Evidence-based advice for babies and children from the 2009 Rourke Well Baby Record  

 

The Nipissing Developmental Screens are now available free of charge to all Ontarians.  This helps you to see if your child is developing well; the screens are available at http://www.ndds.ca, and you will need to register.  Please bring a copy of the Screen to the office if you have any concerns.

 

A communication checklist to help monitor your child's hearing and speech progress is available at http://www.tpsls.on.ca/brochures/checklist/chekeng.pdf.  Please bring this to the office if you have concerns.

 

 

 

 

The following are guidelines and links found in the 2009 Rourke Well Baby Record.  They contain evidence-based advice on taking care of your baby.

 

NUTRITION

 

                        Pediatric nutrition guidelines – Nutrition for Healthy Term Infants

     www.hc-sc.gc.ca/fn-an/pubs/infant-nourrisson/nut_infant_nourrisson_term_e.html  

http://www.osnpph.on.ca/pdfs/ImprovingOddsJune-08.pdf

      Breastfeeding: Breastfeeding with no other liquids or solid foods is recommended for the first six months of life for healthy infants who are not premature. Breast milk is the best food for infants, and breastfeeding (with additional solid food) may continue for up to two years and beyond. Breastfeeding reduces bowel and respiratory infections, such as diarrhea or colds.

       

      • Routine Vitamin D supplementation of 10 μg = 400 IU/day (20 μg = 800 IU/day in northern communities) is recommended for all breastfed full term infants until the diet provides a sufficient source of Vitamin D (about 1 year of age). Formula may only supply a portion of the recommended daily vitamin D intake if less than 1000 mL (33 oz) is consumed daily

  Soy-based formula is not recommended for routine use as an alternative to cow’s milk formula, or for cow milk protein allergy; it is not to be used for premature babies. www.cps.ca/english/statements/N/InfantSoyConcern.htm

Breastfeeding - www.cps.ca/english/statements/N/BreastfeedingMar05.htm

Weaning - www.cps.ca/english/statements/CP/cp04-01.htm

Vitamin D - www.cps.ca/english/statements/II/ii02-02.htm

Colic - www.cps.ca/english/statements/N/NutritionNoteSept03.htm

Ankyloglossia (tongue tie) and breastfeeding - www.cps.ca/english/statements/CP/cp02-02.htm

Maternal medications during breastfeeding – Medications and Mothers’ Milk by T. Hale (2008).

Motherisk - www.motherisk.org

 

Children age 2 and over

      Transition to lower fat diet: A gradual transition from the high-fat infant diet to a lower-fat diet (max 30% fat / 10% saturated fat) begins after age 2 years.

-         www.cps.ca/english/statements/N/n94-01.htm

       

      • Children need a healthy diet as per Canada ’s Food Guide

-         www.hc-sc.gc.ca/fn-an/food-guide-aliment/index_e.html  

 

INJURY PREVENTION

In Canada, unintentional injuries are the leading cause of death in children and youth. Most of these preventable injuries are caused by motor vehicle collisions, drowning, burns, choking, and falls.

Motor vehicle collisions

      • Transport Canada recommendations for Car seats:

  Children < 13 years should sit in the back seat. Keep kids away from all airbags.

Use rear-facing infant seat until at least 1 year old AND 10 kg (22 lb.)

Use forward-facing child seat from at least 1 year of age AND 10 kg (22 lb.) to 22 kg (48 lb.)

– max height/wt may vary with car seat model

Use booster seat from at least 18 kg (48 lb.) to 36 kg (80 lb.) and up to 145 cm (4' 9")

Use lap and shoulder belt in the rear seat for older children over 8 yrs who are at least 36 kg (80 lbs) and 145 cm (4' 9") and fit vehicle restraint system.

-         www.cps.ca/english/statements/IP/IP08-01.htm

-         http://www.safekidscanada.ca/SKCPublicPolicyAdvocacy/custom/BoosterSeatLegislationChart.pdf

 

      Bicycle: wear bike helmets

  Drowning

      Bath safety: Never leave a young child alone in the bath. Do not use infant bath rings or bath seats.

      • Water safety: Encourage swimming lessons (after age 4 years). Encourage pool, diving, and boating safety to reduce the risk of drowning.

-         www.cps.ca/english/statements/IP/IP03-01.htm

Burns: Install smoke detectors in the home on every level.

Keep hot water at a temperature < 49°C.  

Choking: Use safe toys and safe food (avoid hard, small and round, smooth and sticky solid foods until age 3 years). Follow minimum age recommendations and remove loose parts and broken toys

Falls: Assess home for hazards, e.g. never leave baby alone on change table or other high surface; do not use baby walkers; use window guards and stair gates. Do not use trampoline at home: www.cps.ca/english/statements/IP/IP07-01.htm

Poisons: Keep medicines and cleaners locked up and out of child’s reach.

