Changes in the Rourke Baby Record

Highlights of Changes in the 2014 Rourke Baby Record

Download 2014 RBR with changes since 2011 shown in aqua print

National Version 2014 RBR

English French 

Note that on the 2014 Rourke Baby Record (RBR) Guides I to V and Resources pages 1 to 3, all changes from the 2011 RBR are shown in aqua type.  This includes new information, new web links, and updated URLs for the same web links.  Where information has been removed from the 2011 RBR, the letter of the word before the omission and the first letter of the word after the omission are shown in aqua type.  


As in earlier versions of the RBR, the Ontario version differs from the National in only 2 items:

i) 18 month visit on Guide IV includes reference to the Nipissing Developmental Screen (NDDS) with space to add the number of any NDDS item(s) not yet attained.  Due to NDDS support by the province of Ontario, the NDDS is available free of charge in that province, but not elsewhere.

ii) Resources page 2 includes the same Ontario specific early child development and parenting resource system pathway as in the 2011 Ontario RBR.

Ontario Version 2014 RBR

English French


  1. The wording on the printed Resources 1 - 3 pages has been simplified by hyper-linking the words that describe each web link instead of the actual URL itself. This has allowed a larger print font for easier reading. 
     All web links have been updated where appropriate.
  2. Strength of recommendation:  " Strength of recommendation is based on literature review using the classification: Good (bold type); Fair (italic type); Inconclusive evidence/Consensus (plain type). See literature review table at"
    • The regular font on the RBR Guides has been clarified to refer to items with either inconclusive evidence or consensus opinion.
    • There is no change to the system used in the 2014 RBR for evaluating the strength of recommendation: Good (bold type)Fair (italic type); Inconclusive evidence/Consensus (plain type)).  The Canadian Task Force on Preventive Health Care (CTFPHC), however, recently changed its classification system from the one above to the GRADE system, in which the grade of recommendation is either strong or weak.  Extensive discussion occurred to determine whether the RBR should follow suit.  This included discussions with members of the CTFPHC.  It was determined that the GRADE system is not appropriate for all the literature under review for the RBR.  Where appropriate, individual articles have been reviewed using both the GRADE and the former CTFPHC classification system, and can be found in the literature review table on the RBR website.
  3. The Ontario College of Family Physicians is no longer the fund administrator of the Government of Ontario funding support.
  4. To more clearly identify whether or not there are concerns with each item recommended for discussion, the following has been added in a horizontal shaded bar above the Nutrition section on Guides I to IV: “For each o item discussed, indicate “v” for no concerns, or “X” if concerns”.
  5. For the first time, the Dietitians of Canada (DC) has joined the College of Family Physicians of Canada (CFPC) and the Canadian Paediatric Society (CPS) in endorsing the RBR.


  1. The 2014 RBR continues to recommend growth monitoring using growth charts from the 2006 World Health Organization (WHO) Child Growth Standards (birth to 5 years).  The Canadian WHO Growth Charts were revised in early 2014 to address concerns raised by the Canadian Paediatric Endocrinology Group (CPEG) regarding change in shaded percentile range lines; and omission of weight for age curves over 10 yrs of age.  The new web link for the Canadian WHO Growth Charts is
    The CPEG growth charts, if they remain in use, can be found in the literature review table on the RBR website.
  2. The word "percentiles" has been changed to "age" in the Growth cell on the left column of each Guide so that it reads: Correct age until 24 - 36 months if
  3. In all visits up to and including 18 months (on Guides I to IV), the word "Height" has been changed to "Length" in the Growth boxes.


