Bottom Line:
A new section on inclusive and culturally safe care
Reorganization of the family functioning and behaviour section
Improvements in the developmental surveillance section
Deletion of the immunization chart
Increased web links to highlight non-primary care pediatric topics
Section-specific changes:
Growth charts
- now includes information on regaining birth weight and using BMI starting at age 2
Nutrition Section
- Recommendations on cow’s milk consumption has been added, including ranges and maximal amounts to avoid risk of iron deficiency
- New information on plant-based beverages, vegetarian/vegan and other diets, fiber and prebiotics, peanuts, and choosing foods with healthy fats and avoiding processed foods
Education and Advice Section
- Injury Prevention: broadens poisonings to include ingestions (e.g. cannabis, button batteries), expands risk factors for SIDS and choking, provides Canada poison control number
- Inclusive and Anti-oppressive Care: wording added and describes racism as a social determinant of health, encourages cultural humility
- Relationships, parenting, family function: wording to promote early relational health (ERH) is added, and also new info/resources on ERH, children’s mental health and risk factors (including depression in parents), and housing issues are provided; focus on offering support and resources to families
- Healthy Routines: now includes sleep habits, outdoor active play, colic (up to 6 months), read/sing/speak to the child is now emphasized, and describes risk factors for reading difficulties (at 5-years visit)
- Environmental Health: emphasizes pesticides risk in causing adverse neurodevelopmental outcomes, and includes resources on home, environment, air quality, sun, insect bites, well water
Development Section
- Includes seeking further assessment if there is loss of attained milestones or any parental concerns, and adds to ensure milestones are achieved for missed visits and to consider cultural dependence for some milestones
Physical Examination Section
- “Sentinel injuries” has been added for child maltreatment, monitoring for acholic stools has been added as a sign of biliary atresia, and primitive reflexes testing has been added (1 week for presence and 6-month for absence)
Investigations/Screening Section
- Anemia screening is now broadened to include iron deficiency without anemia (evidence that it has impact on brain functioning)
Immunization Section
- Immunization Chart has been deleted completely, adds immunization pain strategies, emphasizes vaccine hesitancy as a global threat, reference to the Canadian Immunization Guide and NACI for current guidelines
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