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2011 Drs. L Rourke, D Leduc and J Rourke Revised July, 2011 Risk factors/Family history: Rourke Baby Record: Evidence-Based Infant/Child Health Maintenance GUIDE I: 0-1 mo
NAME: Birth Day (d/m/yr): _ M [ ] F [ ] Gestational Age: Birth Length: cm Birth Wt: g Head Circ: cm Discharge Wt: g DATE OF VISIT
within 1 week
2 weeks (optional)
GROWTH1 use WHO growth charts. Height
HC (avg 35 cm)
Weight (regains BW Head Circ.
Head Circ.
Correct percentiles until 24-36 months if < 37 weeks gestation  Breastfeeding (exclusive)1
 Breastfeeding (exclusive)1
 Breastfeeding (exclusive)1
Vitamin D 400 IU/day1
Vitamin D 400 IU/day1
Vitamin D 400 IU/day1
 Formula Feeding (iron-fortified)1
 Formula Feeding (iron-fortified)1
 Formula Feeding (iron-fortified)1
[150 mL(5 oz)/kg/day1]
[150 mL(5 oz) /kg/day1]
[450-750 mL(15-25 oz) /day1]
 Stool pattern and urine output  Stool pattern and urine output  Stool pattern and urine output EDUCATION AND ADVICE
Injury Prevention  Car seat (infant)1
 Sleep position/room sharing/avoid bed sharing1  Crib safety1  Firearm safety/removal1
 Carbon monoxide/Smoke detectors1  Hot water <49oC1
 Choking/safe toys1
discussed and no concerns Behaviour and family issues
 Sleeping/crying2
 Soothability/responsiveness  High risk infants/assess home visit need2
 Parenting/bonding  Parental fatigue/postpartum depression2
 Family conflict/stress Other Issues
 Second hand smoke1
 No OTC cough/cold medn1
 Inquiry on complementary/alternative medicine1
 Counsel on pacifier use1
 Temperature control and overdressing  Sun exposure/sunscreens/insect repellent1
 Fever advice/thermometers1
 Sucks well on nipple  Focuses gaze (Inquiry and observation of  No parent/caregiver concerns  Startles to loud noise  Calms when comforted Tasks are set after the time of  Sucks well on nipple normal milestone acquisition.
 No parent/caregiver concerns Absence of any item suggests consideration for further assessment of development.
NB-Correct for age if < 37 weeks gestationü if attained X if not attained  Skin (jaundice, dry)  Skin (jaundice, dry)  Skin (jaundice) Evidence-based screening for specific conditions is highlighted,  Eyes (red reflex)1
 Eyes (red reflex)1
 Eyes (red reflex)1
but an appropriate age-specific  Ears (TMs) Hearing inquiry/screening1  Ears (TMs) Hearing inquiry/screening1
 Corneal light reflex1
focused physical examination is  Heart/Lungs  Heart/Lungs  Hearing inquiry/screening1
recommended at each visit.
 Umbilicus  Umbilicus  Femoral pulses  Femoral pulses  Muscle tone1
 Muscle tone1
 Muscle tone1
 Testicles  Testicles  Male urinary stream/foreskin care  Male urinary stream/foreskin care PROBLEMS AND PLANS
 PKU, Thyroid
 Record Vaccines on Guide V
 If HBsAg-positive parent/sibling Hep B vaccine #23
Discuss immunization pain
 Hemoglobinopathy screen (if at risk)1
 Record Vaccines on Guide V
 Universal newborn hearing screening (UNHS)1
 If HBsAg-positive parent/sibling Hep B vaccine #13
 Record Vaccines on Guide V
Strength of recommendation based on literature review using the classification of the Canadian Task Force on Preventive Health Care: Good (bold type); Fair (italic type); Consensus (plain type).
1see Rourke Baby Record Resources 1: General
2see Rourke Baby Record Resources 2: Healthy Child Development 3see Rourke Baby Record Resources 3: Immunization/Infectious Diseases
Disclaimer: Given the constantly evolving nature of evidence and changing recommendations, the Rourke Baby Record is meant to be used as a guide only.
Financial support has been provided by the Government of Ontario, with funds administered by the Ontario College of Family Physicians. For fair use authorization, see



2011 Drs. L Rourke, D Leduc and J Rourke Revised July, 2011 Past problems/Risk factors: Rourke Baby Record: Evidence-Based Infant/Child Health Maintenance GUIDE II: 2-6 mos
NAME: Birth Day (d/m/yr): _ M [ ] F [ ] Gestational Age: Birth Length: cm Birth Wt: g Birth Head Circ: cm DATE OF VISIT
GROWTH1 use WHO growth charts. Height
Head circ.
Head Circ.
Weight (x2 BW)
Head Circ.
