfort himwith a few soothing words and stay for less

Sleep Problems: Prevention

63-P

4

Leave the door open to your baby’sroom. Babies and children can becomefrightened when they are in a closed space andare not sure that their parents are still nearby. Ifyou've moved your baby into his own room,make sure to leave the door open.

During the day, respond to separationfears by holding and reassuring your baby.This lessens nighttime fears and is especiallyimportant for parents who work outside thehome.

For middle-of-the-night fears, makecontacts prompt and reassuring. For mildnighttime fears, check on your baby promptlyand be reassuring, but keep the interaction asbrief as possible. Try not to take her out of thecrib but provide whatever else she needs forcomfort, keeping the light off and not talking toomuch. Ideally at most, sit next to the crib withyour hand on her. These measures will usuallycalm even a severely upset infant. If your babypanics when you leave, stay in your baby'sroom until she is either calm or goes to sleep.

One-Year-Old ChildrenOne-Year-Old ChildrenOne-Year-Old ChildrenOne-Year-Old ChildrenOne-Year-Old ChildrenEstablish a pleasant and predictable

bedtime ritual. Bedtime rituals, which can startin the early months, become very important to achild by one year of age. Children need afamiliar routine. Both parents can be involved atbedtime, taking turns with reading or making upstories. Both parents should kiss and hug thechild “goodnight.” Be sure that your child’ssecurity objects are nearby. Finish the bedtimeritual before your child falls asleep.

Once put to bed, your child should staythere. Some older infants have tempertantrums at bedtime. They may protest aboutbedtime or even refuse to lie down. You shouldignore these protests and leave the room. Youcan ignore any ongoing questions or demandsyour child makes and enforce the rule that yourchild can’t leave the bedroom. If your childcomes out, return him quickly to the bedroomand avoid any conversation. If you respond tohis protests in this way every time, he will learnnot to try to prolong bedtime.

If your child has nightmares or bedtimefears, reassure him. Never ignore your child’sfears or punish him for having fears. Everyonehas four or five dreams every night. Some ofthese are bad dreams. If nightmares becomefrequent, try to determine what might becausing them, such as something your childmight have seen on television.

Don’t worry about the amount of sleepyour child is getting. Different people needdifferent amounts of sleep at different ages.The best way you can know that your child isgetting enough sleep is that he is not tiredduring the day. Naps are important to youngchildren but long naps during the day caninterfere with nighttime sleep, so ideally keepthem less than two hours long. Children stoptaking morning naps between one and twoyears of age and give up their afternoon napsbetween three and six years of age.

Instructions for Pediatric Patients by Barton D. Schmitt, M.D., Pediatrician. Adapted from Your Child’s Health ,Copyright © 1991 by Barton D. Schmitt, M.D.. Reprinted bypermission of Bantam Books.

VACCINE INFORMATION STATEMENT

Your Baby’s First VaccinesWhat You Need to Know

Many Vaccine Information Statements are available in Spanish and other languages. See www.immunize.org/vis

Hojas de información sobre vacunas están disponibles en español y en muchos otros idiomas. Visite www.immunize.org/vis

Your baby will get these vaccines today: DTaP Polio Hib PCV13 Hepatitis B

(Provider: Check appropriate boxes.)

1 Why get vaccinated?These vaccines can protect your baby from 7 childhood diseases: 1. DiphtheriaSigns and symptoms include a thick coating in the back of the throat that can make it hard to breathe.Diphtheria can lead to breathing problems, paralysis and heart failure.• About 15,000 people died each year in the U.S. from

diphtheria before there was a vaccine.2. Tetanus (Lockjaw)Signs and symptoms include painful tightening of the muscles, usually all over the body.Tetanus can lead to stiffness of the jaw that can make it difficult to open the mouth or swallow.• Tetanus kills 1 person out of every 5 who get it.3. Pertussis (Whooping Cough)Signs and symptoms include violent coughing spells that can make it hard for an infant to eat, drink, or breathe. These spells can last for several weeks.Pertussis can lead to pneumonia, seizures, brain damage, or death.4. Hib (Haemophilus influenzae type b)Signs and symptoms can include fever, headache, stiff neck, cough, and shortness of breath. There might not be any signs or symptoms in mild cases.Hib can lead to meningitis (infection of the brain and spinal cord coverings); pneumonia; infections of the blood, joints, bones, and covering of the heart; brain damage; and deafness.

• Before there was a vaccine, Hib disease was theleading cause of bacterial meningitis in childrenunder 5 years of age in the U.S.

