4-month-old milestones: the CDC checklist

Wording from the CDC.

Most children (75 in 100) do these things by 4 months; mark what your child does and take the list to your child’s doctor.

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Social/Emotional Milestones

Smiles on his own to get your attention
Chuckles (not yet a full laugh) when you try to make him laugh
Looks at you, moves, or makes sounds to get or keep your attention

Language/Communication Milestones

Makes sounds like “oooo”, “aahh” (cooing)
Makes sounds back when you talk to him
Turns head towards the sound of your voice

Cognitive Milestones (learning, thinking, problem-solving)

If hungry, opens mouth when he sees breast or bottle
Looks at her hands with interest

Movement/Physical Development Milestones

Holds head steady without support when you are holding him
Holds a toy when you put it in his hand
Uses his arm to swing at toys
Brings hands to mouth
Pushes up onto elbows/forearms when on tummy

Other important things to share with the doctor

CDC suggests these questions; the wording is CDC’s.

  1. What are some things you and your baby do together?
  2. What are some things your baby likes to do?
  3. Is there anything your baby does or does not do that concerns you?
  4. Has your baby lost any skills he/she once had?
  5. Does your baby have any special healthcare needs or was he/she born prematurely?

What to ask the doctor

Talk with your child’s doctor. You know your child best. If you have a concern, don’t wait for the next visit: call your child’s doctor, share it, and ask about developmental screening.

Screenings at checkups. Doctors are advised to screen every child’s development with a standard questionnaire at the 9-, 18- and 30-month visits, and to screen for autism at the 18- and 24-month visits. You can ask for a screening at any visit.

If your child loses a skill. If your child stops doing something they used to do, at any age, call the doctor. Losing a skill is always worth a call.

You don’t need a referral. If your child is under 3, you can contact your state’s early intervention program yourself. From age 3, contact your local public school district, even if your child doesn’t go there. Find early intervention (CDC)

If you have concerns, talk to your child's doctor.

Sources: Zubler et al. 2022, Pediatrics 149(3) (the 2022 checklists); Lipkin and Macias 2020, Pediatrics 145(1) (the screening schedule); CDC’s early intervention pages.

Act early

You know your child best. Don't wait. If your child is not meeting one or more milestones, has lost skills he or she once had, or you have other concerns, act early. Talk with your child's doctor, share your concerns, and ask about developmental screening.

If you or the doctor are still concerned

  • Ask for a referral to a specialist who can evaluate your child more; and
  • Call your state or territory's early intervention program to find out if your child can get services to help. Learn more and find the number at cdc.gov/FindEI.

From CDC’s “Learn the Signs. Act Early.” page for this age.

Questions parents ask at 4 months

Answered from CDC’s 2022 checklists, quoting CDC’s wording exactly.

Should my 4-month-old be laughing?

CDC’s 4-month list says “Chuckles (not yet a full laugh) when you try to make him laugh”. The single word “Laughs” is on the 6-month list. If you have a question about it, talk with your child’s doctor.

Should my 4-month-old be rolling over?

Rolling is not on CDC’s 4-month checklist. CDC lists “Rolls from tummy to back” at 6 months. At 4 months the movement items include “Pushes up onto elbows/forearms when on tummy” and “Holds head steady without support when you are holding him”. CDC’s advice is to act early: if you have a concern, don’t wait, and talk with your child’s doctor.

Should a 4-month-old grab toys?

At 4 months CDC lists “Holds a toy when you put it in his hand” and “Uses his arm to swing at toys”. Reaching on purpose comes next: “Reaches to grab a toy she wants” is on the 6-month list. If you have a question about how your baby uses her hands, talk with your child’s doctor.

What comes before and after 4 months

Show CDC’s 2-month and 6-month lists

CDC’s checklists for the checkpoints on either side of 4 months, word for word, by area of development. They are here to compare; the checklist to mark is the 4-month one above.