  1. Vitamin D:
    • On the RBR Guides, a bullet symbol has been added in front of Vitamin D, indented under breastfeeding, as an additional prompt.
    • To be consistent with the revised Nutrition for Healthy Term Infants 0 - 6 months and 6 – 24 months, the following revisions have been made:
      • + Vitamin D 400 IU/day in regular font has been added to visits at 12 – 13, 15, and 18 months; and Resources 1 revised to include Vitamin D supplementation for all breastfed infants until the diet provides a sufficient source of Vitamin D (~ 1 – 2 years).  This is in regular font as the evidence is not as strong as it is for under one year of age.
      • Resources 1 statement about use of 800 IU vit D/day has been revised from “northern communities” to “high risk infants”.
      • The following statement has been removed from Resources 1: “Formula may only supply a portion of the recommended daily vitamin D intake if less than 1000 mL (33 oz) is consumed daily.”
  2. Introduction of Solids
    • Significant changes have occurred to the nutrition section of the 6 month and 9 month visits to allow the timely introduction of more solids, including allergenic foods, starting at 6 months.  The word "initial" has been deleted from "introduction of solids" at the 6 month visit as evidence is accumulating that introduction of solids should be considered depending on the infant’s signs of readiness, and may be a few weeks before to just after 6 months.  Introduce iron-rich foods first (to prevent iron deficiency anemia), then add fruits, vegetables and milk products such as yogurt and cheese.  Cow’s milk as the primary milk source should be delayed to sometime between 9 and 12 months.
    • An item has been added at the 4 month visit to discuss the future introduction of solids.
  3. New information and/or web links have been added on Resources 1 for the following topics:
    • Nutrition for Healthy Term Infants (NHTI), formerly for 0 - 24 months, has now been split into 2 documents:  0 to 6 months, and 6 to 24 months; and the CPS Practice Point on NHTI 0 – 6 months included.
    • NutriSTEP web link
    • Baby friendly initiative web link
    • safe infant formula preparation and handling
    • expansion of the positive effects of breastfeeding to include protection against sudden infant death syndrome (SIDS).
    • expansion of the statement on dietary fat content explaining its importance in the first 2 years of life
    • addition of: i) a statement on introduction of solids, ii) new information on the introduction of allergenic foods; and iii) CPS Position Statement on dietary exposures and allergy prevention
    • addition of a statement on iron containing foods
    • addition of a statement on honey avoidance until 1 year of age
    • info on mercury in fish has been expanded to fish consumption in general
  4. Clarification that promotion of cup use at the 12 – 13 and 15 month visits should be an “open” cup.
  5. Avoidance of sweetened juices/liquids has been continued for the 2 – 5 year visits.
  6. Skim milk has been added to 1% and 2% milk as appropriate for children starting at age 2 years.  This is consistent with the literature and with Canada’s Food Guide.
  7. Breastfeeding has been added to the 2 – 3 yr visit in regular font (the evidence isn’t as strong as for younger ages) to be consistent with the Nutrition for Healthy Term Infants document.


A new section of Environmental health items has been created on all the RBR Guides and on Resources.  These items in past RBR editions were generally scattered throughout the “Other” section of the Education and advice section.

Injury prevention

  • Safe Kids Canada web link has been changed to Parachute (new organization).
  • Bicycle safety has been expanded to include advocating for helmet legislation for all ages, and the web link for the new CPS Position Statement has been added to Resources page 1.
  • Firearm safety has been expanded to include safe storage.
  • "Falls" item has been expanded to include unstable furniture and TVs.
  • Pacifier use has been moved from "Other" section to "Injury prevention" section due to evidence that pacifier use may decrease the risk of SIDS.
  • Transportation in motor vehicles has been updated to:
    • recommend rear-facing infant/child seats until age 2 years as per recent recommendations;
    • replace the outdated CPS Position Statement (currently under revision) with a more up to date statement by the American Academy of Pediatrics (AAP).

Behaviour and Family Issues

  • Adoption has been added to foster care statement on Resources 2: Adoption/foster care: Children newly adopted or entering foster care ..."
  • Swaddling item on Resources 2 has been changed from 6 months to 2 months because of safety concerns re SIDS (although no conclusive evidence in the literature).
  • New information has been added on healthy sleep habits
  • The term "shaken baby syndrome" has been changed to "abusive head trauma".
  • Expansion of information on Resources 2 for prevention of child maltreatment
  • The item "Healthy active living/sedentary behaviour" has been expanded and moved from Resources 1 Other Section to Resources 2 Behaviour/Family Issues, and has been renamed “Family healthy active living/sedentary behaviour".  A web link to the Canadian Society for Exercise Physiology (CSEP) guidelines for physical activity and sedentary behaviour has been added to Resources page 2.

