Your Baby Week Eighteen (Four Months Old)

Rice Cereal

Experts usually recommend starting your baby on a dry, iron-fortified baby cereal.
Experts usually recommend starting your baby on a dry, iron-fortified baby cereal, such as one of these brands from Gerber, Earth's Best, or Beech Nut.. Photo © Vincent Iannelli, MD

Experts usually recommend that rice cereal be the first food that you give to your baby.

That is because rice cereal for babies is thought to be the baby food that is least likely to trigger allergic reactions. Single grain rice cereal is gluten free, and free of milk and eggs, other common allergy triggers.

Some brands of baby rice cereal do contain soy, though. This isn't usually a problem because the ingredient isn't actually a soy protein, which typically triggers soy allergies, but is a soy-oil lecithin instead. Check the ingredients list if you are looking for a baby rice cereal without any soy.

Starting Rice Cereal

Once you and your baby have decided that it is the right time to start cereal, get your box of dry baby rice cereal and a feeding bowl ready. You will then mix about 1 teaspoon of cereal with 4 to 5 teaspoons of pumped breast milk or formula (or even water) to get the cereal to a "good" consistency. At first, that will mean that the cereal will not have much consistency to it at all. As your baby does well eating the cereal, add less liquid so that it is thicker.

After starting with just 1 or 2 teaspoons at a time, your baby will likely move up to 3 or 4 teaspoons of baby rice cereal once or twice a day.

Not Ready for Cereal?

If your baby continually pushes the spoon of rice cereal out of her mouth with her tongue or simply doesn't seem to like eating cereal, then she may not be ready for baby food yet. You may want to wait a few weeks and then try again.

You could also try to change the timing of when you are giving your baby cereal. For example, if you are offering cereal before breastfeeding or giving formula, then maybe try nursing or giving a bottle first. Or try cereal first if she seems too full if you already tried it the other way.

Alternatives to Baby Formula

If your baby isn't nursing, the best alternative to formula is going to be another type of formula.
If your baby isn't nursing, the best alternative to a baby formula she isn't tolerating is going to be another type of baby formula, and not goat's milk, soy milk, or a homemade formula.. Photo © Tim Boyle / Getty Images

When parents talk about alternatives to baby formula, they are usually talking about alternatives to a cow's milk-based baby formula. Milk-based formula for your baby can include Enfamil Lipil, Similac Advance, or Nestle Good Start.

If a baby is having a formula intolerance or allergy, with diarrhea, gas, or fussiness, then it might be time for a formula change if you aren't breastfeeding. Since these can also be normal symptoms from time to time, it is often a good idea to talk to your pediatrician before changing your baby's formula.

When you do change from a cow's milk-based formula, parents often change to:

  • a reduced lactose (Enfamil Gentlease Lipil) or lactose-free formula (Enfamil LactoFree Lipil or Similac Sensitive)
  • a soy formula (Enfamil ProSobee Lipil, Similac Isomil Advance, or Nestle Good Start Soy)
  • a hypoallergenic formula (Enfamil Nutramigen Lipil, Similac Alimentum Advance, or Neocate)

Alternatives to Baby Formula

Besides breastfeeding and the formulas listed above, there aren't any other good alternatives for your baby. You should specifically avoid homemade formula made from cow's milk or evaporated milk, soy drinks, and goat's milk.

Goat's Milk

Some parents are surprised about the goat's milk warning since they think it is easier to digest than cow's milk-based formula. That may be true, but goat's milk doesn't have all of the nutrients, specifically vitamin B-12 and folic acid, that a baby needs. So while goat's milk that is pasteurized and vitamin supplemented is usually fine for older children, it should not be given to infants under age 12 months of age as a substitute for breastfeeding or baby formula.

Raw goat's milk, which is unpasteurized, can also put your baby at risk for infections and vitamin deficiencies since raw milk isn't supplemented with vitamins and minerals.


Thrush is caused by the Candida albicans yeast, which can also cause vaginal infections and diaper rashes. When it infects a child's mouth, it is called oropharyngeal Candidiasis, or more simply, thrush.

Although sometimes painful, the most common symptom of thrush is white patches coating the insides of an infant's mouth. You may see these patches on the insides of her cheeks, on her tongue, on the roof of her mouth, and on her lips and gums as it spreads.

These white patches, unlike breast milk or formula, can not easily be wiped away.

Treatments for thrush include:

  • Nystatin oral suspension - a prescription antifungal medication that is given 4 times a day. Keep in mind that it is the direct contact of Nystatin with the yeast that combats the infection, so you want to rub it in with a gauze or your finger after you give your baby her dose.
  • Fluconazole (Diflucan) - another prescription antifungal medication. It is considered a second line treatment to be used when Nystatin isn't working, but has the benefit of once a day dosing and you don't have to rub it in for it to work.
  • Gentian Violet - an older treatment that doesn't require a prescription. Keep in mind that Gentian Violet is rather messy and can turn your baby's lips (temporary) and clothing (not always so temporary) purple, so it is not as popular as other treatments.

Breastfeeding mothers who have a baby with thrush may get a yeast infection on their breasts and nipples, causing pain while nursing. Along with their baby, these mothers also need to be treated by their doctor.

Infants get thrush because the Candida albicans yeast is ubiquitous or everywhere, so no matter how carefully you clean and sterilize pacifiers, bottles, and toys, your baby may get thrush. Still, you should carefully clean any objects that go into your child's mouth.

Infant Care Tips - Vomiting

Pedialyte is a typical treatment to help from getting dehydrated when kids have a stomach virus.
Pedialyte is a typical treatment for vomiting and diarrhea to help keep your kids from getting dehydrated when they have a stomach virus.. Photo © Vincent Iannelli, MD

Parents often worry when their child has a fever, but they seem to feel most helpless when their baby is vomiting.

