Pediatrician Guide to the 4-Month Sleep Regression, Feeding, and Development

This week we are talking all about your four-month-old, the dreaded four-month sleep regression, normal development, and everything you need to be thinking about for your kid of this age. We are also going to share some important things to be thinking about now that are really going to set you up for success in the coming months. So hit that like button, subscribe. Yep, and if this is your first time meeting us, I'm Kurt. I'm a board-certified pediatrician. I'm Sarah. I'm a board-certified OBGYN. And we are the Doctors Bjorkman. Welcome back. If this is your first time to our channel, I'm Sarah. We have three little kids. Yeah, four, two, and just after four months of age. Yes, and so we are updating our kind of newborn series here, talking all about your four-month-old as we're kind of living it. Yeah, so by four months, your baby's doing all sorts of new things, and they're officially out of that newborn phase. They're likely more alert, they're social, and they're starting to show off some big skills. So here are some milestones that you can start to look for around that four-month mark. Yeah, so they should be smiling spontaneously, especially at people like their mom or maybe the dad. Yeah, so much joy there. They are going to look at you, or move, or kind of make sounds to kind of get your attention. Yeah, this could be coos, babbles, more expression. Yes, they push down on their legs when their feet are on a hard surface. Yeah, and when you have them upright, they're holding their head steady without support. They're less little bobble heads. You may, this is the point where they start to roll from tummy to back, especially during tummy time. Yeah, and for many kids, it's that they learn to roll tummy to back before they learn back to front, but really a lot of this depends on where do they spend their most time. Yes, so remember, as soon as your baby starts to roll, if you are still swaddling, you need to get them out of that swaddle. So if you are at that four-month mark and your baby's still in a swaddle, it is probably about time to get them out of that for safety. Yes, sometimes that comes as early as eight to ten weeks, but definitely by the time they're four months of age. Oh, for sure. Probably three is about the latest you want to be doing it. Another good thing to think about kind of at this time where we're at four months of age is, now you've really made it through that really, really challenging two-month age where they're fussy, they're whiny, they're just like, if they're going to have colic, hopefully you're starting to get to that time where like, oh, there's finally some daylight. You know, they're starting to figure out feeding, they're starting to figure out sleeping a little bit better, but maybe your four-month-old isn't quite there. And so that's where for the rest of this episode, we're going to really think about kind of like, what are those things to help them with feeding and sleep to set you up for success now and in the months to come? All right, so a perfect segue. Let's talk about the thing that's breaking parents everywhere, the four-month sleep regression. Yes, now this is a real thing and it's developmentally normal and actual milestone. Around four months of age, your baby's sleep patterns are maturing from that newborn style of sleep to a more adult-like stages. That means more light sleep, some frequent wakings. Yeah, but not a setback, this is progress, they're growing, okay? But if your great sleeper suddenly starts waking every two hours again, it's not you, it's them, it is biology. Yeah, so this is a great time to remind you of some key tips about sleep. We've done an episode all about newborn sleep, that is still helpful at this stage. But just to remind you of some key things to think about here. Yes, so be thinking about an earlier bedtime. These four months old are starting to need an earlier bedtime than those little newborns who are often going to bed 9, 10 o'clock. So be thinking about bedtime between your sweet spots, kind of 7 and 8 p.m. Yeah, also work on making sure your sleep environment is good and sticking with a consistent routine before bed, having the same kind of three to five steps every night. Maybe this is bath, a couple of books, they get put in their sleep sack and you sing them a song and put them down. Yeah, at some point during the day you want to be focusing on some crib sleep, putting the baby down, drowsy but awake, I know that one's a tough one, but starting to make sure you're building some independent sleep habits. If that's the first nap of the day when you have extra sleep pressure, that is trying to do that at night. We're thinking about, you know, down the road. Yeah, absolutely. We've talked about that a couple of times about using, especially that first nap of the day when they seem to be most likely to be able to put themselves down as that time to teach them to fall