Early Years: Because They Don't Come With A Manual

The Early Years
H E A LT H Y PA R E N T S , H E A LT H Y C H I L D R E N
2 nd E D I T I O N
Because they don’t come with a manual
healthyparentshealthychildren.ca
This book belongs to:
My important contact information

Health care provider
Name:
Phone:
Community or public health centre
Name:
Phone:
Other:
Name:
Phone:
Other:
Name:
Phone:
This book has lots of information about parenting and the early years of your child’s life.
The content in this book reflects Alberta Follow us on

Health Services’ (AHS) information
at the time of printing. For more /healthyparentshealthychildren
information and regular updates visit @AHS_HPHC
Copyright © (2013) Second Printing (2014) Third Printing (2018) Second Edition (2018) Second Reprint (2019) Alberta Health
Services. This material is protected by Canadian and other international copyright laws. All rights reserved. These materials may
not be copied, published, distributed or reproduced in any way in whole or in part without the express written permission of
Alberta Health Services. These materials are intended for general information only and are provided on an ‘as is’, ‘where is’ basis.
Although reasonable efforts were made to confirm the accuracy of the information, Alberta Health Services does not make any
representation or warranty, express, implied or statutory, as to the accuracy, reliability, completeness, applicability or fitness for
a particular purpose of such information. These materials are not a substitute for the advice of a qualified health professional.
Alberta Health Services expressly disclaims all liability for the use of these materials, and for any claims, actions, demands or
suits arising from such use.
ISBN 978-0-9916769-2-7
Table of Contents
INTRODUCTION 3
Important Contact Information 3
Important Websites 4
Your Book 5
Thank You! 8
A N OV E R V I E W O F PA R E N T I N G 9
Being a Parent 11
How Children Grow and Develop 15
Your Family Through the Early Years 33
Taking Care of Yourself 38
H E A LT H Y G R O W I N G FA M I L I E S 47
Feeding Your Child 49
Everyday Care 60
Growing and Learning Together 64
Sexual Health and Development 75
Health Checkups 76
Immunizations 82
Travel Safety 90
Common Health Concerns 91
Healthy Homes 102
Preventing Injuries 104
FEED ING YOUR BABY 145
Deciding How to Feed Your Baby 147
Feeding Relationship and Cues 149
Breastfeeding Your Baby 151
The First Week and Beyond 161
Expressed Breastmilk 166
Taking Care of Yourself While Breastfeeding 172
Challenges and What to Do 176
Supplementing 187
Weaning Off the Breast 188
When Breastfeeding is Not Advised 189
Feeding by Bottle 190
Feeding Equipment 191
Formula Feeding 193
Burping Your Baby 204
N E W B O R N S : B I R T H –2 M O N T H S 205
Your Newborn Baby’s Development 207
Newborns 208
Everyday Care 215
Health Checkups 249
Common Parent Concerns 251
Things to Watch for in Newborns 253

Healthy Parents, Healthy Children | The Early Years 1
YOUNG BABIES: 2– 6 MO NTHS 267
Your Young Baby’s Development 269
Young Babies 271
Feeding Your Young Baby 272
Everyday Care 273
Health Checkups 282
O L D E R B A B I E S : 6 – 12 M O N T H S 287
Your Older Baby’s Development 289
Older Babies 291
Feeding Your Older Baby 291
Everyday Care 305
Health Checkups 322
TODDLERS: 1 AND 2 YEAR OLDS 327
Your Toddler’s Development 329
Toddlers 333
Feeding Your Toddler 335
Everyday Care 338
Health Checkups 374
PRESCHOOLERS: 3 AND 4 YEAR OLDS 381
Your Preschooler’s Development 383
Preschoolers 385
Feeding Your Preschooler 386
Everyday Care 387
Health Checkups 411
YOUNG CHILDR E N: 5 YE AR O LDS 417
Your Young Child’s Development 419
Young Children 420
Feeding Your Young Child 421
Everyday Care 423
Health Checkups 440
THE JOURNEY CONTINUES 445
INDEX 447
2 The Early Years | Healthy Parents, Healthy Children