Social/Emotional Milestones

At 2 months

  • Calms down when spoken to or picked up
  • Looks at your face
  • Seems happy to see you when you walk up to her
  • Smiles when you talk to or smile at her

At 6 months

  • Knows familiar people
  • Likes to look at self in a mirror
  • Laughs

Language/Communication Milestones

At 2 months

  • Makes sounds other than crying
  • Reacts to loud sounds

At 6 months

  • Takes turns making sounds with you
  • Blows “raspberries” (sticks tongue out and blows)
  • Makes squealing noises

Cognitive Milestones (learning, thinking, problem-solving)

At 2 months

  • Watches you as you move
  • Looks at a toy for several seconds

At 6 months

  • Puts things in her mouth to explore them
  • Reaches to grab a toy she wants
  • Closes lips to show she doesn’t want more food

Movement/Physical Development Milestones

At 2 months

  • Holds head up when on tummy
  • Moves both arms and both legs
  • Opens hands briefly

At 6 months

  • Rolls from tummy to back
  • Pushes up with straight arms when on tummy
  • Leans on hands to support herself when sitting

Tips and activities for 4 months

From CDC’s “Learn the Signs. Act Early.” program. The tips and activities below are CDC’s, word for word. CDC’s page for this age

What you can do for your 4-month-old

As your baby's first teacher, you can help his or her learning and brain development. Try these simple tips and activities in a safe way. Talk with your baby's doctor and teachers if you have questions or for more ideas on how to help your baby's development.

  • Respond positively to your baby. Act excited, smile, and talk to him when he makes sounds. This teaches him to take turns "talking" back and forth in conversation.
  • Provide safe opportunities for your baby to reach for toys, kick at toys and explore what is around her. For example, put her on a blanket with safe toys.
  • Allow your baby to put safe things in his mouth to explore them. This is how babies learn. For example, let him see, hear, and touch things that are not sharp, hot, or small enough to choke on.
More Parenting Tips and Activities (16)
  • Talk, read, and sing to your baby. This will help her learn to speak and understand words later.
  • Limit screen time (TV, phones, tablets, etc.) to video calling with loved ones. Screen time is not recommended for children younger than 2 years of age. Babies learn by talking, playing, and interacting with others.
  • Feed only breast milk or formula to your baby. Babies are not ready for other foods, water or other drinks for about the first 6 months of life.
  • Give your baby safe toys to play with that are easy to hold, like rattles or cloth books with colorful pictures for her age.
  • Let your baby have time to move and interact with people and objects throughout the day. Try not to keep your baby in swings, strollers, or bouncy seats for too long.
  • Set steady routines for sleeping and feeding.
  • Lay your baby on her back and show her a bright-colored toy. Move the toy slowly from left to right and up and down to see if she watches how the toy moves.
  • Sing and talk to your baby as you help her "exercise" (move her body) for a few minutes. Gently bend and move her arms and legs up and down.
  • Play with your baby by holding him securely under his arms with his feet on your lap. Let him bounce up and down.
  • Play games, such as peek-a-boo. You can cover your eyes with your hands and then uncover and say "peek-a-boo." Watch for your baby's smile or other signs he is enjoying the game.
  • Pay close attention to how your baby reacts to different things. This will help you learn what she likes and doesn't like and what makes her feel good.
  • Copy your baby's sounds and see how long your baby "talks" back and forth with you.
  • Call your baby by his name to help him learn it. He will start to recognize it around 9 months. For example, "Are you ticklish, Jordan?"
  • Playing on the floor or play mat with your baby every day helps him to move, learn, and explore.
  • Hold and talk to your baby; smile and be cheerful while you do.
  • Have quiet play times when you "read" or sing to your baby.

On CDC’s site

The checklist on this page is CDC’s, word for word. CDC’s site already has an online checklist for each age. What this page adds: a corrected-age calculator and a list for the doctor that prints without an email step.

More for parents

Milestone checklist: Centers for Disease Control and Prevention (CDC), “Learn the Signs. Act Early.”, 2022 revision. Source: CDC. Read this checklist on cdc.gov

Use of CDC material on this page does not imply endorsement by CDC, ATSDR, HHS or the United States Government.

Prepared by MyTestAtlas from CDC materials.