asleep on their own and that sets you up for success with those nighttime sleeps. But also don't feel guilty if you're rocking, nursing, contact napping through this, especially for those afternoon naps. We've all been there where like, hey, like night sleep's great, but the naps are challenging. Like finding ways to get that routine of sleep throughout the day. Yes, and it's important to remember that day sleep happens after night sleep. So once they learn to consolidate that night sleep, then naps start happening better. And that's usually around the six months of age mark for naps to be better. So if you're not there yet, if your four-month-old is doing those 26-minute naps, good things are coming. Another thing at this point is where people do start to think about sleep training. When are we ever going to sleep again? And it's certainly not required. And it is not really recommended until little ones are about five to six months. So hang in there that being able to sleep train if you want, time is coming. And this four-month sleep regression is going to pass. You may need an extra coffee or two. So as Tara mentioned, yes, it's not yet time to classically start that sleep learning, sleep training phase. But there's some things at this age at four months you can do that are really going to help set your kiddo up for success of learning how to sleep through the night on their own in the coming months. And the first is trying to space out those middle of the night feeds if they're still doing them. Yes. So you may find your kiddo is waking up at a certain time every night and you're like, oh, it's three o'clock every night or, oh, it's two o'clock or whatever. Yeah. And it's really helpful to know that they don't need to do that anymore. They're big enough. They're healthy enough. They've got the stores that they can make it through the night. Yes. Our pediatrician says that 13 pounds is that magic number. I don't think there's any data to that, but years of experience, she's like, oh, he's almost 13 pounds. He's probably going to sleep 12 hours now. Yeah. I think we were already working on it. We were pretty close, but, um, and so, so, but the question is like, hey, how do you get rid of this midnight feed? Like my baby is awake. They're like expecting mom or whoever's feeding them in the night. Like, how do you set that back? Yep. So what we do, especially cause I breastfeed is hey, baby wakes up. Dad goes in, partner goes in because when mom, it's a lot harder for me to keep them happy for 15 minutes and away from the boom. So, so going in first thing, they're awake. There's some like key little steps and tricks that we'll talk about later in our IRL about like what you're doing to try to help calm them back to sleep. But if they aren't calmable, then you pick them up. You love them. You hold them and trying to distract them and get them to go. Even if you stretch them out 15 more minutes, doing that 15 minute extra time each night over the course of two weeks is an extra two hours. You'll be very surprised. So that Hank would wake up every night at two o'clock. So Kurt would go in at two, try to push him back 15, 20 minutes, and then I'd go feed him. So then the next night he woke up 20 minutes later than he had the night before at two 20. And then the next night it was two 45. And then the next night he went an extra hour. So there's a little things you can get them into their next deep sleep cycle and they extend that. And all of this is setting them up to be able to sleep through the night. Yeah. So you're four months old. What are they doing for feeding? At this time, your baby's probably taking four to six ounces of feed, whether breast milk or formula and doing this every three to four hours during the day. That's usually around 24 to 32 ounces per day. And it's totally normal if they start spacing out their feedings as they're growing. Yeah. And a big question that comes up at this age is, Hey, can we start solids at four months yet? And the short answer here is not yet for most babies. Until around six months when it's when your baby can sit up with minimal support, has good head control and is showing interest in food. A few babies might be ready earlier, but check with your pediatrician first. You don't want your baby working on sitting and controlling their head while trying to swallow and do all these other things. So often it's a little bit further. Yeah. And make sure you're subscribed because in the upcoming weeks, we're going to do detail and episode all about baby led weaning with baby Hank and kind of building on the information So parents and caregivers always want to know what are things we can help with our baby's development and what should we be doing? And the answer is play and play at four months is all about interaction. Babies at this age love mirrors, looking at their cute little face, seeing things. Absolutely. They love grabbing toys, bringing them to their mouth. Indeed. They like peekaboo. They