Important Contact Information
INTRODUCTION
No cost services available in many languages
Emergency Services Health Link

Ambulance, Fire and Police Health advice from a registered nurse.
911 811
Available 24/7 Available 24/7
Addiction AlbertaQuits Helpline Bullying Helpline

Services Helpline Tobacco cessation counsellors Advice or support
Help for problems with can help you make a plan on bullying.
gambling, alcohol, tobacco to quit, manage cravings 1-888-456-2323
and other drugs. and stay on track.
bullyfreealberta.ca
1-866-332-2322 1-866-710-7848 Available 24/7
Available 24/7 albertaquits.ca
8am–8pm
Child Abuse Family Violence Income Support

Hotline Info Line Contact Centre
Provides a 24 hour Hotline Provides information about Financial help for
to report child neglect family violence programs Albertans who do not have
or abuse. and services, as well as the resources to meet their
1-800-387-5437 advice and support. basic needs (e.g., food,
310-1818 clothing, shelter).
Available 24/7
Available 24/7 1-866-644-5135
Available 24/7
Medication & Mental Health Poison & Drug

Herbal Advice Line Helpline Information Service
Advice and information Offers help for mental health Confidential advice about
about medicine and concerns for Albertans. poisons, chemicals,
herbal products from 1-877-303-2642 medicine and herbal
pharmacists and nurses. products.
Available 24/7
1-800-332-1414 1-800-332-1414
Available 24/7 Available 24/7

Important Websites
ahs.ca ahs.ca/options covenanthealth.ca
Alberta Health Know Your Options Covenant Health
Services (AHS) Get the care you need Catholic service
Canada’s largest integrated when you need it. The provider within Alberta’s
health system, responsible best place to start is with healthcare system,
for promoting wellness Health Link at 811 or your with 17 facilities in
and providing health care family doctor. There are 12 communities.
across the province. other options depending
on what you need.
myhealth.alberta.ca alberta.ca immunizealberta.ca

Your resource for To find the Alberta For information on
non-emergency health Government services and Alberta’s routine
information and tools. information you need. immunization schedule
and the answers to
frequently asked
questions.
Find information from Healthy Parents, Healthy Children: Pregnancy and Birth and
Healthy Parents, Healthy Children: The Early Years online with many interactive
features. Browse on a smart phone, tablet or computer.
readyornotalberta.ca
Whether you’re ready for another baby or not, it’s healthy to have a plan.
This website has many interactive features in a user-friendly question and answer
format. Browse on a smart phone, tablet or computer.
teachingsexualhealth.ca
As a parent, it’s never too early to talk about sexual health, or to learn more
yourself. This website has helpful information, resources and communication
strategies for parents of children from birth to 18 years.

Your Book
INTRODUCTION
The first five years of a child’s life can be both exciting and challenging. Children change
quickly and learn more during the early years than at any other time in their lives. As a
parent, you can help your child grow, learn, explore and be healthy.
Healthy Parents, Healthy

Children is a made-in-Alberta
resource that will give you
suggestions for everyday
care and activities. It will take
you from the early stages of
looking after your new baby,
to the thrill of first steps and
words, all the way to their first
days of school.
There’s a lot to know and learn

about raising a child. We want
to give you all the support we
can to help you with this important work. Information about caring for a family is available
on the Internet, in books and from other people. Everybody has advice about raising
children. However, too much information can be confusing, especially when you hear
different things from different sources.
This book is based on today’s knowledge, evidence and best practices. We asked
expectant and new parents what they wanted to learn and we asked health experts from
across Alberta to help write this book. We encourage you to balance the information you
find here with your own knowledge, values, skills and instincts to help guide you through
parenting. This information will help you promote healthy child development and build
strong parent-child relationships in your family.
Families are as unique as the people in them. Your family might include a mother and
father, same-sex parents, adoptive parents, foster parents, grandparents, brothers, sisters,
aunts, uncles or close friends. This book is for you and your family!
In this book, we’ll use the term ‘child’ which will normally refer to all children. For
information specific to certain age ranges under 1 year, we may use the terms ‘newborn’,
‘young baby’ or ‘older baby’.

