3-4 Week Well Visit: Information for Parents & Caregivers

• Babies should be fed only breast milk (at the breast or in a bottle) or iron-fortified formula until they are 4-6 months old.

  • If formula feeding, be sure to prepare the formula using the directions on the container unless your child’s primary care provider give you other directions.

  • Your baby does not need extra water.

• Hold your baby during feeding so you can look at each other. When using bottles, make sure you are always holding them - not propping them up.

• Burp your baby during natural breaks in feeding.

• Pacifiers may help soothe between feedings once breastfeeding is well established and your baby is gaining weight.

• Signs your baby might be hungry: putting hand to mouth, sucking, rooting, or fussing.

• Signs your baby might be full: turning away from the breast or bottle, closing their mouth, or relaxing their arms and hands.

Feeding frequency and amount

Breastfeeding

• Feed on demand, usually every 1 to 3 hours during the day and every 3 hours at night.

• Nursing may last about 10 minutes per breast.

Formula Feeding

• Most babies take 2 to 3 ounces every 2 to 3 hours.

• Total daily intake is usually 24 to 27 ounces.

• If your baby is still hungry, it’s okay to offer more.

• You can store mixed formula in the refrigerator for up to 24 hours.

• 400IU of vitamin D is recommended for babies up until 1 year of age.

• Breastmilk is not a good source of vitamin D. This means that all breast-fed infants should be given vitamin D supplements.

• All formula-fed infants who take less than 1000ml (approximately 33 ounces per day) should also be given vitamin D supplements.

• Vitamin D supplements are available over the counter and should be given once daily.

  • There are 2 main types of vitamin D drops available for babies. Check the packaging of the vitamin D supplement you have to make sure you are giving the correct amount.

    • Some have the recommended amount of vitamin D (400IU) in just one drop.

    • With others, you need to give the entire dropper. Use the dropper that came with the bottle of vitamin D.

Learn more about vitamin D for infants here.

Diapers and Digestion

• Your baby should have at least 5-6 wet diapers every day.

• Some infants will have bowel movements with every day. Some will be more often and others will be less often.

• Straining when passing gas or having bowel movements is also normal.

• If stools are soft and your baby is feeding well, how often they have a bowel movement and what they look like is less important.

• Make an appointment with your baby’s primary care provider if their stools are hard, there is blood or mucous in your baby’s stool, they are vomiting or not feeding well.

Everyday Care

• Sing, talk, and read to your baby. Avoid TV and digital media at this age.

• Calm your baby by stroking their head or gently rocking them.

• Never hit or shake your baby. Shaking can cause serious injury.

Fever and Illness

• A temperature of 100.4°F/38.0°C or higher in a newborn is an emergency.

• The most accurate way to measure your baby’s temperature is with a rectal thermometer.

• If your newborn has a fever, please call your baby’s primary care provider or take them to the pediatric Emergency Department.

Taking Your Baby Outdoors

• You can take your baby outside at any age.

• Dress your baby in the same number of layers as an adult would wear.

• If it’s cold, add a hat to keep them warm.

• Avoid direct sun exposure.  Baby skin is more sensitive to the sun. Protect their skin with long sleeves, long pants, and a hat. No sunscreen until 6 months old.

Bathing Your Baby

• Wait to give a full bath until the umbilical stump has fallen off and the area is completely healed and dry.

• This usually happens around 2-3 weeks of age but might be earlier.

• Until then, clean your baby with sponge baths or gentle wipes.

Every baby grows and learns at their own pace. The following are common milestones that most newborns reach by 1 month of age. These milestones help show how a baby is learning to move, communicate, and connect with others. If there are any concerns, talk to your baby’s primary care provider.

Movement and Physical Skills

• Moves arms and legs equally on both sides.

• Keeps hands in tight fists most of the time.

• Briefly lifts head when lying on tummy (“tummy time”).

• Shows natural reflexes, like grasping a finger or turning toward a touch on the cheek (rooting reflex).  

Hand and Eye Skills

• May bring hands to mouth.

• Looks at faces or objects for a short time.

• May follow moving objects with eyes for a moment.

Communication and Hearing

• Cries when uncomfortable, hungry, or needs attention.

• Calms down when hearing a familiar voice.

• May become alert to unexpected sounds.