5. Hepatitis BSigns and symptoms include tiredness, diarrhea and vomiting, jaundice (yellow skin or eyes), and pain in muscles, joints and stomach. But usually there are no signs or symptoms at all.Hepatitis B can lead to liver damage, and liver cancer. Some people develop chronic (long term) hepatitis B infection. These people might not look or feel sick, but they can infect others.• Hepatitis B can cause liver damage and cancer in 1

child out of 4 who are chronically infected.6. PolioSigns and symptoms can include flu-like illness, or there may be no signs or symptoms at all.Polio can lead to permanent paralysis (can’t move an arm or leg, or sometimes can’t breathe) and death.• In the 1950s, polio paralyzed more than 15,000

people every year in the U.S.7. Pneumococcal DiseaseSigns and symptoms include fever, chills, cough, and chest pain.Pneumococcal disease can lead to meningitis (infection of the brain and spinal cord coverings), blood infections, ear infections, pneumonia, deafness, and brain damage.These diseases are much less common than they used to be. But the germs that cause them still exist, and even a disease that has almost disappeared will come back if we stop vaccinating. This has already happened in some parts of the world. When fewer babies get vaccinated, more babies get sick. Babies usually catch these diseases from other children or adults, who might not even know they are infected. A mother with Hepatitis B can infect her baby at birth. Tetanus enters the body through a cut or wound; it is not spread from person to person.

SHC-PE-3667-NS (Rev. 8-13-15)

Five Childhood Vaccines can protect your baby from these seven diseases:

Vaccine Number of doses

Recommended ages Other information

DTaP (diphtheria, tetanus, pertussis)

5 2 months, 4 months, 6 months, 15-18 months, 4-6 years

Some children should not get pertussis vaccine. These children can get a vaccine called DT (diphtheria & tetanus).

Hepatitis B 3 Birth, 1-2 months, 6-18 months

Polio 4 2 months, 4 months, 6-18 months, 4-6 years

An additional dose of polio vaccine may be recommended for travel to certain countries.

Hib (Haemophilus influenzae type b)

3 or 4 2 months, 4 months, (6 months), 12-15 months

There are several Hib vaccines. With one of them the 6-month dose is not needed.

PCV13 (pneumococcal)

4 2 months, 4 months, 6 months, 12-15 months

Older children with certain health conditions may also need this vaccine.

Your healthcare provider might offer some of these vaccines as combination vaccines — several vaccines given in the same shot. Combination vaccines are as safe and effective as the individual vaccines, and can mean fewer shots for your baby.

2 Some children should not get certain vaccines

Most children can safely get all of these vaccines. But there are some exceptions:• A child who is sick on the day vaccinations are

scheduled might be asked to come back for them at alater date.

• Any child who had a life-threatening allergicreaction after getting a vaccine should not getanother dose of that vaccine.

A child who has a severe (life-threatening) allergyto a substance should not get a vaccine that containsthat substance. Some of these vaccines containneomycin, streptomycin, yeast, lactose, sucrose, orlatex.

Tell your doctor if your child has any severeallergies, or has ever had a severe reaction afterany vaccination.

Talk to your doctor before your child gets……DTaP vaccine, if your child ever had any of thesereactions after a previous dose of DTaP:• A brain or nervous system disease within 7 days,• Non-stop crying for 3 hours or more,• A seizure or collapse,• A fever of over 105°F.…Polio vaccine, if your child has a severe allergyto the antibiotics neomycin, streptomycin or polymyxin B.

…Hepatitis B vaccine, if your child has a severeallergy to yeast.…PCV13 vaccine, if your child has a severe allergyto yeast, or ever had a severe reaction after a dose of DTaP (or other vaccine containing diphtheria toxoid), or after a dose of PCV7, an earlier pneumococcal vaccine.

3 Risks of a Vaccine ReactionVaccines, like medicines, can cause side effects. Most vaccine reactions are not serious: tenderness, redness, or swelling where the shot was given; or a mild fever. These occur soon after the shot is given and go away within a day or two. They happen with up to about half of vaccinations, depending on the vaccine. Polio, Hepatitis B and Hib Vaccines have been associated only with these kinds of mild reactions. Other childhood vaccines have been associated with additional problems:DTaP VaccineMild Problems: Fussiness (up to 1 child in 3); tiredness or poor appetite (up to 1 child in 10); vomiting (up to 1 child in 50); swelling of the entire arm or leg for 1-7 days (up to 1 child in 30) — usually after the 4th or 5th dose.Moderate Problems: Seizure (1 child in 14,000); non-stop crying for 3 hours or longer (up to 1 child in 1,000); fever over 105°F (1 child in 16,000).