How to use this book
In this book, you’ll find:
■■ An Overview of Being a Parent gives you a general look at parenting and some of the
foundational information you need to know to begin your parenting journey whether
you’re parenting with a partner, on your own, or with other family members.
■■ Healthy Growing Families highlights important health, safety and development
information for families with babies and young children.
■■ Feeding Your Baby gives you information about breastfeeding or feeding your baby
commercial infant formula.
■■ Newborns: Birth–2 Months gives you information about caring for your newborn baby
and ideas to help your baby grow, learn, play and be healthy.
■■ Young Babies: 2–6 Months, Older Babies: 6–12 Months, Toddlers: 1 and 2 Year
Olds, Preschoolers: 3 and 4 Year Olds and Young Children: 5 Year Olds are separate
chapters that give you practical ideas to help your child grow, learn, play and be healthy
based on their age and stage of development during their early years.
Throughout this book, we will let you know when we have additional information
available on our website. When you see Links, Videos, Tools or Printables, simply visit
healthyparentshealthychildren.ca/resources to learn more.
“ As a new mom, I have a lot to learn. Whenever I was in a pinch, I found myself
looking to Google® to answer my questions. It often wasn’t super helpful and
I often found conflicting information. When I brought this information to my
doctor, she advised me to stop ‘Googling’ and start looking for answers in the
Healthy Parents, Healthy Children books. Ever since I started doing that, I have
”
found the books to be a great resource and a wonderful reference. It gives me
peace of mind to know the information is accurate and evidence-based.
~ Farzana, mom of a young baby

You’ll also find:
INTRODUCTION
words that you may not know are green and have definitions at the bottom of the page
“
■■
”
■■ Quotes from Alberta parents
■■ text boxes that highlight:
Things to know Helpful activities
If you’re a partner
■■ text boxes that describe when to ask for help:
! !!
Call Health Link at 811 or Call 911 or go to the
your health care provider Emergency Department
within 4–6 hours NOW
■■ QR codes you can scan with your smart phone to link directly to more information. In
some devices a QR reader is built into your phone’s camera.
1. Open a QR code reader on your smart phone.

2. Hold your device over a QR code so that it’s clearly visible within
your screen. You may need to cover other QR codes if there is more than
one on the page.
3. If necessary, press the button to scan.

Healthy Parents, Healthy Children:
Pregnancy and Birth book
We’ve also written another book for you called Healthy Parents, Healthy Children: Pregnancy
and Birth. It’s filled with many things that expectant parents want and need to know about
pregnancy and birth—from the 3 trimesters of pregnancy, to labour, birth, and the first
6 weeks after birth. You can get a copy from a community or public health centre.
Thank You!
We want to thank the many expectant and new parents who shared their ideas and
experiences with us. We also want to thank the health care providers and experts from
across Alberta for their dedication and valuable contributions to the content development
and review of the Healthy Parents, Healthy Children resources.
We looked to many experts (past and present) for their knowledge and suggestions for
healthy child development and parent and child relationships including: M. Ainsworth, A.
Bandura, H.G. Birch, J. Bowlby, S. Chess, E. Erikson, H. Harlow, A. Mazlow, J. Piaget, A. Thomas
and L. Vygotsky, as well as more recent experts in their respective fields: R. Barr, T. B.
Brazelton, S. Brown, J. I. Clarke, B. Coloroso, C. Dunst, J. Durrant, T. Gordon, S. Greenspan, S.
Landy, F. Mustard, J. MacDonald, G. Mahoney, NCAST, J. Nelsen, B. Perry, E. Satter, S. Shanker,
M. Sheedy Kurcinka, J. Shonkoff, P. Steinhauer and C. Trivette.
We also wish to acknowledge these organizations from which we adapted content:

