2025 – PAGE 185 – DEVELOPMENTAL MILESTONES & ANTICIPATORY GUIDANCE
SURVEILLANCE MILESTONES – 4 MONTHS OF AGE
| AGE | LANGUAGE &
COMMUNICATION |
MOVEMENT & PHYSICAL | COGNITIVE | SOCIAL &
EMOTIONAL |
| 4 mo
“rattle” |
Vocally responds to you talking to them; turns head in your voice’s direction | Holds unsupported head stable when held; grasps toys; swings at toys with arms; places hands to mouth; bears weight on elbows or forearms when prone | Opens mouth when hungry and sees bottle or breast; looks at own hands | Tries to get or keep your attention by smiling, making sounds, moving, or looking at you; chuckles (not laughing yet) when you attempt to make them laugh |
MNEMONICS: Spell Rattle with a 4 (4attle) for 4 months of age.
MNEMONIC STORY: Go over the following story over and over again! Imagine a 4-month-old baby wearing a shirt that has 4attles all over it. He loves his RATTLES. He is lying on his belly while BEARING WEIGHT ON HIS ARMS next to a very thin RATTLE that is shaped like a 4. He needs your help to get the rattle, so he GETS YOUR ATTENTION by making sounds. You ask him what he wants, and he VOCALLY RESPONDS BACK. You walk over to see what all the COOING is about and pick up the rattle. You then shake it on his right side. He TURNS TO THE SOUND and SWINGS HIS ARMS at the toy. You then place the rattle in his right hand and note that he is ABLE TO GRASP it well (but not reach for it). He CHUCKLES (not laughing yet) as he LOOKS AT HIS HANDS and BRINGS HIS HANDS TO HIS MOUTH. You notice his bottle on his left side, so you pick him up and show it to him. All that rattling made him HUNGRY AND HE OPENS HIS MOUTH like a baby bird while HOLDING HIS HEAD STABLE so you can feed him.
4-MONTH-OLD MILESTONES TO KEEP ON YOUR RADAR
| AGE | LANGUAGE | GROSS MOTOR | FINE MOTOR | COGNITIVE | SOCIAL | RED FLAGS |
| 4 mo | Bears wt. on feet while being held by hands; Moro reflex disappears at 3-6 months; head lag disappears by 4 months with pull-to-sit | Shakes a rattle at 4–6 months; voluntary palmar grasp at 4-5 mo | ~70% infants are sleeping through the night | Not tracking from side to side; unsteady head control |