Correct percentiles until 24-36 months if < 37 weeks gestation  Breastfeeding (exclusive)1
 Breastfeeding (exclusive)1
 Breastfeeding1 initial introduction of solids
Vitamin D 400 IU/day1
Vitamin D 400 IU/day1
Vitamin D 400 IU/day1
 Formula Feeding (iron-fortified)1
 Formula Feeding (iron-fortified)1
 Formula Feeding iron-fortified1
[600-900 mL(20-30 oz) /day1]
[750-1080 mL(25-36 oz) /day1]
[750-1080 mL(25-36 oz) /day1]
 No bottles in bed Avoid sweetened juices/liquids Iron containing foods (cereals, meat, egg yolk, tofu)  Fruits and vegetables to follow
 No egg white, nut products, or honey
 Choking/safe food1
EDUCATION AND ADVICE
Injury Prevention  Car seat (infant)1
 Sleep position/room sharing/avoid bed sharing/crib safety1
 Poisons1; PCC#1
 Firearm safety/removal1
 Electric plugs/cords  Carbon monoxide/Smoke detectors1
 Hot water <49oC/bath safety1
discussed and no concerns  Falls (stairs, change table, no walkers)1
 Choking/safe toys1 Behaviour and family issues
 Sleeping/crying/Night waking2
 Soothability/responsiveness  High risk infants/assess home visit need2
 Parenting/bonding  Parental fatigue/postpartum depression2
 Family conflict/stress  Child care2/return to work
Other Issues
 Second hand smoke1
 Teething/Dental cleaning/Fluoride1
 No OTC cough/cold medn1
 Fever advice/thermometers1
 Temperature control and overdressing  OTC/complementary/alternative medicine1
 Encourage reading2
 Sun exposure/sunscreens/insect repellent1
 Pesticide exposure1
 Pacifier use1
 Follows movement with eyes  Follows a moving toy or person with eyes  Turns head toward sounds (Inquiry and observation of  Coos - throaty, gurgling sounds  Responds to people with excitement (leg movement/  Makes sounds while you talk to him/her  Lifts head up while lying on tummy  Vocalizes pleasure and displeasure Tasks are set after the time of  Can be comforted & calmed by touching/rocking  Holds head steady when supported at the chest or waist  Rolls from back to side normal milestone acquisition.
 Sequences 2 or more sucks before swallowing/breathing in a sitting position  Sits with support (e.g. pillows)  Smiles responsively  Holds an object briefly when placed in hand  Reaches/grasps objects Absence of any item suggests  No parent/caregiver concerns  Laughs/smiles responsively  No parent/caregiver concerns consideration for further  No parent/caregiver concerns assessment of development.
NB-Correct for age if < 37 weeks gestationü if attained X if not attained  Anterior fontanelle1
 Anterior fontanelle1
Evidence-based screening for  Eyes (red reflex)1
 Eyes (red reflex)1
 Eyes (red reflex)1
specific conditions is highlighted,  Corneal light reflex1
 Corneal light reflex1
 Corneal light reflex/Cover-uncover test & inquiry1
but an appropriate age-specific  Hearing inquiry/screening1
 Hearing inquiry/screening1
 Hearing inquiry/screening1
focused physical examination is recommended at each visit.
 Muscle tone1
 Muscle tone1
 Muscle tone1
PROBLEMS AND PLANS
 Record Vaccines on Guide V
 Record Vaccines on Guide V
 Inquire about risk factors for TB Discuss immunization pain
 If HBsAg-positive parent/sibling Hep B vaccine #33
reduction strategies3
 Record Vaccines on Guide V
Strength of recommendation based on literature review using the classification of the Canadian Task Force on Preventive Health Care: Good (bold type); Fair (italic type); Consensus (plain type).
1see Rourke Baby Record Resources 1: General
2see Rourke Baby Record Resources 2: Healthy Child Development 3see Rourke Baby Record Resources 3: Immunization/Infectious Diseases
Disclaimer: Given the constantly evolving nature of evidence and changing recommendations, the Rourke Baby Record is meant to be used as a guide only.
Financial support has been provided by the Government of Ontario, with funds administered by the Ontario College of Family Physicians.



2011 Drs. L Rourke, D Leduc and J Rourke Revised July, 2011 Past problems/Risk factors: Rourke Baby Record: Evidence-Based Infant/Child Health Maintenance GUIDE III: 9-15 mos
NAME: Birth Day (d/m/yr): _ M [ ] F [ ] Gestational Age: Birth Length: cm Birth Wt: g Birth Head Circ: cm DATE OF VISIT
9 months (optional)
12-13 months
15 months (optional)
GROWTH1 use WHO growth charts. Height
Head circ.
Weight (x3 BW)
HC (avg 47cm)
Head Circ.
Correct percentiles until 24-36 months if < 37 weeks gestation  Breastfeeding1/Vitamin D 400 IU/day1
 Formula Feeding - iron-fortified1
 Homogenized milk [500-750 mLs(16-24 oz) /day1]
 Homogenized milk [500-750 mLs(16-24 oz) /day1]
[720-960 mLs(24-32 oz) /day1]
 Avoid sweetened juices/liquids  Avoid sweetened juices/liquids  Avoid sweetened juices/liquids  Promote standard cup instead of bottle  Promote standard cup instead of bottle  Encourage change from bottle to cup  Appetite reduced  Choking/safe foods1
 No bottles in bed  Choking/safe foods1
 Inquire re: vegetarian diets1
 Cereal, meat/alternatives, fruits, vegetables  Inquire re: vegetarian diets1
 Cow's milk products (e.g., yogurt, cheese, homogenized milk)  No egg white, nut products, or honey
 Choking/safe foods1
EDUCATION AND ADVICE
Injury Prevention  Car seat (infant)1
 Poisons1; PCC#1
 Firearm safety/removal1
 Carbon monoxide/Smoke detectors1  Hot water <49oC/bath safety1
discussed and no concerns Childproofing, including:  Electric plugs/cords  Falls/stairs/no walkers1
 Choking/safe toys1
Behaviour and family issues
 Sleeping/crying/Night waking2
 Soothability/responsiveness  High risk children/assess home visit need2  Siblings
 Parenting2
 Parental fatigue/depression2
 Family conflict/stress  Child care2/return to work

Other Issues
 Second hand smoke1
 Teething/Dental cleaning/Fluoride/Dentist1
 Complementary/alternative medicine1  No OTC cough/cold medn1
 Fever advice/thermometers1
 Active healthy living/screen time1
 Encourage reading2
 Pacifier use1  Footwear1
Environmental health including:  Sun exposure/sunscreens/insect repellent1
 Serum lead if at risk1
 Pesticide exposure1
 Looks for an object seen hidden  Responds to own name  Says 5 or more words (words do not have to be clear) (Inquiry and observation of  Babbles a series of different sounds (eg. baba, duhduh)  Understands simple requests, eg. Where is the ball?  Picks up and eats finger foods  Responds differently to different people  Makes at least 1 consonant/vowel combination  Walks sideways holding onto furniture Tasks are set after the time of  Makes sounds/gestures to get attention or help  Says 3 or more words (do not have to be clear)  Shows fear of strange people/places normal milestone acquisition.
