Early Infancy (4-6 Months Adjusted Age)

Welcome to an exciting phase of your baby’s growth! At 4-6 months adjusted age, your little one is mastering head and neck control, starting to roll over, and showing an incredible curiosity about their surroundings. Sleep patterns are improving, making it the perfect time to establish a bedtime routine. Socially, they are becoming more interactive, responding with delightful babbles and laughter to your voice and facial expressions. This is also when they may show interest in starting solid foods, adding even more joy to mealtime.

My Baby Loves to Stand and Jump. Why Shouldn’t I Put Them in a Jolly Jumper, Exersaucer, or Other Standing Device?

While babies look adorable in these devices and seem to love them, there are a few reasons we generally discourage their use, especially for babies born prematurely.

Reasons to Avoid Standing Devices

Muscle Imbalance: These devices often promote pushing or extending through the legs, encouraging babies to be up on their tiptoes. The muscles that allow your baby to straighten their body and legs are already the strongest at this stage. Exercising them more can make it more difficult later to break those motor patterns and learn to use those muscles with control, which is essential for crawling and walking.
Delayed Motor Touchpoints: Not only do babies not need these devices for their development, but they can also be harmful and delay their motor touchpoints.

What to Do Instead

The good news is that what is more beneficial for their development is spending time on their tummies and sitting on the floor with you engaging them. This helps them develop a balanced muscle strength and control, which is crucial for their motor skills. Plus, it’s free!

So, while it might be disappointing to skip the Jolly Jumper or Exersaucer, remember that these alternatives are much better for your baby’s growth and development.

Tummy Time

Promoting Muscle Balance: Tummy time helps develop core muscles, including the neck, shoulders, arms, and back, which are crucial for future motor skills like crawling and walking. It also helps prevent your baby from having a flat head, which can occur from spending too much time lying on their back.
Stimulating Sensory Experiences: Being on their tummy allows babies to experience a different range of motions, helping them develop a more expansive “movement library.” Tummy time provides different sensory inputs, stimulating their proprioceptive (sense of body position) and vestibular (sense of balance) systems.
Practical Tips for Tummy Time:
- Start Early and Gradually. Begin tummy time as soon as your baby comes home from the NICU. Start with short sessions, even just one minute at a time each time you change your baby’s diaper, and gradually increase the duration as your baby gets stronger. Check out the video to the right to see a great demo of tummy time!
- Engage and Entertain. Make tummy time engaging by placing toys or a mirror within your baby’s reach. Lie down on the floor or have siblings nearby to keep them company and encourage them.
- Place Toys Strategically. As your baby becomes more comfortable in tummy time, start positioning toys at 45° to foster pivoting and continued development of the abdominal musculature.

Motor Development

Impact of NICU on Posture and Motor Skills

Posture and Muscle Development: Full-term babies naturally have the opportunity for abdominal flexion (bending and twisting using tummy muscles) in utero, which helps in developing core strength and proper posture. Preterm babies often miss out on this opportunity and can have weaker abdominal muscles. They also spend extended periods in the NICU in positions that do not promote balanced muscle development.

Impact of NICU Environment: In the NICU, preterm babies often have limited movement due to medical equipment and positioning, which can affect their motor skill development. The presence of tubes and sensors up babies’ noses can trigger the use of back muscles more than abdominal muscles, leading to an imbalance in muscle development. Imagine if someone were to stick something up your nose; surely that would cause you to twitch and pull back, too! The effects of gravity and weak muscles can further complicate their ability to develop balanced motor skills.
Core Muscle Strengthening: To counteract weak abdominal muscles, provide opportunities for tummy time and activities that encourage flexion. Gentle abdominal massage and holding your baby in flexed positions can help strengthen their core muscles.
Observation and Intervention: Regularly observe your baby’s head and body positioning and seek early intervention if you notice any persistent head tilt or muscle imbalances. Early physical therapy can address these issues and promote balanced muscle development.

Prop Sitting

What is Prop Sitting? Prop sitting is when a baby sits with support from their hands on the ground. It helps them develop the muscles and balance needed for independent sitting.
When to Start: Around 4-5 months corrected age, help your baby into a prop sitting position and support them as needed. Encourage them to reach for toys to improve balance.
Below is another fantastic video by Maureen on how to help your baby into prop sitting!

Transferring Objects

Babies will begin transferring objects from one hand to another, an important skill that helps with hand-eye coordination and cognitive development. Provide opportunities for your baby to practice this by giving them toys that are easy to hold and pass between hands.

Communication

Hearing Development

Babies rely on hearing to learn about the world around them. They are born with the ability to hear sounds and begin to differentiate between different tones and pitches. By this age, your baby is developing their ability to localize sounds and understand where they are coming from. Talking, singing, and playing music with your baby helps them develop these crucial skills. Pay attention to how your baby responds to different sounds—they may turn their head or react with interest. This interaction helps them learn to recognize voices and sounds, laying the groundwork for language development.

