Concerns About My 4-Month-Old Baby's Development: Is It Normal?

May I ask if Dr. Tsai has received this letter?

My baby is currently 3 months and 25 days old.
He was born weighing 2100 grams.
I've noticed that at over 3 months old, when he is on his stomach, he can lift his head and his neck is quite strong.
However, when he is on his stomach, his face is completely pressed against the bed, and he doesn't seem to have much strength in his legs.
Sometimes his neck is strong, and sometimes it isn't.
He can now make sounds, smile at people, suck on his hands, kick the blanket, pull on clothes, hold the bottle with slight support, and scream.
But he only lifts his head and doesn't stand well, and his neck isn't very strong.
Is there a problem with this? Could it be a sign of developmental delay? My baby usually drinks milk every 3 to 4 hours, but if he sleeps a bit longer (5 to 6 hours), should I wake him up? Thank you, doctor!

Xinji de mama, 20~29 year old female. Ask Date: 2005/05/16

Dr. Cai Zhengxian reply Pediatrics

Dear anxious mother,
Due to the hospital management system notifying me to delete duplicate inquiries, I was unable to respond to your previous message.
A normally developed baby who is four months old can lie prone with their pelvis flat against the surface, while their head and chest can lift off the surface.
When assisted to sit up, there may be only slight lagging of the head (gross motor skills).
In terms of fine motor skills, the baby will automatically open their hands and often raise their hands to gaze at them.
For language communication, the baby will turn their head toward the source of sound and make cooing sounds when someone speaks to them.
In social interaction, the baby can maintain eye contact with people and track moving objects, often displaying a warm smile towards their mother.
Therefore, your baby is performing well in fine motor skills, language communication, and social interaction, but there may be some delay in gross motor development.
This could be related to your baby's lower birth weight.
I recommend consulting a pediatrician or a pediatric neurologist for a more detailed assessment to accurately understand your baby's condition.
Lastly, if your baby weighs over 5 kg, it is acceptable to let them sleep for longer periods without waking them (within 5-6 hours).
Wishing your baby health and happiness!
Sincerely,
Dr.
Tsai Cheng-Hsien, Pediatrician, Tainan City Hospital

Reply Date: 2005/05/16

More Info

It's completely understandable for new parents to have concerns about their baby's development, especially when it comes to milestones and overall health. Based on your description, your baby is currently 3 months and 25 days old, and you have observed several developmental behaviors that are quite common at this age. Let's break down your concerns and provide some reassurance.

Firstly, regarding your baby's ability to lift their head while lying on their stomach, this is a significant milestone. By around 3 months, many babies can lift their heads to about a 45-degree angle when on their tummy. However, it's also normal for babies to have varying degrees of strength in their neck muscles. If your baby is sometimes able to hold their head up but not consistently, this is not unusual. As they continue to grow and develop, you will likely see improvements in their neck strength and head control.

You mentioned that your baby sometimes has their face flat against the bed while lying on their stomach. This can happen, especially if they are still developing their muscle strength. It's important to provide supervised tummy time to help them build those muscles. Tummy time is crucial for developing the muscles necessary for rolling over, sitting up, and eventually crawling. Aim for short sessions several times a day, gradually increasing the duration as your baby becomes more comfortable.

As for your baby's social interactions, such as smiling, making sounds, and reaching for objects, these are all positive signs of development. At this age, babies are becoming more aware of their surroundings and are starting to engage with caregivers. The fact that your baby can laugh, coo, and show interest in their environment is a great indication that they are developing well socially and emotionally.

Regarding your concern about your baby not being able to stand or having a "wobbly" neck, it's essential to remember that each baby develops at their own pace. While some may achieve certain milestones earlier than others, there is a wide range of what is considered normal. If your baby is showing progress in other areas, such as social engagement and motor skills, it's likely that they are on the right track.

Now, concerning feeding, it's common for babies to have varying sleep patterns. If your baby sleeps longer than usual (5-6 hours), it's generally not necessary to wake them for a feeding, especially if they are gaining weight appropriately and meeting other developmental milestones. Babies have different sleep cycles, and longer stretches of sleep can be normal, particularly as they grow. However, if you have concerns about their weight gain or feeding habits, it may be worth discussing with your pediatrician.

In summary, based on the information you've provided, your baby's development seems to be within a normal range, albeit with some areas that may need a little more time to strengthen. Continue to engage with your baby through play, tummy time, and social interaction. If you have ongoing concerns about their development or feeding habits, don't hesitate to reach out to your pediatrician for further evaluation and guidance. They can provide personalized advice and reassurance based on your baby's specific needs. Remember, every baby is unique, and development can vary widely from one child to another.

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