 Sits without support  Crawls or ‘bum' shuffles  Crawls up a few stairs/steps  Stands with support when helped into standing position  Pulls to stand/walks holding on  Tries to squat to pick up toys from the floor Absence of any item suggests  Opposes thumb and fingers when grasps objects  Shows distress when separated from parent/caregiver  No parent/caregiver concerns consideration for further  Plays social games with you (eg. nose touching, peek-  Follows your gaze to jointly reference an object assessment of development.
 No parent/caregiver concerns  Cries or shouts for attention NB-Correct for age if < 37 weeks  No parent/caregiver concerns gestationü if attained X if not attained  Anterior fontanelle1
 Anterior fontanelle1
 Anterior fontanelle1
Evidence-based screening for  Eyes (red reflex)1
 Eyes (red reflex)1
 Eyes (red reflex)1
specific conditions is highlighted,  Corneal light reflex/Cover-uncover test & inquiry1
 Corneal light reflex/Cover-uncover test & inquiry1
 Corneal light reflex/Cover-uncover test & inquiry1
but an appropriate age-specific  Hearing inquiry/screening1
 Hearing inquiry/screening1
 Hearing inquiry/screening1
focused physical examination is  Snoring/tonsil size1
 Snoring/tonsil size1
recommended at each visit.  Teeth1
 Teeth1
PROBLEMS AND PLANS
 If HBsAg positive mother check HBV antibodies and HBsAg3 (at 9 or 12 months)
 Record Vaccines on Guide V
Discuss immunization pain
 Hemoglobin (If at risk)1
reduction strategies3
 Record Vaccines on Guide V
Strength of recommendation based on literature review using the classification of the Canadian Task Force on Preventive Health Care: Good (bold type); Fair (italic type); Consensus (plain type).
1see Rourke Baby Record Resources 1: General
2see Rourke Baby Record Resources 2: Healthy Child Development 3see Rourke Baby Record Resources 3: Immunization/Infectious Diseases
Disclaimer: Given the constantly evolving nature of evidence and changing recommendations, the Rourke Baby Record is meant to be used as a guide only.
Financial support has been provided by the Government of Ontario, with funds administered by the Ontario College of Family Physicians. For fair use authorization, see



2011 Drs. L Rourke, D Leduc and J Rourke Revised July, 2011 Past problems/Risk factors: Rourke Baby Record: Evidence-Based Infant/Child Health Maintenance GUIDE IV: 18 mo - 5 yr
(National)
NAME: Birth Day (d/m/yr): _ M [ ] F [ ] Gestational Age: Birth Length: cm Birth Wt: g Birth Head Circ: cm DATE OF VISIT
18 months
2-3 years
4-5 years
GROWTH1 use WHO growth charts. Height
Head circ.
HC if prior abN
Correct percentiles until 24-36 mos if < 37 weeks gestation  1% to 2% milk [ 500 mLs(16 oz) /day1]
 1% to 2% milk [ 500 mLs(16 oz) /day1]
 Homogenized milk [500-750 mLs(16-24 oz) /day1]
 Gradual transition to lower fat diet1
 Inquire re: vegetarian diets1
 Avoid sweetened juices/liquids  Inquire re: vegetarian diets1
 Canada's Food Guide1
 Canada's Food Guide1
EDUCATION AND ADVICE
Injury Prevention  Car seat (child)1
 Car seat (child/booster)1
 Bike helmets1
 Firearm safety/removal1
 Bath safety1
 Carbon monoxide/smoke detectors1  Water safety1
 Choking/safe toys1
 Parent/child interaction  Discipline/parenting skills programs2
 High-risk children2
 Parent/child interaction  Parental fatigue/depression1
 Family conflict/stress  Discipline/Parenting skills programs2
 Assess child care /preschool needs/school readiness2
 Second-hand smoke1
 Dental cleaning/Fluoride/Dentist1  No pacifiers1
 Complementary/alternative medicine1  Toilet learning2
 No OTC cough/cold medn1
 High-risk children2
 Active healthy living/screen time1
 Socializing opportunities  Encourage reading2
 Socializing/peer play opportunities Environmental health including:  Wean from pacifier1
 Sun exposure/sunscreens/insect repellent1  Pesticide exposure1
ü discussed and no concerns  Dental care/Dentist1
 Serum lead if at risk1
 Toilet learning2
 Encourage reading2
(Inquiry and observation of  Combines 2 or more words  Understands 3-part directions  Child's behaviour is usually manageable  Understands 1 and 2 step directions  Asks and answers lots of questions (eg."What are you  Interested in other children  Walks backward 2 steps without support Tasks are set after the time of  Usually easy to soothe  Tries to run  Walks up/down stairs alternating feet normal milestone acquisition.
