Ontario's enhanced 18-month well-baby visit

Madely Health Headlines Commentary for June 1, 2010


The Minister of Children and Youth announces that every child will receive an enhanced 18-month visit:

Family Physicians Play Key Roles in Healthy Child Development

Conducting an enhanced 18 month well-baby visit

The enhanced 18-month well-baby visit builds on the current 18-month check-up.  It is an initiative designed to build strong partnerships among family physicians, parents and community services. The initiative introduces a process, using standardized tools, for 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.

Recommended tools

The Expert Panel on the 18-Month Well-Baby Visit recommended the use of the Rourke Baby Record (Ontario version) and the Nipissing District Developmental Screen™ (NDDS™), a parent-completed developmental checklist. Both tools were offered as examples in the schedule of benefits and are available on a number of websites, including the OCFP’s (www.ocfp.on.ca – 18-Month Well-Baby Visit).

The Evidence

-Recent studies show that 25-30% of children are arriving at school without the skills necessary to learn and succeed (Offord Centre, Early Development Instrument (EDI)).

-Evidence suggests clinical judgment alone is not sufficient for identifying all vulnerable children (GAC 18 month Clinical Report).  Using a consistent, comprehensive evaluation process with every child that combines clinical judgment with the Rourke Baby Record and NDDS™ will significantly improve identification of all children at risk, even those who clinically do not appear to be at risk.

Why focus on an enhanced visit at 18 months?

-Family practices are one of the only places where all children are routinely seen in the first two years (97% of children aged 0 to 2 in Ontario: ICES data).  Some children are not routinely seen again until 5 years of age. The 18-month visit is an ideal opportunity for health promotion, prevention and early intervention.

-70% of parents have concerns about the social and mental development of their child, and about their parenting skills, but only 28% actually discuss these with their family doctor (GAC 18-month Clinical Report). Having every parent complete the NDDS™ gives them the opportunity to reflect on their child’s development and creates the opportunity for them to express their concerns and address their questions to you.

What family doctors can do

-All parents and children can benefit from the resources in the community such as the Ontario Early Years Centres, libraries, and recreation centres. Encourage parents to access the universal parenting and play programs in the community.

-Make a referral to community/specialized services if you have any concerns. Avoid the unwise ‘wait and see’ strategy.

-Research has proven that children whose parents read with them consistently from an early age are more likely to be successful in school. Encourage reading, speaking, singing and telling stories to all children from birth. Simple reminders to families from their physician about the importance of reading with their child everyday have a big impact on behaviour (Read, Speak, Sing Literacy Program, http://cps.ca).

Education and information to support the enhanced visit

-An online education and information strategy accessed through an 18-month web portal has been developed and is available at: (http://machealth.ca/programs/18-month).

-Mainpro credit modules are available.

-The OCFP’s Healthy Child Development program can be presented in your community (contact Mary Clelland at 416 867 9646 ext. 50).

-Helpful resource manuals Healthy Child Development – Improving the Odds and Healthy Child Development – Facing the Challenges can be downloaded from the OCFP website (www.ocfp.on.ca – Healthy Child Development).

Background Information

-Definition/required elements of service: Well-baby care is a periodic assessment of a well newborn/infant during the first two years of life including complete examination with weight and measurements, and instructions to the parent(s) or patient’s representative regarding health care.

-Rourke Baby Record (RBR) 2009 Ontario version (www.rourkebabyrecord.ca , http://machealth.ca/programs/18-month or www.cfpc.ca or http://www.cps.ca or in the “forms” section of www.ontariomd.ca) is an evidence-based point of care tool for health professionals in the delivery of the enhanced visit.

-Nipissing District Developmental Screen™ (NDDS™) http://ndds.ca or http://machealth.ca/programs/18-month, or in the “forms” section of http://www.ontariomd.ca) is a parent-completed developmental checklist for recording the development and progress of infants and children within certain age groupings.

-Any ‘no’ responses are red flags that indicate possible delay, warrant further investigation, possible referral and a follow up.

-The developmental tasks are set beyond the time when most children would have achieved the skill. The activities on the 15-month NDDS can help to prepare for the 18-month screen.

-GAC clinical report

Final Report to the OCFP for the Evidence to Support the 18-Month Well-Baby Visit