Babbling

What to Expect: Around 4-6 months corrected age, your baby will start to coo and make speech-like babbling sounds like “pa,” “ba,” and “mi.”
Encouraging Babbling: Respond to your baby’s sounds and introduce new sounds to imitate. Engage in early “conversations” by taking turns making sounds.

Reading Together: Use board books with bright pictures and simple text. Books with textures or interactive elements, such as touch-and-feel books, engage your baby’s senses and curiosity. These tactile experiences help stimulate their sensory development and make reading time more interactive and enjoyable for both of you. Point to pictures and name objects to build their vocabulary.

Vision Development

Vision development is crucial during the early months of life. By 4-6 months corrected age, most babies have gained better control of their eye movements and can track objects with their eyes. However, if you notice that your baby’s eyes are not aligning or crossing consistently after 4 months, it’s essential to discuss this with your pediatrician. Addressing vision issues promptly helps ensure your baby’s visual development progresses. Regular check-ups with a pediatric eye specialist may be recommended to monitor and support your baby’s vision development.

Early Conversations with Your Baby: You can have meaningful interactions with your baby even before they can talk!

Step 1: OWL - Observe, Wait, and Listen Observe:
- Watch what your baby is looking at.
- Wait: See if your baby sends a message (eye contact, smile, movement).
- Listen: Pay attention to any sounds your baby makes, like giggles, coos, or babbles.
Step 2: Follow Your Baby’s Lead
- Comment on what your baby shows interest in.
- Acknowledge and respond to their attempts to communicate.
Step 3: Make It Big
- Use gestures, repetition, expression, and emphasis when you talk to your baby.
Step 4: Repeat
- Continue observing, waiting, listening, and responding. Notice how you and your baby have a back-and-forth “conversation!”

How Do Babies Learn?

Babies learn by playing, not by watching TV! Play helps them explore the world and build their brains. This can look like:
- Putting hands and toys in their mouth
- Shaking toys, banging a toy on a surface, or banging two toys together
- Throwing items off their highchair
- Searching for hidden items
- Imitating actions

Families often ask what toys are best for their child. At this age, it’s less about the specific toys and more about how and with whom they’re playing. Playing on the floor with you at their level is best for their development!

Play: The Work of Childhood

Supportive Play

Play is not just fun for your child; it’s essential for learning. Through play, children develop creativity, communication, and problem-solving skills. Parents can support play by allowing their child to take the lead in selecting what interests them and encouraging their efforts.
Tips for supportive play:
- Let your child choose what interests them and follow their lead.
- Give them time to problem solve and avoid overstimulation with too many toys.
- Provide breaks when needed.
- Remember that banging toys, throwing objects, and putting things in their mouth are natural parts of development!

Ideal Place to Play

The ideal play environment for babies is on the floor in a prone (tummy-down) position. This setup allows them to explore and move freely while reducing the risk of falling. It supports their development of motor skills, such as crawling and reaching, in a safe and comfortable manner.

Feeding

Introducing Solids: Around 4-6 months corrected age, you can start introducing solid foods. Begin with iron-fortified cereals and pureed fruits and vegetables. Babies may be sensitive to lumps and textures, so start with smooth purees. If making homemade purees, use breastmilk or formula as the liquid to ensure your baby gets additional nutrients and calories if your baby’s growth catch-up is still an active goal. Watch for signs of readiness, like being able to sit up with support and showing interest in food.
Start Thin and Gradually Add Thickness: Begin with thin purees and gradually increase thickness as your baby matures in their feeding skills. This progression allows them to develop the ability to handle different textures and prepare for more varied foods in the future.

Start With Thickened Smooth Puree When:
- Your baby is putting their hands or toys in their mouth.
- Your baby opens their mouth to the spoon.
- Your baby’s tongue moves food from the front to the back of their mouth to swallow.
- Your baby can sit with support in a high chair, minimally reclined.
- Your baby starts moving their jaw up and down when chewing (munching chew).

Sleep “Onion”

Just as an onion has many layers, so does your baby’s sleep routine. Each layer represents different elements that contribute to their sleep habits and patterns. It’s important to peel back these layers gradually, allowing your baby to learn to sleep on their own while feeling secure and comfortable. This process may involve establishing soothing bedtime rituals, ensuring a safe sleep environment, and responding to their cues with patience and consistency.

Sleep

Consistent Routines: Establish a consistent bedtime routine to help your baby recognize when it’s time to sleep, including activities like a warm bath, gentle rocking, and reading a story.

Amount of Sleep: As your little person matures, sleep becomes more organized and less all-consuming, with babies approaching 4 months corrected age sleeping around 12 to 16 hours per day, usually with one stretch at night that’s a bit longer and then up to 3 naps per day. Around 6 months corrected age, babies shift to needing 2 naps per day and generally stay in this pattern through the first year. Some babies nap very briefly and really power down for the overnight sleep. Some babies are great nappers and sleep less lengthy overnights.