Have Poison Control Centre number handy; in Ontario: 1-800-268-9017. Do not use syrup of ipecac to make child vomit.

Safe sleeping environment: www.cps.ca/english/statements/CP/cp04-02.htm

             Sleep position and SIDS: Healthy infants should be positioned on their backs for sleep. Their heads should be placed in different positions on alternate days. While awake, infants should have supervised tummy time. Other risk factors for Sudden Infant Death Syndrome: overheating, maternal smoking or second-hand smoke.

                       Bed sharing: should be avoided.

                        Co-sleeping: Put infant in a government-approved crib in parents’ room for the first 6 months of life. Room sharing is protective against Sudden Infant Death Syndrome.

  Firearm safety/removal: There is evidence-based association between a firearm in the home and increased risk of unintentional firearm injury, suicide, or homicide.

For more safety information: www.safekidscanada.ca

www.cps.ca/english/publications/InjuryPrevention.htm

OTHER

        Second-hand smoke exposure: contributes to childhood illnesses such as colds, ear infections, persistent cough, pneumonia, asthma, and SIDS.

      Complementary and alternative medicine ( CAM ): Please tell your physician if you use homeopathy and other complementary and alternative medicine therapy or products, especially for children with chronic conditions.

  - www.cps.ca/english/statements/DT/DT05-01.htm

- Homeopathy - www.cps.ca/english/statements/CP/cp05-01.htm

      Pacifier use: is a parental choice. Pacifier use may decrease risk of SIDS, but may lead to breastfeeding difficulties, and should be restricted in children with chronic and recurrent ear infections. - www.cps.ca/english/statements/CP/cp03-01.htm

      • Fever advice/thermometers: Fever 38°C in an infant < 3 months needs urgent evaluation. Acetaminophen (Tylenol, Tempra) or Ibuprofen (Motrin, Advil) are both effective. Acetaminophen (Tylenol) is the first choice for fever control under 6 months of age; after that ibuprofen or acetaminophen may be used. Alternating acetaminophen with ibuprofen for fever control is not recommended.

  -         Temperature measurement - www.cps.ca/english/statements/CP/cp00-01.htm

        Healthy Active Living: children need physical activity and decreased sedentary pastimes, with parents as role models.

  - www.cps.ca/english/statements/HAL/HAL02-01.htm

 

        • Sun exposure/sunscreens/insect repellents: Minimize sun exposure. Wear protective clothing, hats, properly applied sunscreen with SPF 30 for those > 6 months of age. No DEET in < 6 months; 6-12 months 10% apply maximum once daily.      

      Pesticides: Avoid pesticide exposure. Encourage pesticide-free foods.

 

      Lead Screening is recommended for children who:

      • Websites about environmental issues:

  - Canadian Partnership for Children’s Health & Environment (CPCHE) - www.healthyenvironmentforkids.ca/

   - Health and housing - www.cmhc-schl.gc.ca/

  - Environmental health section of CDC - www.cdc.gov/node.do/id/0900f3ec8000e044

  - Commission for Environmental Cooperation – www.cec.org/children

      Dental Care:

- Dental cleaning: Fluoride toothpaste should be used twice per day with a minimum amount of water used to rinse the mouth after brushing. Children under 6 years of age should be supervised during brushing and only use a small amount (e.g. pea-sized portion) of toothpaste. Children under 3 years of age should have their teeth brushed by an adult using only a smear of toothpaste.

      - Fluoride supplements are not recommended under 6 yrs of age unless the child is considered at high risk for dental caries. www.cda-adc.ca/_files/position_statements/fluorides.pdf

- To prevent dental caries: avoid sweetened liquids and constant sipping of milk or natural juices in both bottle and cup.

 

BEHAVIOUR

Night waking/crying:

Night waking/crying occurs in 20% of infants and toddlers who do not require night feeding. Helpful things to do: Positive bedtime routines (including training the child to fall asleep alone), removing nighttime positive reinforcers, keeping morning awakening time consistent, and rewarding good sleep behaviour

-         www.mja.com.au/public/issues/182_05_070305/sym10800_fm.html

PARENTING/DISCIPLINE

Guides for discipline:

- www.cps.ca/english/statements/PP/pp04-01.htm

-Best Start Ontario

www.beststart.org/resources/hlthy_chld_dev /pdf/HCD_complete.pdf (section 3)

TOILET LEARNING

Your child will let you know when he or she is ready to begin; watch for cues (being interested, indicating when he or she needs to go.

- www.cps.ca/english/statements/CP/cp00-02.htm

   

LITERACY

Help your kids to learn to read.  Useful things to do: Watching less television, playing fewer video games or computer games and reading more to your children.

- www.cps.ca/english/statements/PP/pp02-01.htm