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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 500 mL (16 oz) pasteurized 2%, 1% or skim cow’s milk daily.
  • 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.nutritionscreen.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.

Development

  • At 4 years your child should:
    • Understand 3-part directions.
    • Ask and answer lots of questions. (Eg. What are you doing?)
    • Walk up and down stairs alternating feet.
    • Undo buttons and zippers.
    • Try to comfort someone who is upset.
  • At 5 years your child should:
    • Count out loud or on fingers
    • Speak clearly in adult-like sentences most of the time.
    • Throw and catch a ball.
    • Hop on 1 foot several times.
    • Dress and undress with little help.
    • Cooperate with adult requests most of the time.
    • Retell the sequence of a story.
    • Separate easily from you.
  • 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.

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.

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 - formerly Safe Kids Canada (www.parachutecanada.org)
  4. Dietitians of Canada (www.dietitians.ca)
  5. Health Canada (www.hc-sc.gc.ca)

Support and Acknowledgements

The RBR Parent Resources website and this series of information sheets were created by then Memorial University of Newfoundland (MUN) medical student, Dr. Laura Butler, and the RBR authors (Drs. L. Rourke, D. Leduc and J. Rourke). Two MUN Summer Undergraduate Research Awards and MUN Faculty of Medicine Office of Professional Development supported these projects. Evaluation project by Dr Aimee Holla, MUN FM Resident. 2020 brochure revisions by Dr. Anne Rowan-Legg.

Support for the RBR includes the Government of Ontario and MUN's Dr. W. Ingram Award. Licensing contributions for RBR electronic medical record use go to the MUN RBR Development Fund.

As evidence-based information is constantly changing, the Rourke Baby Record and these recommendations should be used as a guide only.

May 2020