The U4 examination takes place in the 3rd to 4th month of life. Your baby is now more alert, moves more actively, and increasingly responds to voices, faces, and its surroundings.

During the U4, the pediatrician checks growth, motor development, perception, and early social skills. It also covers vaccinations and questions about sleep, nutrition, and your family routine.

U4 at a Glance

Timing: 3rd – 4th month of life
Location: Your pediatrician's office
Focus Areas: Growth, motor skills, perception, development, vaccinations, and advice

You can find the exact examination window in the Yellow Examination Booklet and in the tio App.

What is Examined During the U4?

As with every check-up, your baby will be thoroughly examined. This includes:

  • Weight, body length, and head circumference
  • Heart, lungs, and abdomen
  • Skin, eyes, and ears
  • Spine, arms, and legs
  • Muscle tone and reflexes
  • Head control and movement behavior

The overall development of your child is more important than any single measurement.

How is My Baby Developing?

At three to four months, many babies show significant progress.

The doctor will look for signs such as whether your baby:

  • Holds their head more steadily,
  • Supports themselves on their forearms when on their tummy,
  • Moves both sides of the body evenly,
  • Looks at or reaches for objects,
  • Brings hands to the center of their body,
  • Shows interest in their surroundings.

Not every baby develops at the same pace. Small differences are completely normal.

Should My Baby Be Rolling Over Yet?

No. Some babies roll from tummy to back or vice versa, but many do so a few weeks later.

What’s more important is that your baby increasingly controls their movements and uses both sides of their body evenly.

Talk to your pediatrician if your baby consistently favors one side or shows little enthusiasm for movement.

Seeing, Hearing, and Early Communication

In the third and fourth months, many babies begin to communicate intensely with their environment.

During the U4, it will be observed whether your baby:

  • Makes eye contact,
  • Follows faces,
  • Responds to sounds,
  • Smiles,
  • Cooing or making first sounds.

These abilities develop individually. It may be concerning if your baby rarely responds to voices or sounds.

What Vaccinations Are Due at the U4?

Depending on the previous vaccination status, further vaccinations are usually given during the U4.

These include:

  • Six-in-one vaccination
  • Pneumococcal
  • Meningococcal B
  • Possibly rotavirus
  • Other recommended vaccinations according to the vaccination schedule

Bring the vaccination record to every check-up appointment.

What Vaccination Reactions Are Normal?

After a vaccination, temporary reactions may include:

  • Redness or swelling at the injection site
  • Mild fever
  • Fatigue
  • Restlessness
  • Reduced appetite

These symptoms usually subside after one to two days.

Sleep and Nutrition

Many babies are now sleeping a bit longer at night but still wake up regularly. This is normal at this age.

Breast milk or infant formula remains the most important nutrition. The U4 check-up is a good opportunity to discuss questions about starting solid foods, which usually begins a few weeks later.

Crying and Restlessness

Even at three to four months, there are phases when babies cry a lot or have difficulty calming down.

Talk openly about it if the situation is stressful for you or if your baby cries for a long time and is hard to soothe.

You don't have to handle it alone.

How to Support Your Baby

Your baby learns the most through shared time.

Helpful activities include:

  • Daily supervised tummy time
  • Lots of eye contact
  • Talking and singing
  • Free movement on a safe surface
  • Time to grasp and explore

No special toys are needed for this.

Safety Becomes More Important

Even if your baby isn't reliably rolling over yet, they can suddenly move further than expected.

Therefore, you should:

  • Never leave your baby unattended on a changing table or sofa,
  • Always keep one hand on your baby while changing,
  • Keep small objects out of reach,
  • Avoid carrying hot drinks over your baby,
  • Secure your baby correctly in a rear-facing car seat.

What to Bring to the U4 Check-Up

Helpful items include:

  • Yellow examination booklet
  • Vaccination record
  • Health insurance card
  • Diapers and a change of clothes
  • Bottle or food if needed
  • Your questions and observations

Make a note of anything you've noticed about sleep, nutrition, or development beforehand.

Typical Questions for the U4

Many parents want to know:

  • Is my baby developing appropriately for their age?
  • Are the movements normal?
  • Which vaccinations are due now?
  • When does solid food start?
  • Is frequent waking still normal?
  • How can I effectively support my baby?