 Comes for comfort when distressed  Puts objects into small container  Undoes buttons and zippers Absence of any item suggests Communication Skills  Uses toys for pretend play (eg. give doll a drink)  Tries to comfort someone who is upset consideration for further  Points to several different body parts  Continues to develop new skills  No parent/caregiver concerns assessment of development.
 Tries to get your attention to show you something  No parent/caregiver concerns  Turns/responds when name is called NB-Correct for age if < 37 weeks  Points to what he/she wants  Looks for toy when asked or pointed in direction  Understands 2 and 3 step directions (eg. "Pick up your  Counts out loud or on fingers to answer "How many  Imitates speech sounds and gestures hat and shoes and put them in the closet.") are there? X if not attained  Says 20 or more words (words do not have to be clear)  Uses sentences with 5 or more words  Speaks clearly in adult-like sentences most of the time  Produces 4 consonants, e.g. B D G H N W  Walks up stairs using handrail  Throws and catches a ball  Twists lids off jars or turns knobs  Hops on 1 foot several times  Walks alone  Shares some of the time  Dresses and undresses with little help  Feeds self with spoon with little spilling  Plays make-believe games with actions and words  Cooperates with adult requests most of the time (eg. pretending to cook a meal, fix a car)  Retells the sequence of a story  Removes hat/socks without help  Turns pages one at a time  Separates easily from parent/caregiver  No parent/caregiver concerns  Listens to music or stories for 5 - 10 minutes  No parent/caregiver concerns  No parent/caregiver concerns  Anterior fontanelle closed1
 Blood pressure  Blood pressure Evidence-based screening for  Eyes (red reflex)1
 Eyes (red reflex)/Visual acuity1
 Eyes (red reflex)/Visual acuity1
specific conditions is highlighted,  Corneal light reflex/Cover-uncover test & inquiry1
 Corneal light reflex/Cover-uncover test & inquiry1
 Corneal light reflex/Cover-uncover test & inquiry1
but an appropriate age-specific  Hearing inquiry  Hearing inquiry  Hearing inquiry focused physical examination is  Snoring/tonsil size1
 Snoring/tonsil size1
 Snoring/tonsil size1
recommended at each visit.
 Teeth1
 Teeth1
 Teeth1
ü if normalX if abnormal PROBLEMS AND PLANS
 Record Vaccines on Guide V
 Record Vaccines on Guide V
 Record Vaccines on Guide V
Discuss immunization pain
reduction strategies3

Strength of recommendation based on literature review using the classification of the Canadian Task Force on Preventive Health Care: Good (bold type); Fair (italic type); Consensus (plain type).
1see Rourke Baby Record Resources 1: General
2see Rourke Baby Record Resources 2: Healthy Child Development 3see Rourke Baby Record Resources 3: Immunization/Infectious Diseases
Disclaimer: Given the constantly evolving nature of evidence and changing recommendations, the Rourke Baby Record is meant to be used as a guide only.
Financial support has been provided by the Government of Ontario, with funds administered by the Ontario College of Family Physicians. For fair use authorization, see
2011 Drs. L Rourke, D Leduc and J Rourke Revised July, 2011 Childhood Immunization Record as per NACI Recommendations Rourke Baby Record: Evidence-Based Infant/Child Health Maintenance GUIDE V: Immunization
(as of July 29, 2011)For additional information, refer to the National Advisory Committee on Immunization website: NAME: Birth Day (d/m/yr): _ M [ ] F [ ] Provincial guidelines vary and are available online: Date given
Lot number
Expiry date
dose #1 (6 wks - 14 wks/6 days) # doses varies with ± dose #3 (by 8 mos/0 days) 4 doses (2, 4, 6, 18 months) dose #1 (2 months) dose #2 (4 months) dose #3 (6 months) dose #4 (18 months) 4 doses (2, 4, 6, 12-15 months)dose #1 (2 months) dose #2 (4 months) dose #3 (6 months) dose #4 (12-15 months) Men-C-C:2-3 doses under 12 mos (2-11 mos) AND booster dose between 12-24 monthsOR Men-C-C: 1 dose at 12 months Men-C-C or Men-C-ACWY:1 dose at 12 years or during adolescence3 doses in infancy OR Hepatitis B3
2-3 doses preteen/teen dose #1 MMR or MMRV3
2 doses (12 mths, 18 mths OR 4 yrs) dose #1 (12 months) dose #2 (18 months OR 4 years) 2 doses (12 mo-12 yrs - MMRV or univalent) OR 2 doses (>13 years- univalent) dose #1 1 dose (4-6 years) In females 9 - 26 years, 3 doses at 0, 2, and 6 months.
dose #1 1 dose (14-16 years) 1 dose annually(6-23 months and high risk > 2 years) First year only for < 9 years - give 2 doses one month apart Disclaimer: Given the constantly evolving nature of evidence and changing recommendations, the Rourke Baby Record is meant to be used as a guide only.
3see Rourke Baby Record Resources 3: Immunization/Infectious Diseases
Financial support has been provided by the Government of Ontario, with funds administered by the Ontario College of Family Physicians. F
Rourke Baby Record: RESOURCES 1: General (July, 2011)
Important: Corrected age should be used at least until 24 to 36 months of age for premature infants
Second-hand smoke exposure: contributes to childhood illnesses such as URTI, middle ear
born at <37 wks gestation.
effusion, persistent cough, pneumonia, asthma, and SIDS.
