Rourke Baby Record

Evidence-based infant/child health maintenance guide

Table 1. Recommendations Grades for Specific Clinical Preventive Actions
A	There is good evidence to recommend the clinical preventive action.
B	There is fair evidence to recommend the clinical preventive action.
C	The existing evidence is conflicting and does not allow to make a recommendation for or against use of the clinical preventive action; however, other factors may influence decision making.
D	There is fair evidence to recommend against the clinical preventive action.
E	There is good evidence to recommend against the clinical preventive action.
I	There is insufficient evidence (in quantity or quality) to make a recommendation; however, other factors may influence decision making.
The CTF recognizes that in many cases patient specific factors need to be considered and discussed, such as the value the patient places on the clinical preventive action; its possible positive and negative outcomes; and the context and /or personal circumstances of the patient (medical and other). In certain circumstances where the evidence is complex, conflicting or insufficient, a more detailed discussion may be required.
Table 2. Levels of Evidence - Research Design Rating
I	Evidence obtained from at least one properly randomized trial.
II-1	Evidence obtained from a well-designed, controlled trial without randomization.
II-2	Evidence obtained from a well-designed cohort or case-controlled analytic studeis, preferably from more than one centre or research group.
II-3	Evidence obtained from comparisons between times and places, with or without the intervention; dramatic results in uncontrolled experiments could also be included in this category.
III	Opinions of respected authorities, based on clinical experience, descriptive studies or reports of expert committees.
Table 3. Levels of Evidence - Quality (Internal Validity) Rating (see Harris et al., 2001)
Good	A study (including meta-analyses or systematic reviews) that meets all design-specific criteria* well.
Fair	A study (including meta-analyses or systematic reviews) that does not meet (or it is not clear that it meets) at least one design-specific criterion* but has no known "fatal flaw".
Poor	A study (including meta-analyses or systematic reviews) that has at least one design-specific* "fatal flaw", or an accumulation of lesser flaws to the extent that the results of the study are not deemed able to inform recommendations.
	*General design-specific criteria are outlined in Harris et al., 2001.

Download the 2009 RBR (Ontario Version)

The Rourke Baby Record (RBR) consists of 4 guides for charting well baby/child visits up to five years of age.

Guide I: visits at up to one week, two weeks, and one month of age;
Guide II: visits at two, four, and six months of age;
Guide III: visits at nine, 12, and 15 months of age;
Guide IV: visits at 18 months, two to three years, and four to five years of age.

Guide V is a table for charting immunizations.

There are three sheets of Guidelines/Resources that accompany the RBR:

Selected guidelines/resources dealing with growth monitoring, nutrition, physical examination, and education and advice issues excluding those on development, behaviour, immunization and infectious diseases.
Selected guidelines/resources dealing with development, behaviour, and parenting resources.
Selected guidelines/resources dealing with immunization and infectious diseases.

Fonts used in the Rourke Baby Record
Three fonts are used in the Rourke Baby Record to reflect the strength of recommendation based on literature review using the classification system of the Canadian Task Force on Preventative Health Care.: Good (bold type); Fair (italic type); Consensus (plain type).

Ontario Version 2009 RBR

The Ontario version retains the NACI immunization schedule. It differs from the national version in two places:

The 18-month visit development section contains a space to record which items on the Nipissing District Development Screen™ (NDDS™) have not yet been achieved. The NDDS is freely available to Ontario healthcare providers.
The Early Child Development and Parenting Resource System found on the Healthy Child Development Selected Guidelines/Resources is Ontario specific.

The Ontario version may be downloaded in either English or French.

Ontario has funded an enhanced 18 month well baby visit which in addition to the components of a usual well baby visit, uses standardized tools to allow physicians to have a discussion with parents on child development and parenting, to identify those children who will require referral to specialized services, and to inform parents about the local community programs that promote healthy child development and early learning. .” (Web Resources: www.machealth.ca/programs/18-month and/or www.18monthvisit.ca )

Download English 2009 RBR Ontario

Download French 2009 RBR Ontario

Download Growth Charts

With the August 2009 edition of the Rourke Baby Record, there is a change in the growth charts that accompany the RBR. We are now recommending the use of the World Health Organization (WHO) Child Growth Standards. The WHO Child Growth Standards were released in April 2006 and were developed using data collected in the WHO Multicentre Growth Reference Study. http://www.who.int/childgrowth/en/ This study followed more than 8,000 children from six countries (Brazil, Ghana, India, Norway, Oman, USA) who were raised under optimal health conditions (exclusive or predominantly breastfed for more than four months, complementary foods by six months, continuation of breastfeeding until at least 12 months, immunized, receiving healthcare, nonsmoking environment). Under these optimal conditions there were only 3% intersite differences, and thus the WHO Child Growth Charts may be used in children of different racial backgrounds. As these WHO growth charts are based on optimal health conditions, they are called growth standards.

In past versions of the RBR, the growth charts used were from the United States Centers for Disease Control and Prevention (CDC). http://www.cdc.gov/nchs/about/major/nhanes/growthcharts/clinical_charts.htm These CDC growth charts are based on the growth of American children without controlling for optimal health conditions and are better called growth references rather than growth standards.

Changing from CDC to WHO growth charts will result in different prevalence of underweight, overweight and obesity:

0 - 6 months: WHO charts reflect a heavier sample - due to faster initial rate of weight gain in breastfed compared to formula fed infants
- Higher rates of under-nutrition
- Lower rates of overweight and obesity
Over 6 months: WHO charts reflect a taller lighter sample- due to slower rate of weight gain in breastfed and ideally nourished children
- Lower rates of under-nutrition
- Higher rates of overweight and obesity

The recent release of the WHO Growth Standards and Growth References has prompted a re-evaluation of which growth charts are appropriate for monitoring and assessing the growth of Canadian children. Promoting Optimal Monitoring of Child Growth in Canada: Using the New WHO Growth Charts, a practice guideline for health professionals, was developed collaboratively by Dietitians of Canada, Canadian Paediatric Society, The College of Family Physicians of Canada and Community Health Nurses of Canada. The project includes the full report, executive summary, health professionals’ guide, questions and answers for health professionals and for parents, and set of WHO Growth Charts adapted for the primary health setting for Canada. http://www.cps.ca/english/publications/CPS10-01.htm OR http://www.dietitians.ca/growthcharts

Rourke Baby Record

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Download the 2009 RBR (Ontario Version)

Download Growth Charts