Serious problems: Long term seizures, coma, lowered consciousness, and permanent brain damage have been reported following DTaP vaccination. These reports are rare.Pneumococcal VaccineMild Problems: Drowsiness or temporary loss of appetite (about 1 child in 2 or 3); fussiness (about 8 children in 10).Moderate Problems: Fever over 102.2°F (about 1 child in 20).Problems that could happen after any vaccine:• Brief fainting spells can happen after any medical

procedure, including a vaccination. Sitting or lyingdown for about 15 minutes can help prevent fainting,and injuries caused by a fall.

• Severe shoulder pain and reduced range of motionin the arm where a shot was given can happen, veryrarely, after a vaccination.

• Severe allergic reactions from a vaccine are veryrare, estimated at less than 1 in a million doses. Ifone were to occur, it would usually be within a fewminutes to a few hours after the vaccination.

As with any medicine, there is a very remote chance of a vaccine causing a serious injury or death.The safety of vaccines is always being monitored. For more information, visit: www.cdc.gov/vaccinesafety/

4 What if there is a serious reaction?

What should I look for?• Look for anything that concerns you, such as signs

of a severe allergic reaction, very high fever, orbehavior changes.

Signs of a severe allergic reaction can include hives,swelling of the face and throat, difficulty breathing, afast heartbeat, dizziness, and weakness. These wouldusually start a few minutes to a few hours after thevaccination.

What should I do?• If you think it is a severe allergic reaction or other

emergency that can’t wait, call 9-1-1 or get the personto the nearest hospital. Otherwise, call your doctor.

• Afterward, the reaction should be reported to theVaccine Adverse Event Reporting System (VAERS).Your doctor should file this report, or you can do ityourself through the VAERS web site atwww.vaers.hhs.gov, or by calling 1-800-822-7967.

VAERS does not give medical advice.

5 The National Vaccine Injury Compensation Program

The National Vaccine Injury Compensation Program (VICP) is a federal program that was created to compensate people who may have been injured by certain vaccines.Persons who believe they may have been injured by a vaccine can learn about the program and about filing a claim by calling 1-800-338-2382 or visiting the VICP website at www.hrsa.gov/vaccinecompensation. There is a time limit to file a claim for compensation.

6 How can I learn more?• Ask your doctor.• Call your local or state health department.• Contact the Centers for Disease Control and

Prevention (CDC):- Call 1-800-232-4636 (1-800-CDC-INFO)- Visit CDC’s website at www.cdc.gov/vaccines or

www.cdc.gov/hepatitis

Vaccine Information Statement (Interim)

42 U.S.C. § 300aa-26

10/22/2014Office Use Only

VACCINE INFORMATION STATEMENT

Rotavirus VaccineWhat You Need to Know

Many Vaccine Information Statements are available in Spanish and other languages. See www.immunize.org/vis

Hojas de información sobre vacunas están disponibles en español y en muchos otros idiomas. Visite www.immunize.org/vis

1 Why get vaccinated?Rotavirus is a virus that causes diarrhea, mostly in babies and young children. The diarrhea can be severe, and lead to dehydration. Vomiting and fever are also common in babies with rotavirus.Before rotavirus vaccine, rotavirus disease was a common and serious health problem for children in the United States. Almost all children in the United States had at least one rotavirus infection before their 5th birthday.Every year before the vaccine was available:• more than 400,000 young children had to see a doctor

for illness caused by rotavirus,• more than 200,000 had to go to the emergency room,• 55,000 to 70,000 had to be hospitalized, and• 20 to 60 died.Since the introduction of the rotavirus vaccine, hospitalizations and emergency visits for rotavirus have dropped dramatically.

2 Rotavirus vaccineTwo brands of rotavirus vaccine are available. Your baby will get either 2 or 3 doses, depending on which vaccine is used.Doses are recommended at these ages:• First Dose: 2 months of age• Second Dose: 4 months of age• Third Dose: 6 months of age (if needed)Yourchildmustgetthefirstdoseofrotavirusvaccinebefore 15 weeks of age, and the last by age 8 months. Rotavirus vaccine may safely be given at the same time as other vaccines.Almost all babies who get rotavirus vaccine will be protected from severe rotavirus diarrhea. And most of these babies will not get rotavirus diarrhea at all.The vaccine will not prevent diarrhea or vomiting caused by other germs.Another virus called porcine circovirus (or parts of it) can be found in both rotavirus vaccines. This is not a virus that infects people, and there is no known safety risk. For more information, see www.fda.gov/BiologicsBloodVaccines/Vaccines/ApprovedProducts/ucm205547.htm.