Measuring growth - The growth of all term infants, both breastfed and non breastfed, and • Advise parents against using OTC cough/cold medications.
preschoolers should be evaluated using Canadian growth charts from the 2006 World Health Organization Child Growth Standards (birth to 5 years) with measurement of recumbent length (birth • Complementary and alternative medicine (CAM): Questions should be routinely asked on the use of to 2-3 years) or standing height (≥ 2 years), weight, and head circumference (birth to 2 years). homeopathy and other complementary and alternative medicine therapy or products, especially for children with chronic conditions. - NUTRITION -
Pacifier use may decrease risk of SIDS and should not be discouraged in the 1st year of life after breastfeeding is well established, but should be restricted in children with chronic/recurrent otitis • Breastfeeding: Exclusive breastfeeding is recommended for the first six months of life for healthy
term infants. Breast milk is the optimal food for infants, and breastfeeding (with complementary • Fever advice/thermometers: Fever ≥ 38oC in an infant < 3 months needs urgent evaluation. foods) may continue for up to two years and beyond unless contraindicated. Breastfeeding reduces Ibuprofen and acetaminophen are both effective antipyretics. Acetaminophen remains the gastrointestinal and respiratory infections. Maternal support (both antepartum and postpartum) first choice for antipyresis under 6 months of age; thereafter ibuprofen or acetaminophen may increases breastfeeding and prolongs its duration. Early and frequent mother-infant contact, be used. Alternating acetaminophen with ibuprofen for fever control is not recommended in rooming in, and banning handouts of free infant formula increase breastfeeding rates.
primary care settings as this may encourage fever phobia, and the potential risks of medication - Breastfeeding - error outweigh measurable clinical benefit. - - Ankyloglossia and breastfeeding - • Footwear: Shoes are for protection, not correction. Walking barefoot develops good toe - Maternal medications when breastfeeding - gripping and muscular strength - • Healthy Active Living: Encourage increased physical activity and decreased sedentary pastimes with parents as role models.
• Routine Vitamin D supplementation of 400 IU/day (800 IU/day in northern communities) is
recommended for all breastfed infants until the diet provides a sufficient source of Vitamin D ( 1 year of age). Formula may only supply a portion of the recommended daily vitamin D intake if • Sun exposure/sunscreens/insect repellents: Minimize sun exposure. Wear protective clothing, less than 1000 mL (33 oz) is consumed daily. Breastfeeding mothers should continue to take Vitamin hats, properly applied sunscreen with SPF ≥ 30 for those > 6 months of age. No DEET in < 6 D supplements for the duration of breastfeeding. months; 6-24 months 10% DEET apply max once daily; 2 - 12 yrs 10% DEET apply max TID.
• Infant formula - formula composition and algorithm re use • Pesticides: Avoid pesticide exposure. Encourage pesticide-free foods. • Milk consumption range is consensus only & is provided as an approximate guide.
• Soy-based formula is not recommended for routine use in term infants as an equivalent alternative • Lead Screeningecommended for children who: to cow's milk formula, or for cow milk protein allergy, and is contraindicated for preterm infants. - in the last 6 months lived in a house or apartment built before 1978; - live in a home with recent or ongoing renovations or peeling or chipped paint; • Transition to lower fat diet: A gradual transition from the high-fat infant diet to a lower-fat diet begins - have a sibling, housemate, or playmate with a prior history of lead poisoning; after age 2 years as per Canada's Food Guide. - live near point sources of lead contamination; • Encourage a healthy diet as per Canada's Food Guide - have household members with lead-related occupations or hobbies; - are refugees aged 6 mo - 6 yrs, within 3 months of arrival and again in 3-6 months.
• Vegetarian diets Even for blood levels less than 10ug/dL, evidence suggests an association, and perhaps partial • Mercury in fish - causal relationship with lower cognitive function in childr 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, • Websites about environmental issues: choking, burns, poisoning, and falls. For more safety information: • Transportation in motor vehicles:
Dental Care:
Children < 13 years should sit in the rear seat. Keep children away from all airbags. • Dental Cleaning: As excessive
Install and follow size recommendations as per specific car seat model and keep child in each stage swallowing of toothpaste by young as long as possible.
children may result in dental Use rear-facing infant seat until at least 1 year of age AND 10 kg (22 lb).
fluorosis, children 3-6 years of Use forward-facing child seat after 1 year of age AND 10 - 22 kg (22 - 48 lb) and up to 122 cm (48"). age should be supervised during Maximum ht/wt may vary with car seat model.
brushing and only use a small Use booster seat from at least 18 - 36 kg (40 - 80 lb) and up to 145 cm (4'9"). amount (e.g. pea-sized portion) Use lap and shoulder belt in the rear seat for children over 8 yrs who are at least 36 kg (80 lb) and 145 of fluoridated toothpaste twice cm (4'9") and fit vehicle restraint system.
daily. Children under 3 years of age • Bicycle: wear bike helmets. Replace if heavy impact or sign of damage.
should have their teeth and gums brushed twice daily by an adult - Bath safety: Never leave a young child alone in the bath. Do not use infant bath rings or bath seats.
using either water (if low risk for - Water safety: Recommend adult supervision, training for adults, 4-sided pool fencing, lifejackets, tooth decay) or a rice grain sized swimming lessons, and boating safety to decrease the risk of drowning. portion of fluoridated toothpaste (if • Choking: Avoid hard, small and round, smooth and sticky solid foods until age 3 years. Use safe at carries risk).
toys, follow minimum age recommendations, and remove loose parts and broken toys.