like singing. And tummy time is still so important. So important. So be aiming for at least 15 to 30 minutes of tummy time a day. You can break this up into shorter bursts, but this really is going to help with a lot of things. Motor development, head control, avoiding those flat spots on the back of the head. Yes. And it's helping them build all those muscles and skills they're going to need to start crawling, to start cruising, to be able to sit up and support themselves. So tummy time is so important and often at this age, they're starting to hate it a little bit less. Yes. Another key thing here, this is a great time to be talking a lot. Just narrating your life, responding to baby's cues, talking through all the things you're doing like, oh, I'm picking up the toys now. Oh, I'm going to carry you to your changing table. We're going to change your diaper. Oh, we'll get this red apple. Like all of these fun things, building language pathways just through speech during the day. And then also remember reading lots of books, like just letting them hear language and interact with the world through sound and communication. Awesome things for development. At four months of age, your babies also do for a routine well check with their pediatrician where they're going to do all sorts of the standard things like measuring weight, length and head circumference. Yes. They are going to check in on those motor and social milestones you've been talking about. Yep. There are some standard four month vaccines that are offered at this age. Yep. And they're going to ask you about feeding, sleep, tummy time, whether your baby seems happy and engaged. Yep. And from that standpoint, don't stress if your baby hasn't hit every milestone perfectly. We care more about progress than perfection. And that brings us some to, you know, some red flags or things to watch for. When should you be talking to your pediatrician? Yep. So there's definitely a kind of this list that we think about things like, hey, your baby isn't smiling. They aren't showing interest in people. Right. They aren't tracking objects with their eyes. Yep. Maybe they have really stiff limbs or they're really floppy and loose. If they aren't cooing or babbling at all, maybe touch base with your pediatrician. Yep. Or if by four months of age, they're having trouble holding their head up. And as always, if anything feels off, trust your instincts. Your pediatrician wants to help and it is never a bad idea to touch base with them. So you made it to four months. I think it's important to say that at four months of age, we've had three very different babies from our three kiddos. Like the first one was like eating great, sleeping great. Yep. At four months of age. Baby number two was still... A train wreck. Not sleeping well at night. Okay at night. Not napping well at all. Not eating well. But getting like sort of starting to get happier during the day. I feel like around four to six, four to five months, finally with number two, we were like, oh, maybe we're going to have a happy baby eventually. But we hit four months with our like second baby and had a 22 month old or just turned two year old and like he, it was still very hard. It was. And then now baby three is like just watching him nap. Like just like a gem, like just happy temperament. And I, however, we went from like, hey, we're sleeping, we're swaddled. We're finally into this routine. And then four months, hey, we're waking up in the night. Yeah. And I think that's even the biggest thing in this episode is like being aware that, hey, the four month sleep regression is a real thing. Yeah. And then how do you like, hey, they're maturing in their sleep patterns. How do you use this time to help set them up to be able to sleep through the night on their own again, which is kind of a nice goal that like has worked so well for us in our life with our kiddos. And I feel like we've really gotten him back into his good sleep patterns without like sleep learning officially, just walking back those feeds kind of like Kurt was talking about. And actually it's really interesting. You know, one of our subscribers reached out to us this last week. Kevin Satsinger actually was recently on parental leave and like made an app about like, hey, guiding you through kind of like some of those midnight calming techniques. And just like, I think this is really nice. It's called Cribside. We can try to find a link for it to put in there, but just like happened to email us like while we were thinking about writing this episode. And it like talks you through what to do and with a timer. Yeah. Like, hey, you're going to go into the room. Remember, hey, like giving a pause even before you go in the room, like there's been a handful of times where Hank is like made noise in the night and you're like, oh, is he awake? Or during his nap right now we're filming. He was crying fussing and we're like, oh, well, we gotta go get Hank. But then he put himself down. And