Evidence-based advice for babies and children from the 2006 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 2006 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  

Infants

      • 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).

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 and breastfeeding - www.cps.ca/english/statements/CP/cp02-02.htm

Maternal medications during breastfeeding – Medications and Mothers’ Milk by T. Hale (2005).

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 2002 recommendations for Car seats:

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

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

Use forward-facing child seat from 10 kg (22 lb.) to 18-22 kg (40-48 lb.)

– about 1-4½ years old - as per specific car seat model

Use booster seat from 18-22 kg (40-48 lb.) to 27 kg (60 lb.) – about 4½ -8 years old

Use lap and shoulder belt in the rear seat for older children

-         www.tc.gc.ca/roadsafety/childsafety/menu.htm

-         www.cmaj.ca/cgi/content/full/167/7/769

      • 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).

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.

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

Have Poison Control Centre number handy. 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.

                        • Changes in skull shape because of sleeping position: www.cps.ca/english/statements/IP/cps01-02.htm

                        • 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 SIDS.

  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: Rectal temperature is the method of choice in those < 5 years and oral temperature thereafter. Fever ≥ 38°C in an infant < 3 months needs urgent evaluation. Acetaminophen (Tylenol, Tempra) remains the first choice. Ibuprofen (Motrin, Advil) is off-label therapy for children < 2 years.

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

Footwear: Shoes are for protection, not correction. Walking barefoot develops good toe gripping and muscular strength - www.cps.ca/english/statements/CP/cp98-02.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

- Media use - www.cps.ca/english/statements/PP/pp03-01.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.

  -         Pesticides/herbicides - www.ocfp.on.ca/english/ocfp/communications/ publications/default.asp?s=1#EnvironmentHealth

        • Lead Screening is recommended for children who:

       - in the last 6 months lived in a house or apartment built before 1950;

- live in a home with recent or ongoing renovations or peeling or chipped paint.

- have a sibling, housemate, or playmate with a prior history of lead poisoning;

- have been seen eating paint chips.

      • 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: After the eruption of the first tooth, clean with only water using a washcloth or soft brush until age 2 years; thereafter using only a pea-sized amount of fluoridated dentifrice; child should start brushing teeth themselves, with a parent supervising.

      - Fluoride supplements are recommended where the child is not getting fluoride from other sources. Sources include fluoridated dentifrice and all home and child-care water sources. Fluoride is to be started only after the eruption of the first primary tooth.

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