■■ Health Canada
■■ Government of Alberta
■■ Society of Obstetricians and Gynaecologists of Canada
■■ Managing Mental Health Conditions During Pregnancy and Early Parenthood—A guide for
women and their families (Beyond Baby Blues, Australia)
■■ Palix Foundation

An Overview
of Parenting

9
An Overview of Parenting
Whether you’re a new parent, or have been a parent for a while, you’re likely to
have many questions. With your child growing and changing so quickly, in the
time between now and when your child starts school, you’ll probably have many
more questions. It may seem hard to believe, but there are only about 2,000 days
between your child’s birth and their first day of kindergarten. As a parent, you
have a huge impact on your child’s development during these first 2,000 days.
It’s your relationship with your child, and what you do every day, that really
makes a difference.
In this chapter, you’ll learn how children develop and grow and how this is
influenced by their developing brain. You’ll also learn what you can do to support
your child’s healthy growth and development.
In the age-specific chapters that follow, you’ll learn how to apply these parenting
concepts to help your child gradually learn the skills they’ll need for a lifetime.
10
Being a Parent
OV E R V I E W O F PA R E N T I N G
There are all kinds of parents: birth parents, adoptive parents, foster parents, step-parents,
same-sex parents and people who became parents through new relationships or for other
reasons. Some parents live together, while others do not. Some children have extended
family such as grandparents, aunts or uncles who may act as parents. Some adults have lots
of experience with children, while others have very little. Learning to be a parent takes time.
How parents learn and grow

Parenting is the art of raising a child. You already have the basics of what you need to be
a parent: your love for your child, instincts and common sense. All parents bring their own
skills, attitudes, experiences, beliefs, values and culture to their families. As time goes on,
you’ll continue to build these skills.
Every family has their own way of raising

a child. What works for one child or family
may not work for another. Research tells us
it’s important for you to:
■■ know how a child typically grows and
learns, so that you can be sensitive to,
and understanding of, your child’s needs
■■ keep your child safe and healthy
■■ provide warmth in your everyday
interactions with your child
“
■■ give your child structure through
day-to-day routines, experiences, Be okay asking for help. You
guidance and teaching don’t need to do it all if you
”
■■ value the differences in each child have a partner or someone
■■ be a positive role model to rely on.
■■ try your best and get the support you need ~ Ali, parent
warmth: the love and support parents give their children. Warmth helps children feel understood, loved, safe and
secure. It helps them want to learn and to try to do their best.
interaction: an action or communication that goes back and forth between two people
structure: the guidance and information parents give their children. Structure gives children guidelines with reasons
and gives them the information they need to learn, make good decisions and fix their mistakes.
routines: doing something in a regular and consistent way

Research is clear about what children
need from their caregivers to thrive. Loving, supportive care
Growing children need two essential The most powerful thing you can do for
things from their parents and caregivers: your child is to provide loving, supportive
warmth and structure throughout each care. Nothing gives your child more
confidence and security than knowing
stage of development.
that you love them, will take care of them,
and will keep them safe from harm.
Provide warmth Provide structure

■■ Make sure your child feels safe. ■■ Have predictable routines.
■■ Make sure your child feels loved, no matter ■■ Give guidelines for behaviour and clearly
what. explain reasons.
■■ Show your love with words and actions. ■■ Give information and support to help your
■■ Think about how your child feels and thinks child succeed.
at each stage of development. ■■ Be a positive role model.
■■ Keep your child's needs in mind. ■■ Encourage your child's own thoughts and
ideas.
■■ Problem-solve together.
“ My best advice about parenting is to stop and use your intuition and
common sense. You know what is best for your baby.
”
~ Ameera, parent of two children
Raising a child is one of the most important things you’ll ever do. When children are young,
it’s very common for parents to focus on what happens day-to-day. However, parenting
is not a sprint—it’s a long-distance run. Take a few minutes to think about your long-term
goals for you and your child.
development: changes in your child’s physical abilities, thinking, communicating, and emotional and social skills