• Fluoride supplements are not recommended before eruption of the first permanent tooth • Burns: Install smoke detectors in the home on every level. ( 6 - 8 years) unless the child is at high risk for dental caries. Keep hot water at a temperature < 49oC. • Poisons: Keep medicines and cleaners locked up and out of child's reach. Have Poison Control
To prevent early childhood caries: avoid sweetened juices/liquids and constant sipping of milk or Centre number handy. Use of ipecac is contraindicated in children.
natural juices in both bottle and cup.
• Falls: Assess home for hazards- never leave baby alone on change table or other high surface; use window guards and stair gates. Baby walkers are banned in Canada and should never be used. Advise against trampoline use at home. • Vision inquiry/scr • Safe sleeping environment:
- Check Red Reflex for serious ocular diseases such as retinoblastoma and cataracts.
Sleep position and SIDS/Positional plagiocephaly: Healthy infants should be positioned on
- Corneal light reflex/cover-uncover test & inquiry for strabismus: With the child focusing on a
their backs for sleep. Their heads should be placed in different positions on alternate days. light source, the light reflex on the cornea should be symmetrical. Each eye is then covered in Sleep positioners should not be used. While awake, infants should have supervised tummy turn, for 2 – 3 seconds, and then quickly uncovered. The test is abnormal if the uncovered eye time. Counsel parents on the dangers of other contributory causes of SIDS such as overheating, "wanders" OR if the covered eye moves when uncovered.
maternal smoking or second-hand smoke.
Hearing inquiry/screening – Any parental concerns about hearing acuity or language delay should Bed sharing: Advise against bed sharing which is associated with an increased risk for SIDS.
prompt a rapid referral for hearing assessment. Formal audiology testing should be performed Crib safety/Room sharing: Encourage putting infant in a crib, cradle or bassinette, that meets
in all high-risk infants, including those with normal UNHS. Older children should be screened if current Canadian r parents' room for the first 6 months of life. Room sharing is protective against SIDS. • Fontanelles – The posterior fontanelle is usually closed by 2 months and the anterior by 18 • Firearm safety/removal: There is evidence-based association between a firearm in the home and
increased risk of unintentional firearm injury, suicide, or homicide. • Muscle tone – Physical assessment for spasticity, rigidity, and hypotonia should be performed.
• Hips – There is insufficient evidence to recommend routine screening for developmental dysplasia of the hips, but examination of the hips should be included until at least one year, or Anemia screening: All infants from high-risk groups for iron deficiency anemia require screening
between 6 and 12 months of age, e.g. Lower SES; Asian; First Nations children; low-birth-weight and • Snoring in the presence of sleep-disordered breathing warrants assessment re obstructive sleep premature infants, and infants fed whole cow's milk during their first year of life.
Hemoglobinopathy screening: Screen all neonates from high-risk groups: Asian, African & Mediterranean.
Universal newborn hearing screening (UNHS) effectively identifies infants with congenital hearing loss
& allows for early intervention & impr
Disclaimer: Given the constantly evolving nature of evidence and changing recommendations, the Rourke Baby Record is meant to be used as a guide only.
Financial support has been provided by the Government of Ontario, with funds administered by the Ontario College of Family Physicians. F
Rourke Baby Record: RESOURCES 2: Healthy Child Development (July, 2011) National
PARENTAL/FAMILY ISSUES - HIGH RISK INFANTS/CHILDREN
Maneuvers are based on the Nipissing District Development Screen™ () and other developmental literature. They are not a developmental screen, but rather an aid to developmental • Maternal depression - Physicians should have a high awareness of maternal depression, which surveillance. They are set after the time of normal milestone acquisition. Thus, absence of any is a risk factor for the socio-emotional and cognitive development of children. Although less one or more items is considered a high-risk marker and indicates consideration for further studied, paternal factors may compound the maternal-infant issues.
developmental assessment, as does parental or caregiver concern about development at any stage. - "Best Start" website contains resources for maternal, newborn, and early child development - • Fetal alcohol spectrum disorder (F • Foster care - Children entering foster care are a high risk population requiring special needs for - OCFP Healthy Child Development: Improving the Odds publication is a toolkit for primary health supervision. • Assess home visit need: There is good evidence for home visiting by nurses during the perinatal
period through infancy for first-time mothers of low socioeconomic status, single parents or teenaged parents to prevent physical abuse and/or neglect. • Risk factors for physical abuse: low SES; young maternal age (<19 years); single parent family; parental experiences of own physical abuse in childhood; spousal violence; lack of social Crying: Excessive crying may be caused by behavioral or physical factors or be the upper limit support; unplanned pregnancy or negative parental attitude towards pregnancy.
of the normal spectrum. Evaluation of these etiological factors and of the burden for parents is • Risk factors for sexual abuse: living in a family without a natural parent; growing up in a family essential and raises awareness of the potential for the shaken baby syndrome.
with poor marital relations between parents; presence of a stepfather; poor child-parent Shaken baby syndrome: relationships; unhappy family life. Night waking: occurs in 20% of infants and toddlers who do not require night feeding. Counselling
around positive bedtime routines (including training the child to fall asleep alone), removing
nighttime positive reinforcers, keeping morning awakening time consistent, and rewarding good
NONPARENTAL CHILD CARE
sleep behaviour has been shown to reduce the prevalence of night waking, especially when this counselling begins in the first 3 weeks of life. Inquire about current child care arrangements. High quality child care is associated with improved paediatric outcomes in all children. Swaddling: Proper swaddling of the infant for the first 6 months of life may promote longer sleep Factors enhancing quality child care include: practitioner general education and specific training; periods but could be associated with adverse events (hyperthermia, SIDS, or development of hip group size and child/staff ratio; licensing and registration/accreditation; infection control and dysplasia) if misapplied. A swaddled infant must always be placed supine with free movement of injury prevention; and emergency procedures. hips and legs, and the head uncovered.