Oral health

  • Expansion of information to include 1) fluoride varnish, and 2) a caries risk assessment tool (AAP).


  1. There is no change to the items in this section on the RBR Guides.
  2. Two new web links have been added to Resources 2 for new CPS Position Statements:
    • Getting it right at 18 months
    • Measuring in support of early childhood development
  3. On Resources 2, the Modified Checklist for Autism in Toddlers (M-CHAT) has been revised and the follow-up questions for initial positive screening questions incorporated in a single document:
    M-CHAT-R/F.  The M-CHAT-R is also available in an electronic format for parents to complete.


  1. On all Guides (I to IV), the Physical Examination column wording has been clarified to: "An appropriate age-specific physical examination is recommended at each visit.  Evidence-based screening for specific conditions is highlighted. "
  2. Checking visual acuity at age 3 - 5 years has been added to Resources 1.
  3. The wording for "obstructive sleep apnea" has been updated to "sleep disordered breathing".
  4. "Tongue mobility" has been added to Guide 1 (visits 1 wk 2 wk and 1 mo) and "Inspect tongue for ankyloglossia" has been added to Resources 1. 
  5. “Patency of anus” has been added to the physical examination within 1 week.


  1. The format of the Guide V Immunization chart has been improved with a new column to separate the date from the name of the vaccine.
  2. A direct link to the Canadian Immunization Guide (in addition to the NACI homepage) has been added to the Guide V Immunization chart and to Resources page 3.
  3. Meningococcal vaccine terminology has been updated from MenC-C to MVC-C and MCV-4.
  4. “Females” has been removed from the HPV vaccine item on Guide V: Immunization chart as HPV vaccine is now recommended for both genders.
  5. MMR wording has been clarified on Resources page 3 re the timing of the second dose.
  6. Vaccine notes on Resources page 3 now indicates that live attenuated influenza vaccine can be used at age 2 years and above if no contraindication.
  7. Regarding TB, web links to the Canadian TB Standards have been added, and more simplified wording has been used on Resources page 3.

Highlights of Changes in the 2011 Rourke Baby Record

Rourke L, Leduc D, Constantin E, Carsley S, Rourke J, Li P. Getting it right from birth to kindergarten What’s new in the Rourke Baby Record? Canadian Family Physician 2013;59:355-359.

A version of the 2011 national English RBR highlighting all the changes from the previous edition can be downloaded for viewing here. Changes in content in the 2011 RBR are shown in magenta (pink) print and new web links in the 2011 RBR are in green print.


  1. Growth monitoring: the strength of the evidence has improved from fair to good with use of the WHO growth charts.
  2. "Regains birth weight between 1 and 3 wks" has been added to the 2 week visit.


  1. Change from bottle to cup discussion occurs earlier at 9 months.
  2. Vegetarian diets: new topic and resources.  
  3. Breastfeeding mothers are advised to continue vitamin D supplements for the duration of breastfeeding.
  4. New resources on:
    - infant formulas,
    - medications during breastfeeding,
    - mercury in fish.

Education and Advice

  1. Safe sleep wording expanded to include:
    - advice against using sleep positioners,
    - stronger advice against bed sharing,
    - cradle and bassinette safety statement.
  2. Lead screening risk factors and resources expanded.
  3. Children entering foster care: new topic and resources.
  4. Updated resources on:
    - health and the environment,
    - shaken baby syndrome,
    - fetal alcohol spectrum disorder.

Physical Examination

  1. Fontanelle examination and closure wording has been clarified.
  2. Hip exam recommended until at least one year of age, or until the child can walk.
  3. Obstructive sleep apnea wording includes the presence of snoring.


  1.  Premature infants: included in the at-risk group for anemia screening.
  2.  Universal newborn hearing screening: included with good strength of evidence.

Immunization/Infectious diseases

  1. Immunization pain reduction strategies and resources: included with good strength of evidence.
  2. Immunization info web links for parents and physicians have been expanded.
  3. Rotavirus vaccine has been added to the RBR Immunization chart (Guide V) along with resources.
  4. Varicella vaccine schedule has been updated on the RBR Immunization chart (Guide V).
  5. Statements have been updated for:
    - varicella vaccine,
    - pneumococcal conjugate vaccine,
    - meningococcal conjugate vaccine.