so sometimes even just like waiting for 60 seconds or two minutes can make a big difference. And then like, if you're going to intervene, you can slowly increase how much you're intervening, starting out with like some noise, some shushing above your white noise. And then thinking about some light touch. Maybe you're placing your hand on their back, giving them a little bit of pressure again, helping them feel that warm, safe, secureness and doing that for a little bit of time and then moving to maybe you're going to add a pacifier if that's something your child's doing. And then if like they're still not calming with those things, then you're going to pick them up. You're going to rock them. You're going to hold them, which is really what we do a lot for the, as we're stepping those feeds back. A lot of times this is like, hey, dad, the non-feeding partner is going to go in there and do all of these things because I don't have boobs full of milk to offer him. And so it like just makes it a lot easier for me to kind of work through these steps. And then I'll hold them. And oftentimes I'll try to hold him for a long time. Even like if I'm, if I'm psychologically okay and he's safe with it, I know he like hasn't pooped or something like that. And then I, I'll hold him and try to stretch that 15 minutes at a time before giving up to say, Hey, you know, he's really like, he just needs mom. Let's feed him and get him back to bed. But like through that process, you've stretched like, Hey, he woke up at two, but now it's two 20. It's amazing. The next night, maybe he doesn't wake up till two 20. And then as you get them back into that sleep cycle, maybe they're going to stretch just long enough where they're next. Like, well, they sleep through that light window. Then all of a sudden they stretch out by two or three hours. So it's, I think it's, I've seen it called a soothing ladder, taking care of babies. And I call it sit back or some of the steps just things to try as you're trying to help them learn, but it's, it is work, right? It is work. It is much easier to go in, pick your baby up, put them on the boob, give them a bottle. Like it's helping them learn to sleep and work through. This is a lot of work in the middle of the night. And it was like, it was really hard for a second. Like there was lots of nights like, Hey, I'd like take him away from Sarah, away from our two-year-old at the time. So like his crying, wasn't going to wake everyone in the house. Yeah. Our first hard time was she really liked to wake up at five. Yeah. No, like, yes. But like, you know, doing the, like the middle of the night, waking it into like, just trying to like push things back. Like, Hey, like, how are we going to distract them? Get them back to sleep. You know, again, they're four months of age. They don't need to eat in the middle of the night. If you, if that's something you love still, you want to like, um, dream feed them. Great. By all means. It's wonderful. Mamas who, especially who work outside the home say, Hey, this is our time. I get to hold my baby in the middle of the night. It's quick. I see them. They go right back to sleep. If that's working for you, that's awesome. That's wonderful. Saves you from having to pump in the middle. Right. Um, at some point, sometimes that breaks down and it becomes, Hey, we're not just waking up once in the night. We're waking up at two and three and four and five and six. And that's just, everybody needs some rest. So hang in there. Often, you know, six, Kurt wishes all our babies were born about six months of age. Yeah. But like, I will say like, this is generally the four month old is like the one I'm starting to bond with a lot because we're spending extra time in the middle of the night together. Um, and they just like, they're starting to be more interactive. They smile back at you. I mean, when they start giving back a little, like, you know, Hank looks at you and just Yeah. Who does this face? You're like, I can do anything. Just when you thought you were going to break from the exhaustion of your two to three month old, they like start to get a little bit better at some things and they start smiling. Yep. So enjoy that. And if you're not there yet, please know it's coming. Just keep working. Yes. Some kids are just gassy. Malcontents is, is what they call them. Malcontents. Yes. Not happy. Little babies. And good luck with yours. We've had, we've been there. Yes. So anyway, hang in there. Hopefully you found this episode helpful. If you did, please make sure to give it a like, make sure you subscribe because we've got great more baby content in addition to toddler content and other pregnancy postpartum stuff coming your way in the weeks ahead. See you next week. Bye guys. We're doctors. But not your doctors. Anything we've said in this video is for education or entertainment purposes only. It is not medical advice. Any specific medical questions you have should be directed to your provider.