PARENTING/DISCIPLINE
Inform parents that warm, responsive, flexible & consistent discipline techniques are assoc with
positive child outcomes. Over reactive, inconsistent, cold & coercive techniques are assoc with
AUTISM SPECTRUM DISORDER
negative child outcomes. Specific screening for ASD at 18 - 24 months using the M-CHAT should be performed on all children with any of the following: failed items on the social/emotional/communication skills inquiry, sibling with autism, or developmental concern by parent, caregiver, or physician.
Refer parents of children at risk of, or showing signs of, behavioral or conduct problems to If the M-CHAT is abnormal, use the M-CHAT Follow-up Interview to reduce the false positive rate structured parenting programs which have been shown to increase positive parenting, improve and avoid unnecessary referrals and parental concern. The M-CHAT tool and follow-up interview child compliance, and reduce general behavior problems. Access community resources to determine the most appropriate and available research-structured programs. (eg. The Incredible Years, Right from the Start, COPE program).
TOILET LEARNING
The process of toilet learning has changed significantly over the years and within different Encourage parents to read to their children within the first few months of life and to limit TV, video cultures. In Western culture, a child-centred approach, where the timing and methodology of and computer games to provide more opportunities for reading. toilet learning is individualized as much as possible, is recommended. - Arch Dis Child; 2008;93:554-7 Early Child Development and Parenting Resource System - National
Areas of concern
 Parent/family issues  Social emotional  Communication skills  Motor skills Universal
 Adaptive skills  Sensory impairment (problems with vision or hearing)  Need for additional assessment (more than one developmental area affected) Central ‘HUB' Number if available: (varies in each community)
Local children's Service 0-6 Years, Public Health, Parenting Centres • Paediatrician • Infant Hearing Program • Developmental Paediatrician • Children's Mental Health Services • Preschool Speech Language Services • Child Development Specialized Assessment Team • Infant Development Program • Specialized medical services • Children's Treatment Centre (e.g. otolaryngology) • Infant Development Program • Services for the deaf and hard of hearing • Specialized medical services (e.g. ophthalmology) • Services for speech and language concerns • Services for the blind and visually impaired• Services for physical and developmental disabilities• Specialized Child care programming• Community Care Resources Public Health, Dental Services, Child care, Family Resource Programs, Community Parks and Recreation programs, Schools, Child Protection Services Disclaimer: Given the constantly evolving nature of evidence and changing recommendations, the Rourke Baby Record is meant to be used as a guide only.
Financial support has been provided by the Government of Ontario, with funds administered by the Ontario College of Family Physicians. For fair use authorization, see
Rourke Baby Record: RESOURCES 3: Immunization/Infectious Diseases (July, 2011)
National Advisory Committee on Immunization (NACI) recommended immunization schedules for infants, children and youth can be found at the following website:
Provincial/territorial immunization schedules may differ based on funding differences. For provincial/territorial immunization schedules, see Canadian Nursing Coalition on Immunization chart
on the website of the Public Health Agency of Canada: • Additional information for parents on vaccinations can be accessed through: CPS Parent website Responding to Parental Refusals of Immunization of Children - Dispelling myths held by parents about the influenza vaccine - • Information for physicians on vaccine safety can be accessed through: Presentation on vaccinations - Autism spectrum disorder: No causal r Vaccine literacy - • Immunization pain reduction strategies: During vaccination, pain reduction strategies with good evidence include breastfeeding or use of sweet-tasting solutions, use of the least painful
vaccine brand, and consideration of topical anaesthetics. VACCINE NOTES (Adapted from NACI website: July 29, 2011)
Diphtheria, Tetanus, acellular Pertussis and inactivated Polio virus vaccine (DTaP-IPV): DTaP-IPV vaccine is the preferred vaccine for all doses in the vaccination series, including completion of
the series in children < 7 years who have received ≥ 1 dose of DPT (whole cell) vaccine (e.g., recent immigrants).
Haemophilus influenzae type b conjugate vaccine (Hib): Hib schedule shown is for the Haemophilus b capsular polysaccharide – PRP conjugated to tetanus toxoid (Act-HIBTM) or the
Haemophilus b oligosaccharide conjugate - HbOC (HibTITERTM) vaccines. This vaccine may be combined with DTaP in a single injection.
