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Parents often wonder about their child’s health, leading to the frequently asked question: “Is my baby healthy and growing normally?”

These information sheets outline normal and healthy growth and developmental milestones, and common health topics for your baby.

Due to space constraints, some messages are repeated at several ages while others appear once only. Read the complete set of sheets to obtain the entire information.

The Rourke Baby Record (RBR) is a guide that many Canadian doctors and other healthcare professionals utilize for well baby and child visits for babies and children from 1 week to 5 years of age.

photo of a 4-5 year old female

4 - 5 Years

Feeding & Growth

  • Offer a maximum of 500 - 600 mL cow milk or unsweetened fortified soy beverage per day in an open cup.
  • Avoid sweetened liquids or fruit juices as they can cause tooth decay, problems with weight gain or diarrhea, and can take the place of healthy foods. Encourage water.
  • Avoid processed foods high in sugar and/or salt.
  • Remember to let her eat as little or as much as he is hungry for. Never force your child to eat.
  • Be a good role model for healthy eating. Eat together as a family away from the TV or other distractions.
  • Find out if your child is a healthy eater using Nutri-eSTEP at www.nutristep.ca

Preventing Injuries

  • Car seat safety: Follow the instructions that come with your car seat to install it properly, and keep your child in each stage as long as possible. Maximum height and weight may vary with your car seat model.
  • Both you and your child should wear a properly fitting bicycle helmet when cycling. Replace it if there is a heavy impact, if it shows signs of damage, or if it is over 5 years old.
  • To decrease the risk of drowning, supervise your child near water, encourage swimming lessons, fence any pool completely with selfclosing and -latching gates, use life jackets, and take boating and water safety training.
  • Avoid home trampolines.
  • Remove or safely secure all guns/firearms in the home to prevent unintentional or intentional injury.
  • Prevent sunburn by minimizing sun exposure, wearing protective clothing, hats, and sunscreen with SPF of at least 30.
  • Use a maximum of 10% DEET applied no more than 3 times a day to prevent insect bites.

Other Advice

  • Second-hand smoke (from cigarettes, E-cigs, cannabis) is harmful to your child. Ask your health care provider for help to quit smoking. Cannabis edibles should be locked away to prevent unintentional poisoning.
  • See your dentist for regular check-ups. Assist her brushing twice daily with a small amount (peasized portion) of fluoridated toothpaste. Floss her teeth daily if her teeth touch each other.
  • Children can still have episodes of bed-wetting at this age. Talk to your health care provider if this is an ongoing issue.
  • Having a healthy lifestyle yourself with healthy eating and physical activity will provide a good role model for your child.
  • Your child will soon be attending pre-school and kindergarten. If he is currently in full-time childcare, the transition should not be difficult. Speak to your childcare worker about any concerns to discuss with your healthcare provider. They may recommend community resources such as parenting skills programs for you or social skills training for your child.
  • Limit screen time to <1 hour per day, and do not use within 1 hour of bedtime. Do not have a TV or computer in the bedroom. For children 2-4 years, screen time should be limited to educational programming.
  • Recommended sleep duration per 24 hrs in 3–5 yr olds is 10-13 hrs.
  • Decrease sedentary pastimes and encourage daily and frequent physical activity, with you as role model, with free and unstructured outdoor active play for young children.

Development

  • At 4 years your child should:
    • Walk up and down stairs alternating feet.
    • Follow 3-part directions. E.g. Point to your shoe, stand up, and clap your hands.
    • Ask and answer lots of questions. E.g. What are you doing?
    • Try to comfort someone who is upset.
  • At 5 years your child should:
    • Throw and catch a ball.
    • Hop on 1 foot several times.
    • Cut with scissors.
    • Have a good pencil grasp.
    • Dress and undress with little help.
    • Count 6 objects to answer “How many are there?”
    • Speak clearly in adult-like sentences most of the time.
    • Retell the sequence of a story.
    • Cooperate with adult requests most of the time.
    • Separate easily from you.
    • Identify emotions and feelings.
  • Limit TV, video and computer time, and do not use within 1 hour of bedtime. Do not have a TV or computer in the bedroom.
  • Allow more time for reading and for physical activity with you. Your child needs both quiet time and group activities.
  • Play rhyming games, memory games, ball games, and group games.
  • Listen to your child when she talks to you. Notice when she is doing something good. She will feel important if she has a few simple tasks.
  • Have fun with your child with drawing, painting, gluing, cutting, puzzles, lacing, mazes, and printing.
  • Be sure your child knows his full name, phone number and address.
  • Report any concerns about your child’s development, including her hearing and vision, to her physician or other healthcare professional.
  • Empathetic, consistent and responsive discipline techniques are associated with positive results. Praise good behaviour.

Resources

For more information on your baby’s health, the top 5 websites cited by the RBR Parent Resources are:

  1. Canadian Pediatrics Society – Caring for Kids (www.caringforkids.cps.ca)
  2. Hospital for Sick Children – About Kids Health (www.aboutkidshealth.ca)
  3. Parachute - (www.parachutecanada.org)
  4. Dietitians of Canada – UnlockFood (www.unlockfood.ca/en/default.aspx)
  5. Health Canada (www.hc-sc.gc.ca)

Support and Acknowledgements

Financial support for the Rourke Baby Record has been provided by the Government of Ontario. In-kind support from the Canadian Paediatric Society, College of Family Physicians of Canada, and Dietitians of Canada. 2024 brochure revisions by Dr. Anne Rowan-Legg. As information is constantly changing, the Rourke Baby Record and these brochures should be used as a guide only.

August 2024