3 Some babies should not get this vaccine

A baby who has had a life-threatening allergic reaction to a dose of rotavirus vaccine should not get another dose. A baby who has a severe allergy to any part of rotavirus vaccine should not get the vaccine. Tell your doctor if your baby has any severe allergies that you know of, including a severe allergy to latex.Babieswith“severecombinedimmunodeficiency”(SCID) should not get rotavirus vaccine.Babies who have had a type of bowel blockage called “intussusception”shouldnotgetrotavirusvaccine.Babies who are mildly ill can get the vaccine. Babies who are moderately or severely ill should wait until they recover. This includes babies with moderate or severe diarrhea or vomiting.Check with your doctor if your baby’s immune system is weakened because of:• HIV/AIDS, or any other disease that affects the

immune system• treatment with drugs such as steroids• cancer, or cancer treatment with x-rays or drugs

4 Risks of a vaccine reactionWith a vaccine, like any medicine, there is a chance of side effects. These are usually mild and go away on their own. Serious side effects are also possible but are rare.Most babies who get rotavirus vaccine do not have any problems with it. But some problems have been associated with rotavirus vaccine:Mild problems following rotavirus vaccine:• Babies might become irritable, or have mild,

temporary diarrhea or vomiting after getting a dose of rotavirus vaccine.

85-P (Rev. 9-3-15)

Serious problems following rotavirus vaccine:• Intussusception is a type of bowel blockage that is

treated in a hospital, and could require surgery. Ithappens“naturally”insomebabieseveryyearintheUnited States, and usually there is no known reasonfor it.

There is also a small risk of intussusception fromrotavirus vaccination, usually within a week after the1st or 2nd vaccine dose. This additional risk is estimatedto range from about 1 in 20,000 to 1 in 100,000 USinfants who get rotavirus vaccine. Your doctor can giveyou more information.

Problems that could happen after any vaccine:• Any medication can cause a severe allergic reaction.

Such reactions from a vaccine are very rare, estimatedat fewer than 1 in a million doses, and usuallyhappen within a few minutes to a few hours after thevaccination.

As with any medicine, there is a very remote chance of a vaccine causing a serious injury or death.The safety of vaccines is always being monitored. For more information, visit: www.cdc.gov/vaccinesafety/

5 What if there is a serious problem?

What should I look for?For intussusception, look for signs of stomach pain along with severe crying. Early on, these episodes could last just a few minutes and come and go several times in an hour. Babies might pull their legs up to their chest.Your baby might also vomit several times or have blood in the stool, or could appear weak or very irritable. These signswouldusuallyhappenduringthefirstweekafterthe 1st or 2nd dose of rotavirus vaccine, but look for them any time after vaccination.Look for anything else that concerns you, such as signs of a severe allergic reaction, very high fever, or unusual behavior.Signs of a severe allergic reaction can include hives, swellingofthefaceandthroat,difficultybreathing,orunusual sleepiness. These would usually start a few minutes to a few hours after the vaccination.What should I do?If you think it is intussusception, call a doctor right away. If you can’t reach your doctor, take your baby to a hospital. Tell them when your baby got the rotavirus vaccine.If you think it is a severe allergic reaction or other emergency that can’t wait, call 9-1-1 or get your baby to the nearest hospital.

Otherwise, call your doctor.Afterward, the reaction should be reported to the“VaccineAdverseEventReportingSystem”(VAERS).Yourdoctormightfilethisreport,oryoucando it yourself through the VAERS web site at www.vaers.hhs.gov, or by calling 1-800-822-7967.VAERS does not give medical advice.

6 The National Vaccine Injury Compensation Program

The National Vaccine Injury Compensation Program (VICP) is a federal program that was created to compensate people who may have been injured by certain vaccines.Persons who believe they may have been injured by a vaccinecanlearnabouttheprogramandaboutfilingaclaim by calling 1-800-338-2382 or visiting the VICP website at www.hrsa.gov/vaccinecompensation. There isatimelimittofileaclaimforcompensation.

7 How can I learn more?• Ask your doctor. Your healthcare provider can give

you the vaccine package insert or suggest othersources of information.

• Call your local or state health department.• Contact the Centers for Disease Control and

Prevention (CDC):- Call 1-800-232-4636 (1-800-CDC-INFO) or- Visit CDC’s website at www.cdc.gov/vaccines

Vaccine Information Statement Rotavirus Vaccine

42 U.S.C. § 300aa-26

04/15/2015Office Use Only