• Starts to make short, simple sounds (like “ah” or “oh”).

Social and Emotional Development

• Looks at faces, especially when someone is talking or smiling.

• May make eye contact for a few seconds.

• Begins to show interest in people by watching their faces.

What to Remember

• Babies develop at different rates. Some may reach these milestones a little earlier or later.

• These milestones are guidelines, not rules. If a baby is not doing some of these things yet, it may still be normal.

• If a baby does not move both sides of the body equally, does not respond to loud sounds, or seems very stiff or floppy, let your baby’s primary care provider know.

Safe Sleep and Crib Safety

• At this age, your baby should always sleep on their back.

• Choosing a safe sleep space is important for your baby’s health and safety.

• Use a firm sleep surface, like a crib, bassinet, or “Pack-and-play” with a tight-fitting sheet.

  • It should be in a safe location, away from heaters or direct heat sources.

  • Make sure the crib sides are fully up and secure.

  • Use a crib with slats no more than 2⅜ inches apart to prevent injury.

• Remove all soft objects from the crib or bassinet: No blankets, pillows, sleep positioners, or bumper pads.

• Room-sharing, NOT bed-sharing, is recommended for at least the first 6 months, ideally up to 1 year.

• Your baby should not sleep on or in:

  • soft surfaces like your bed or couch

  • loungers or pillows like “Dock-a-tot”

  • bouncers or swings

  • Car seats. If your baby falls asleep while you are driving, that is fine - but once you get to your destination, take them out of their car seat and move them to a safe sleep space.

Sleep Patterns and Tips

• Babies usually sleep 16 or more hours a day.

• Some wake every 2-4 hours, while others sleep longer stretches — every baby is different.

• Feeding right before bed doesn’t guarantee longer sleep.

• Put your baby in their sleep space when they are drowsy but still awake.

• Do not put your baby to bed with a bottle.

• Learn infant CPR and first aid. Keep a first aid kit at home.

• Make a list of emergency phone numbers and keep it somewhere easy to find.

• Prepare for disasters or other unexpected events by having an emergency plan.

Car Safety

• Use a rear-facing car seat in the back of all vehicles. Ask your child’s primary care provider if you have questions about their car seat.

• Make sure your baby always stays in the car seat during travel. If they become fussy or need to feed, stop the vehicle and take them out of the car seat.

• Never leave your baby in the car alone. Start habits that prevent you from ever forgetting your baby in the car, such as putting your cell phone in the back seat.

• Your baby’s safety depends on you.

  • Always wear your lap and shoulder seat belt.

  • Never drive after drinking alcohol or using drugs.

  • Never text or use a cell phone while driving.

Fires and Burns

• Check your smoke detectors regularly to make sure they work.

• Keep a fire extinguisher in or near the kitchen.

• Never eat, drink, or carry anything hot near your baby or while holding them.

• Set your water heater to 120°F (50°C) to prevent burns.

Falls

• Never leave the baby alone except in a crib with the sides up.

• Do not leave your baby on high surfaces, like changing tables, beds, or sofas.

• Falls from over 2 feet can cause serious injuries.

Water Safety

• Never leave an infant or toddler in a bathtub alone.

Poison Prevention

• Keep the Poison Control Center number saved in your phone: 1-800-222-1222 or 911 in an emergency.

• Avoid smoking, vaping, alcohol and drug use around your baby.

• Avoid using pesticides indoors.

Choking and Suffocation

• Keep cords, strings, and small objects away from your baby.

• Don’t let your baby wear necklaces or bracelets.

Tobacco Exposure

• Create a tobacco-free home and car to keep children healthy.

• Babies exposed to smoke have more frequent and more severe respiratory infections.

• Resources if you are thinking about quitting:

  Call 1-800-NO-BUTSS

  https://www.nobutts.org

• Immunizations protect your child against serious, life-threatening diseases.

• The routinely recommended vaccines at this well visit are:

  • Hepatitis B - if your baby did not receive the immunization right after birth.

  • RSV - This depends on the time of year and whether the birth parent received the RSV immunization during pregnancy.

• It is safe for your child to be given all recommended vaccines according to the schedule published by the American Academy of Pediatrics.

• Vaccines are safe, effective, and proven to save lives.

• At CPCMG, we offer combination vaccines whenever possible to decrease the number of injections.

