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Highlights of Revisions in the 2024 Rourke Baby Record

Download a version of the 2024 RBR

Changes since 2024 (shown in teal print).

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Changes in the 2024 Ontario RBR

(Shown in teal print).

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Differences between 2024 National and Ontario RBR

(Shown in red print).
About These Differences

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THE MOST SIGNIFICANT REVISIONS in the 2024 RBR GUIDES/NOTES are:

  1. A new section on anti-racist, inclusive, culturally safe care.
  2. Reorganization of the family functioning and behaviour section to include early relational health, mental health, and healthy routines, and a shift from labelling high risk groups to offering support and resources.
  3. Advances in the developmental surveillance domain to improve clarity, position, and organization of some milestones.
  4. Deletion of GUIDE V IMMUNIZATION CHART.
  5. NOTES 1 – 4 are the renamed Resources pages 1 – 4.
  6. Expanded and updated web links to information for healthcare professionals and families. There has been a gradual change in some topics from clinician-oriented information to family-oriented information as organizations such as the Canadian Paediatric Society have shifted from providing evidence-based clinician-focused statements and practice points relevant to the RBR to those directed at complex non-primary care paediatric topics.

GROWTH MONITORING

  • The NOTES include information on regaining birth weight and on the use of BMI for measuring growth starting at age 2 yrs.

NUTRITION SECTION

  • Recommended range and maximal amounts of cow’s milk in children over 9 months have been clarified on the GUIDES to minimize the risk of iron deficiency.
  • The NOTES contain new information/resources related to plant-based beverages, GE reflux, baby-led weaning, vegetarian and vegan diets, dietary fibre and prebiotics, age-appropriate forms of peanut products, avoiding highly processed foods, and choosing foods with healthy fats.

EDUCATION AND ADVICE SECTION

Injury prevention
  • The GUIDES broaden poisonings to ingestions, including cannabis products.
  • The NOTES expand the risk factors for SIDS and clarify that they are risk factors rather than causal factors; include latex balloons as a choking risk and encourage caregivers to learn choking first aid; incorporate the dangers of cannabis and button battery ingestion; and add a Canada wide poison control number 1-844-POISON-X.
Inclusive and anti-oppressive care

This is a starting point for practising patient- and family-centred anti-racist and culturally safe care where patients feel respected and safe.

  • Wording has been added to the EDUCATION AND ADVICE heading for all visits.
  • The new NOTES section describes racism as a social determinant of health that has profound lifelong effects on children and families. It encourages cultural humility through reflection of personal bias, and the practice of trauma-informed care.
Relationships, parenting, family function

There is a shift from merely identifying deficit-based and high-risk groups to observing and identifying positive interactions to help mitigate trauma and adversity and to build resilience.

  • On GUIDES I – IV, the items in this domain have been consolidated and clarified. Wording to promote early relational health (ERH) has been added to this heading
  • The NOTES include new information and resources on early relational health; children’s mental health; depression in parents as a risk factor for both safety of children as well as for their socio-emotional and cognitive development; housing issues as an aspect of the social determinants of health; and offering support and resources to families with unmet social needs.
  • Siblings has been deleted as an item on the GUIDES due to confusion on the meaning and a lack of evidence.
Healthy routines
  • The NOTES include new information and resources related to healthy “adequate” sleep habits; and to the importance of unstructured outdoor active play for young children.
  • Colic has been added to the visits of infants up to 6 months of age.
  • Read, speak sing to/with the infant/child is now in bold print (good evidence) on all GUIDES. The NOTES have been expanded beyond reading to include singing and telling stories in the language of choice to promote language and early literacy skills, as well as socioemotional and relational development. The NOTES now list risk factors for reading difficulties with a prompt at the 5-year visit.
Environmental Health
  • With good evidence that exposure to pesticides is associated with adverse neurodevelopmental outcomes, this item is now in bold font on GUIDES I – IV.
  • The NOTES include new resources on healthy homes, health and environment, air quality and children’s health, sun safety, insect bites and repellents, and on testing well water regularly for contamination.

DEVELOPMENT SECTION

  • In 2022, two seminal evidence-based articles on developmental milestone acquisition resulted in the opportunity to re-examine the developmental surveillance section of GUIDES I - IV.
  • We were very fortunate to collaborate with Dr. Cara Dosman and her colleagues for this detailed review. For some items, this has resulted in clarifying the wording and/or changing the age at which they are included.
  • As in prior editions of the RBR, tasks are set after the time of typical milestone acquisition. Absence of any item, loss of attained items, or parental concern suggests consideration for further assessment of development. Ensure that milestones have been achieved for any missed visits and be aware that parental familiarity with certain milestones may be culturally dependent.
  • The milestones are now consistently listed in the order: gross motor, fine motor, communication, cognitive, social-emotional.

PHYSICAL EXAMINATION SECTION

  • The term “sentinel injuries” has been added and defined to increase the recognition of child maltreatment.
  • Acholic stools has been added to the Urine output and stool pattern item in the Nutrition domain in visits up to 2 months, and to the NOTES, as acholic stools and prolonged jaundice (predominantly conjugated) can be signs of biliary atresia.
  • Testing for developmental reflexes (also called primitive reflexes) has been added to the physical exam at the first visit (within 1 wk – 2 wks), and to their absence by the 6-month visit. Abnormal findings may be early signs of neuromotor disorder suggesting the need for further assessment.
  • The NOTES clarify the manoeuvres of choice for the P/E of hips in infants at different ages and the considerations for selective imaging.

INVESTIGATIONS/SCREENING SECTION

  • Consideration for anemia screening has been broadened to include iron deficiency, as recent evidence has shown that iron deficiency without anemia has impacts on health including brain functioning.
  • The NOTES now contain more general wording on hemoglobinopathy screening due to the heterogeneity of different types of hemoglobinopathy.

IMMUNIZATION SECTION

  • GUIDE V Immunization Chart has been deleted as other systems exist for documenting immunizations.
  • Immunization pain reduction strategies have been expanded in keeping with current evidence.
  • Vaccine hesitancy, identified by the WHO in 2019 as one of the 10 threats to global health, has been added to the NOTES along with evidence-based interventions to improve vaccine confidence.
  • Although revisions and additions have been made to some individual VACCINE NOTES, RBR users are advised to use the Canadian Immunization Guide and NACI for current information on specific vaccines, due to the amount of evolving evidence with rapidly changing recommendations.