  1. One month visit is no longer optional: to insure adequate growth, nutrition and parent adjustment.

Changes in the 2009 Rourke Baby Record 

Rourke L, Leduc D, Constantin E, Carsley S, Rourke J. Update on well-baby and well-child care from 0 to 5 years: What’s new in the Rourke Baby Record? Canadian Family Physician 2010; 56: 1285-90.


Rourke Baby Record: 2009 edition - Summary of major changes from the 2006 RBR


  1. No major format changes.
  2. Same endorsement by the CFPC and CPS as for the 2000 and 2006 editions of the RBR.
  3. Web links updated.
  4. Paper hard copies are no longer being distributed by McNeil Consumer Healthcare. The 2009 edition of the RBR may be downloaded from the Rourke Baby Record website ( and from various organization websites such as the CFPC and CPS.
  5. See the Rourke Baby Record website ( for pending updates including proposed new section for literature review with levels of evidence and new section for parent resources.


  1. Change from the CDC 2000 growth charts to the WHO 2006 growth standards.
  2. Update in recommendations for correction of growth measurement for premature infants.


  1. Addition of suggested daily volumes of milk intake as an approximate guide at different ages.
  2. Update re vitamin D supplementation.
  3. Change in the recommended fat content in milk given to 2 to 5 year olds.
  4. New recommendations on the indications for using soy-based formula.

Education & Advice - Anticipatory Guidance

Injury prevention issues

  1. Update in information/evidence regarding transportation in motor vehicles, bicycle helmets, hazards re choking and falls, aspects of water safety.
  2. Clarification of safe sleeping terminology.

Behaviour/Family/Development issues

  1. New guidelines for screening for autism spectrum disorder including use of the MCHAT.
  2. Update in information/evidence regarding non-parental childcare, facilitating literacy, and crying and the risk of shaken baby syndrome.
  3. The inclusion of recommendations for infant swaddling and on parenting programs.

Other issues

  1. Update in information/evidence regarding pacifiers, antipyretics, insect repellents, and dental care/oral health statements.
  2. New evidence and recommendations on OTC cough/cold medications and on serum lead levels

Development Milestones

  1. External reviews of levels of evidence for various developmental milestone items with subsequent revision of some items.
  2. Update in recommendations for correction of developmental milestones for premature infants.

Physical Examination

  1. Revision in level of evidence for vision screening and for screening for developmental dysplasia of the hips.
  2. New evidence and statements on hearing screening including universal newborn hearing screening.
  3. Clarification of the expected norms for fontanelle examination.


  1. Update of immunizations as per NACI recommendations.
  2. New evidence and statements on rotavirus vaccine.
  3. Updated schedule for meningococcal vaccine.
  4. New resources for parents regarding immunizations.

2009 Rourke Baby Record: National and Ontario versions
As in the 2006 edition, the only differences between the Ontario and National versions of the 2009 edition of the RBR are found on Guide IV and its reverse (Healthy Child Development Selected Guidelines/Resources)

  1. On the Ontario version, the 128 month visit development section includes the following statements not on the national version:
    "Enhanced inquiry after Nipissing Developmental Screen™ (NDDS™)**
    List NDDS™ items not yet attained: _______________"
  2. 2. The 2009 Early Child Development and Parenting Resource System found on the reverse of Guide IV (Healthy Child Development Selected Guidelines/Resources) are either national or Ontario specific.

Changes in the 2006 Rourke Baby Record

The major changes to the September 2000 version found in the May 2006 version of the Rourke Baby Record are as follows:  

  • Expansion of visits from 3 guides to 4 to allow more writing space, with an optional 15-month visit to accommodate some immunization preferences/schedules.
  • Major emphasis on the 18-month visit as a critical time for assessing development.
  • Use of the Centers for Disease Control’s full-page growth charts.
  • Creation of an immunization chart to more easily document immunization.
  • Reorganization of the Education & Advice section to avoid omitting issues if a visit is missed.
  • Incorporation of selected evidence-based environmental, literacy, and healthy active living issues.
  • More detail on child development, including new evidence-based information on the reverse of Guide 4.
  • Incorporation of web-based resources for further information.