• If you have concerns about vaccines, please talk to your child’s primary healthcare provider for accurate information.

• Learn more about recommended immunizations from the American Academy of Pediatrics.

Common side effects from vaccines

• Fever - can be treated with acetaminophen.

• Soreness - can be treated with a cool compress.

• Swelling at the injection site - can be treated with a cool compress.

For more details, visit the immunizations section on our Health Hub.

• More than half of new parents experience “postpartum blues”.

  • This usually starts 3 or 4 days after delivery and usually gets better within 1 to 3 weeks.

  • Symptoms can include tearfulness, feeling tired or sad, and trouble thinking clearly.

  • These feelings are linked to a sudden drop in hormones after birth.

• Many parents feel guilty or confused about these emotions, especially when they expected to feel only joy.

• There are healthy ways to manage postpartum blues.

  • Acknowledge your feelings. Talk with a partner, trusted friend, your healthcare provider, or your baby’s primary care provider.

  • Get enough rest. If possible, sleep when your baby sleeps.

  • Ask for help. Let others help with meals, baby care, or tasks around the home.

  • Stay connected. Try not to isolate - spend time with people who support you.

• If you’re still feeling down by the time your baby is 1 month old, please talk to your healthcare provider. You might benefit from counseling or other support.

• If your feelings are making it hard for you to care for yourself and your baby, get help as soon as possible.

  Helpful access and crisis lines:

  San Diego County 888-724-7240

  Riverside County 951-686-HELP (4357)

  Crisis Text Line: 741741 - text any word (like HELP or TALK) to start a discussion

  You can call the National Suicide Prevention Lifeline (text 988) at any time to speak with someone immediately.

  For more information on 10 signs of postpartum depression, click here.

  For more information and resources for therapists and counselors in San Diego County and Riverside County, click here.

• The first few weeks at home with a newborn can be challenging. You may feel tired, overwhelmed, or even lonely. These feelings are common —and you’re not alone.

• Accept help from family, friends, or trusted support people when it’s offered.

• If possible, encourage your partner to take time off from work. They can help with household chores and baby care.

• If you have older children, ask visitors to spend time with them too. This helps everyone feel included.

• To help prevent illness:

  • Limit visitors to close family and friends during the first month.

  • Make sure everyone that is around your baby is healthy and up-to-date on vaccines.

  • Wash hands often and before touching your baby.

• Try to rest when your baby sleeps.

• Try to spend time with your other children without the baby.

• Keep some of your usual routines —this can help your family adjust.

• Let your child’s primary care provider know if:

  • You feel unsafe or have been hurt by someone close to you. We can connect you with confidential support and hotlines.

  • You’re worried about your living situation or having enough food.

• Programs like SNAP and WIC may help with:

  • Buying formula for infants.

  • Getting food for breastfeeding parents and children up to age 5.

  • For more information on the WIC program please ask your doctor or contact WIC directly.

    • WIC San Diego 1-800-500-6411, http://sandiegowic.org/

    • WIC Riverside: 1-800-472-2321, http://cms.sbcounty.gov/wic/Home.aspx

• We will talk about:

  • Taking care of your baby, your family, and yourself

  • Getting back to work or school and finding childcare

  • Getting to know your baby

  • Feeding your baby

  • Keeping your baby safe at home and in the car

• Bring your child’s immunization card to all visits.

• We are here for you between Well Visits!

  • We understand that it is not possible to address all concerns at the Well Visit.

  • For medical conditions, illnesses, mental health and behavioral health, and other concerns between Well Visits, please schedule an appointment with your child’s primary care provider.

Immunizations

Immunizations protect your child against serious, life-threatening diseases.

The routinely recommended vaccines at the next well visit (the 2 month visit) are:

• DTaP (Diphtheria, Tetanus, acellular Pertussis)  

• Hib (Haemophilus influenza type B)  

• Polio  

• Pneumococcal

• Oral Rotavirus  

• Some babies also receive a hepatitis B vaccine at this age.

At CPCMG, we offer combination vaccines whenever possible to decrease the number of injections. Your child’s primary care provider may recommend a combination vaccine that includes DTaP, Hib, Polio, and Hepatitis B.  

Learn more about recommended immunizations from the American Academy of Pediatrics