Measles, Mumps and Rubella vaccine (MMR): A second dose of MMR is recommended, at least 1 month after the first dose for the purpose of better measles protection. For convenience,
options include giving it with the next scheduled vaccination at 18 months of age or at school entry (4-6 years) (depending on the provincial/territorial policy), or at any intervening age that is practical. The need for a second dose of mumps and rubella vaccine is not established but may benefit (given for convenience as MMR). The second dose of MMR should be given at the same visit as DTaP-IPV (± Hib) to ensure high uptake rates. MMR and varicella vaccines should be administered concurrently (at different sites if the MMRV [combined MMR/varicella] is not available) or separated by at least 4 weeks. • Varicella vaccine: Children aged 12 months to 12 years who have not had varicella should receive 2 doses of varicella vaccine (univalent varicella or MMRV). Unvaccinated individuals ≥ 13 years
who have not had varicella should receive two doses at least 28 days apart (univalent varicella only). Consult NACI guidelines for recommended options for catch-up varicella vaccination. Varicella and MMR vaccines should be administered concurrently (at different sites if the MMRV [combined MMR/varicella] vaccine is not available) or separated by at least 4 weeks. • Hepatitis B vaccine (Hep B): Hepatitis B vaccine can be routinely given to infants or preadolescents, depending on the provincial/territorial policy. The first dose can be given at 2 months of age
to fit more conveniently with other routine infant immunization visits. The second dose should be administered at least 1 month after the first dose, and the third at least 2 months after the second dose, but again may fit more conveniently into the 4- and 6-month immunization visits. A two-dose schedule for adolescents is an option. For infants born to chronic carrier mothers, the first dose should be given at birth (with Hepatitis B immune globulin). (See also SELECTED INFECTIOUS DISEASES RECOMMENDATIONS below.) • Pneumococcal conjugate vaccine 13-valent (Pneu-Conj): Recommended schedule, number of doses and subsequent use of 23 valent polysaccharide pneumococcal vaccine depend on the age of
the child, previous administration of -7 or-10 valent vaccine, if at high risk for pneumococcal disease, and when vaccination is begun. Consult NACI guidelines for maximizing coverage up to 59 months of age.
Meningococcal conjugate vaccine (Men- - Monovalent vaccine to Type C (Men-C-C) is indicated for all ages, and quadravalent to Types A/C/W/Y
(Men-C-ACWY) for age 2 yrs and over. Recommended vaccine, schedule and number of doses of meningococcal vaccine depend on the age of the child and vary between provinces/territories. Possible schedules include: - Men-C-C: 2 - 3 doses under 12 mos of age AND booster dose between 12 - 24 mos age.
- Men-C-C: 1 dose at 12 mos of age. Men-C-C or Men-C-ACWY booster dose should also be given at 12 yrs of age or during adolescence.
Diphtheria, Tetanus, acellular Pertussis vaccine - adult/adolescent formulation (dTap): a combined adsorbed "adult type" preparation for use in people ≥ 7 years of age, contains less diphtheria
toxoid and pertussis antigens than preparations given to younger children and is less likely to cause reactions in older people. This vaccine should be used in individuals > 7 years receiving their primary series of vaccines.
Influenza vaccine: Recommended for all children between 6 and 23 months of age, and for older high-risk children. Previously unvaccinated children up to 9 years of age require 2 doses with an
interval of at least 4 weeks. The second dose is not required if the child has received one or more doses of influenza vaccine during the previous immunization season. • Rotavirus vaccine: Universal rotavirus vaccine is recommended by NACI and CPS. Two oral vaccines are currently authorized for use in Canada: Rotarix (2 doses) and RotaTeq (3 doses). Dose #1 is
given between 6 wks and 14 wks/6 days with a minimum inter SELECTED INFECTIOUS DISEASES RECOMMENDATIONS
Hepatitis B immune globulin and immunization:
Infants with HBsAg-positive parents or siblings require Hepatitis B vaccine at birth, at 1 month, and 6 months of age. Infants of HBsAg-positive mothers also require Hepatitis B immune globulin at birth and follow-up immune status at 9 – 12 months for HBV antibodies and HBsAg. Hepatitis B vaccine should also be given to all infants from high-risk groups, such as: - infants where at least one parent has emigrated from a country where Hepatitis B is endemic; - infants of mothers positive for Hepatitis C virus; - infants of substance-abusing mothers.
Human Immunodeficiency Virus type 1 (HIV-1) maternal infections:
Breastfeeding is contraindicated for an HIV-1 infected mother even if she is receiving antiretroviral therapy. • Hepatitis A or A/B combined (when Hepatitis B vaccine has not been previously given):
These vaccines should be considered when traveling to countries where Hepatitis A or B are endemic.
Tuberculosis - TB skin testing:
TB skin testing should be done if the infant is living with anyone being investigated or treated for TB. TB skin testing should also be considered in high-risk groups, including Aboriginal people, immigrants and long-term travellers from areas with a high prevalence of TB.
Disclaimer: Given the constantly evolving nature of evidence and changing recommendations, the Rourke Baby Record is meant to be used as a guide only.
Financial support has been provided by the Government of Ontario, with funds administered by the Ontario College of Family Physicians.
For fair use authorization, see

Source: http://rourkebabyrecord.ca/pdf/RBR2011Nat_Eng_High.pdf

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The Experiences of Massachusetts Families in Obtaining Mental Health Care for their Children Health Care For All and Parent/Professional Advocacy League Written by: Ariel Frank, Josh Greenberg and Lisa Lambert October 2002 The Experiences of Massachusetts Families in Obtaining Mental Health Care for their Children

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OMCR 2014 ;6 (3 pages) Pregnancy delusion hinders the diagnosis of achalasia in a patientwith life-threatening emaciation Rafael Dias Lopes, Claudio E. M. Banzato and Amilton Santos Jr* Department of Psychiatry, Faculty of Medical Sciences, University of Campinas (Unicamp), Campinas, SP, Brazil *Correspondence address. Department of Psychiatry, Faculty of Medical Sciences, University of Campinas (Unicamp),Campinas, SP 13083-970, Brazil. Tel: þ55-19-3521-7206; Fax: þ55-19-3521-7206;E-mail: amilton1983@yahoo.com.br