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.

An Interactive Walk Through the 2009 RBR

The Rourke Baby Record (RBR) consists of four guides for charting well baby/child visits up to five years of age, a table for charting immunizations, and three sheets of selected guidelines/resources.

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).

To explore the Rourke Baby Record and the associated medical evidence, click on one of the page images below. The page selected will display on the site and any areas/items that have additional information available will be highlighted in light blue. To explore the additional information, simply click on a highlighted area and an information panel will open. To close the information panel click on the X icon in the upper right-hand corner of the panel.

Guide I: Contains visits within one week, at two weeks, and at one month of age. Each visit includes:

discussion of parent concerns about the infant,
measurement of growth parameters,
assessment of nutrition,
a brief surveillance of development
physical examination findings
documentation of problems and plans
referral to Guide V for immunization

Age appropriate education and advice topics for anticipatory guidance are listed across the guide to be discussed one or more times over the three visits as needed.

Guide II: Contains visits at two, four and six months of age. Each visit includes:

discussion of parent concerns about the infant,
measurement of growth parameters,
assessment of nutrition,
a brief surveillance of development
physical examination findings
documentation of problems and plans
referral to Guide V for immunization

Age appropriate education and advice topics for anticipatory guidance are listed across the guide to be discussed one or more times over the three visits as needed.

Guide III: Contains visits at 9, 12 to 13, and 15 months of age. Each visit includes:

discussion of parent concerns about the infant,
measurement of growth parameters,
assessment of nutrition,
a brief surveillance of development
physical examination findings
documentation of problems and plans
referral to Guide V for immunization

Age appropriate education and advice topics for anticipatory guidance are listed across the guide to be discussed one or more times over the three visits as needed.

Guide IV: Contains visits at 18 months, 2 to 3 years, and 4 to 5 years of age. Each visit includes:

discussion of parent concerns about the infant,
measurement of growth parameters,
assessment of nutrition,
a brief surveillance of development
physical examination findings
documentation of problems and plans
referral to Guide V for immunization

Age appropriate education and advice topics for anticipatory guidance are listed separately for the 18 month enhanced visit.

Guide V: Childhood Immunization Record – as per NACI (National Advisory Committee on Immunization) as of July 28, 2009. This allows charting to be collected in one place as it includes the injection site, lot number and expiry date of vaccine, initials of person administering vaccine, and any comments.

Selected Guidelines/Resources: This page contains further information regarding items on Guides I to IV identified with one asterisk (*). Generally this is information pertaining to:

Growth
Nutrition
Education and advice relating to injury prevention
Other education and advice items generally not related to behaviour, development or family issues
Physical examination
Problems and plans

Healthy Child Development Selected Guidelines/Resources: This page contains further information regarding items on Guides I to IV identified with two asterisks (**). Generally this is information pertaining to:

Development
Behaviour
Family issues

An early child development and parenting resource system is included to facilitate the use of other resources when there are one or more areas of concern in development.

Infectious Diseases and Immunization Selected Guidelines/Resources: This page contains further information on immunization including vaccine notes, and is taken from NACI as of July 28, 2009. Canadian Paediatric Society Position Statements regarding several infectious diseases are also included.

Rourke Baby Record

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An Interactive Walk Through the 2009 RBR