And it is usually easy to understand why, after all:

  • no medications stop babies from vomiting.
  • parents worry that their baby will become dehydrated.
  • even though a stomach virus is the most common cause of vomiting, especially when the child also has diarrhea, parents usually think that the vomiting is caused by other more serious conditions, such as an intestinal blockage.

Home Treatments for Vomiting

Unfortunately, in trying to keep their kids from getting dehydrated, parents often give their child too much to drink when they are vomiting. This often leads to more vomiting.

While fluids are important when a child is vomiting, experts usually recommend that you give small amounts of fluids at a time, and then give frequently. For example, you might give your baby 1 or 2 teaspoons of Pedialyte, LiquiLytes, or other oral rehydration solution (ORS) every 5 or 10 minutes instead of several ounces at once. Vomiting babies can usually tolerate small amounts at a time, while they will almost always vomit if you give them more than a few ounces a time.

You should avoid giving fruit juice, plain water, or rice water when your baby is vomiting, though.

Once your baby is tolerating 1 or 2 teaspoons at a time, you can move up to 1 or 2 tablespoons every 5 or 10 minutes for a few hours and then 1 or 2 ounces at a time. She can next begin breastfeeding or drinking formula again.

Call your pediatrician if your baby continues vomiting or has other symptoms, such as fever, irritability, or if she is getting dehydrated.



Centers for Disease Control and Prevention. Managing Acute Gastroenteritis Among Children. MMWR Recomm Rep. 2003;52(RR-16):1–16.

Infant Q&A - Baby Sinus Infections

Do babies have sinuses? Can they get sinus infections?

It is a common misunderstanding that babies do not have sinuses.

In fact, babies are born with sinuses, but they are just not very well developed. Newborns have very small maxillary (under your cheeks) and ethmoid sinuses (between your eyes), but they can't be seen on regular x-rays until a child is one to two years old.

The frontal sinuses (under your forehead), which often contribute to typical adult sinus headaches, and sphenoid sinuses (around your eyes) don't begin to develop until a child's second year and can't be seen on an x-ray until the child is five to six years old.

The sinuses continue to grow until your child becomes a teenager.

Is it is a Sinus Infection?

And since they do have sinuses, babies can get sinus infections. However, just because your baby has a green or yellow runny nose, that doesn't mean that he has a sinus infection.

A runny nose, even if the discharge has some color to it, is more often caused by a simple cold. If the runny nose lasts for more than 10 to 14 days, then your child's cold may have turned into a sinus infection (sinusitis).



American Academy of Pediatrics Subcommittee on Management of Sinusitis and Committee on Quality Improvement. Clinical Practice Guideline: Management of Sinusitis. Pediatrics 2001 108: 798-808.

Health Alert - Mercury Thermometers

An old style mercury thermometer, which isn't safe if it breaks, and could be hard to read anyway.
An old style mercury thermometer, which isn't safe if it breaks, and could be hard to read anyway.. Photo ©

Parents are often quick to get out their thermometer whenever their baby feels warm or seems sick, with a runny nose, cough, or some extra fussiness.

And that used to mean using a mercury thermometer, which were long thought to be the best for taking a child's temperature.

That was before experts spread the word about the dangers of mercury, even the small amount in a mercury thermometer. Now, the American Academy of Pediatrics recommends that parents avoid using mercury thermometers.

The recommendation is actually several years old, though. So you will likely not even be able to buy a new mercury thermometer anymore since they aren't sold in regular drug stores now. You likely have a digital thermometer to use to take your baby's temperature instead.

Some people may have an old one in the house, though. If you do, it is likely time to get rid of it.

Disposing of a Mercury Thermometer

Unfortunately, getting rid of a mercury thermometer is not as simple as throwing it in the trash. If you do, the mercury will simply be released into the environment. Instead, call your local health department or your state environmental protection department to find out where you can take your mercury thermometer for safe disposal.

If you have a mercury thermometer and it breaks, keep your child away from it and call your local poison control center (1-800-222-1222) for information about how to clean it up safely.



Goldman LR, Shannon MW, and the Committee on Environmental Health. Technical report: mercury in the environment: implications for pediatricians. Pediatrics.2001; 108 :197 –205.

Michele DiCarlo, PharmD, et. al. How Should a Fever Mercury Thermometer be Disposed of? A Survey of Those Likely to be Asked. PEDIATRICS Vol. 109 No. 5 May 2002, pp. e71.

Four Month Well-Child Check

Your baby will get a thorough checkup and his vaccines and his four-month well child visit.
Your baby will get a thorough checkup and his vaccines at his four-month well child visit with his pediatrician.. Photo © Photodisc / Getty Images

Your baby's four-month checkup will be a lot like her two-month checkup. She will even be getting the same vaccines.

At the four-month checkup with your pediatrician, you can expect:

  • A complete physical exam, with special attention to your baby's hips to check for developmental hip dysplasia.
  • An examination of your infant's growth and development.
  • A review of feeding and sleep schedules.
  • Measurement of his height, weight and head circumference.
  • Counseling for injury prevention.
  • Immunizations: DTaP, HepB, Hib, IPV, Prevnar, and RotaTeq.

The next check up with your pediatrician will be when your baby is six months old.

Ask Your Pediatrician

Remember that your visits to your pediatrician are not simply so that your baby can get her shots. In addition to keeping your baby's vaccines up-to-date, and helping make sure that your baby is growing and developing normally, these visits are an opportunity for you to ask any questions you may have about your baby.

At four months, you might ask:

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