Newborn Fourth Week Guide

Your baby's fourth week: First social smiles, improved head control, and emerging personality

21-28 days
Age Range
7-11
Feeds per day
14-16 hrs
Sleep per day
4-6 hrs
Longest sleep stretch

Week 4 Major Milestones

First Social Smile

  • • Genuine smiles in response to faces
  • • Different from reflexive smiles
  • • Usually appears between 4-6 weeks
  • • Triggered by familiar voices and faces

Improved Head Control

  • • Can lift head 45° during tummy time
  • • Holds head steady for brief moments
  • • Better neck muscle strength
  • • Can turn head from side to side

Feeding Patterns - Week 4

Feeding TypeFrequencyAmount/DurationNotes
Breastfeeding7-10 times/day20-40 minutesMore efficient feeding, may go 3-4 hours between feeds
Formula6-8 times/day3-5 oz per feedLonger stretches between feeds, especially at night

Good news: Many babies start to have slightly longer feeding intervals and may sleep for longer stretches at night.

Sleep Development - Week 4

Sleep Patterns

  • • Total sleep: 14-16 hours per day
  • • Longest stretch: 4-6 hours at night
  • • Daytime naps: 3-4 naps of 1-3 hours
  • • Wake windows: 1-1.5 hours

Sleep Improvements

  • • Beginning to consolidate nighttime sleep
  • • More predictable sleep/wake cycles
  • • Better distinction between day and night
  • • May sleep longer after evening feeds

Physical Development & Motor Skills

Head & Neck

  • • Lifts head 45° during tummy time
  • • Better head control when held upright
  • • Can turn head to follow objects briefly
  • • Less head lag when pulled to sitting

Arms & Hands

  • • Stronger grip reflex
  • • May swipe at objects
  • • Hands starting to open more
  • • Brings hands toward face

Legs & Body

  • • Stronger kicking movements
  • • Better muscle tone overall
  • • Can push feet against surfaces
  • • More coordinated movements

Sensory Development

Vision

  • • Can focus on objects 8-15 inches away
  • • Tracks moving objects with eyes
  • • Prefers high contrast patterns
  • • Shows interest in faces and bright colors

Hearing & Communication

  • • Recognizes familiar voices
  • • May turn toward sounds
  • • Makes more varied vocalizations
  • • Beginning to 'coo' sounds

Social & Emotional Development

Emerging Social Skills

Social Interaction:

  • • First genuine social smiles
  • • More sustained eye contact
  • • Shows preference for faces
  • • May quiet when spoken to

Communication:

  • • Different cries for different needs
  • • Beginning cooing sounds
  • • Responds to familiar voices
  • • Shows contentment after feeding

Growth Expectations

Typical Growth by Week 4

  • • Weight: Back to birth weight + 450-900g more
  • • Length: 1-2 inches longer than birth
  • • Head circumference: 1-1.5 inches larger
  • • More filled-out appearance

Physical Changes

  • • Umbilical cord stump usually fallen off
  • • Skin less wrinkled and blotchy
  • • Hair texture may be changing
  • • More alert and responsive expressions

Essential Care Tips

Encourage Social Interaction

Talk, sing, and make faces to encourage those first smiles. Respond to baby's attempts at communication.

Tummy Time

Increase tummy time to 3-5 minutes several times daily to strengthen neck and shoulder muscles.

Sleep Routine

Start establishing gentle bedtime routines with dimmed lights and calm activities.

Stimulation Balance

Provide gentle stimulation but watch for overstimulation cues and allow quiet time.

Common Concerns & Solutions

6-Week Growth Spurt Approaching

Around 6 weeks, another growth spurt is common. Some babies may show early signs around 4-5 weeks.

Prepare for: Increased feeding frequency, more fussiness, and temporary sleep disruption.

Not Smiling Yet?

Social smiles typically appear between 4-8 weeks. Some babies are just developing at their own pace.

Keep trying: Continue talking, singing, and making eye contact. The smiles will come!

Sleep Regression

Some babies experience temporary sleep disruption around 4 weeks due to developmental changes.

Stay consistent: Maintain routines and be patient as baby's nervous system develops.

Approaching One Month: What to Expect

As you approach the one-month mark, your baby will become increasingly interactive and alert. The first month is a huge milestone for both baby and parents!

More Awake Time
Longer periods of alertness
Better Feeding
More efficient and predictable
Stronger Interaction
Social smiles and eye contact

When to Contact Your Pediatrician

Urgent Signs:

  • • Fever over 100.4°F (38°C)
  • • Difficulty breathing or blue lips
  • • Persistent vomiting or inability to keep feeds down
  • • No wet diapers for 12+ hours
  • • Extreme lethargy or difficulty waking

Developmental Concerns:

  • • No visual tracking by 6 weeks
  • • Not responding to loud sounds
  • • Poor muscle tone or excessive floppy movements
  • • Significant feeding difficulties persisting
  • • Any behavior that concerns you

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