Long-term goals
What kind of person do you hope your child will grow up to be? What qualities and
characteristics do you hope to see when your child is an adult?
What kind of relationship do you want to have with your child when they’re an adult?
What kind of a parent do you want to be—today and when your child is grown?
If you parent with someone else, ask about their goals. How will you work together?
When you have an idea of what you wish to achieve, list a few things you can do to help
get you there.
“ Parenting goals? I’m sure this changes as your kids get older. But right now,
”
with little kids, we want to protect them, give them confidence and ensure
they’re kind people.
~ Andres, dad of two toddlers

Learning to be a parent takes time
Knowing how to parent does not happen overnight—it’s an ongoing process.
The way you interact with your child every day makes a difference. Take care of your
relationships with others as well. Your child learns how to relate to people by watching
and playing with you.
You were not born knowing how to be a parent. You’ll learn as you go. This book will help
you understand the basics of parenting and help you build your child’s skills, as well as
your relationship at each stage of their
development. As you learn and grow with
your child, you’ll soon become the parent
you want to be.
Keep in mind that nobody is perfect. All

parents have times when they wish they
had done something differently with
their children. Look at these times not as
mistakes but as something you can learn
from. Ask yourself what you could do
differently the next time. This way, you’ll
learn and grow as a parent and be able to
help your child be everything they can be.
To watch videos about connecting with your baby, visit the Videos section at
healthyparentshealthychildren.ca/resources
Community of support
Your child’s relationship with you is at the centre of
their world. Relationships with grandparents, other
relatives, siblings, friends, caregivers and teachers are
also very important and affect your child’s growth
“ We have to let each other
parent the way that’s
best for our kids. We’re
all different, but for the
and development. Beyond these relationships
”
most part, we have the
with other people, there are also supports, services
and groups within your community. A sense of same goals.
belonging and connectedness to your community
~ Alex, parent of two
are important for your child’s development.
young children
growth: changes in your child’s body (e.g., height and weight)

“ I felt alone when my daughter
was born. None of my friends
had babies and my family
lived far away. I found a mom
and baby group at my local
community centre, and it was
everything to me in those first
few months. I’m still friends
”
with those families, even
three years later.
~ Jenna, mom of two children
Children need nurturing care and stable relationships. To provide this, you’ll need
support for your own health, happiness and well-being. Building a community of support
contributes to a family’s overall health and development.
There are many places in your community where you can find support
and services. Your local community association or Parent Link Centre
are good places to start. To learn more about programs, services and
resources that support families of young children, visit the Links section at
How Children Grow and Develop

By understanding children’s typical growth and development, you and other caregivers
can better support your child at each stage. While each child grows and develops at their
own pace, their overall development follows a pattern. As your child develops, you’ll see
changes in:
■■ their size and shape
■■ what they can do
■■ how they think, talk, learn and understand
■■ what they know about, how they recognize, and what they do to manage their feelings
■■ how they interact with and get along with others
nurturing care: when you provide care for your child that supports and encourages their growth and development

Child development is often
described in terms of stages, tasks Children develop at their own pace
and milestones. Development All children will develop through similar stages,
happens within a certain period tasks and milestones, but at their own rate and
of time or age range (stage) when time. This development can also be impacted by
your child’s social and cultural environment.
your child is learning a new set of
skills (tasks) or getting better at the
ones they already have. Each stage of development builds on the stages that came before
it, and sets the foundation for the stages to come.
Every stage of development also has specific markers (milestones) that tell you how
children will usually develop during that period of time and whether they’re developing as
expected. Your child will typically reach milestones at any time in that stage.
You’ll find developmental charts in each of the age-specific chapters in this book. These
charts give you information on stages, tasks and milestones to expect for each age.
Children’s development occurs in four main areas (domains):

■■ Physical: how the body grows and functions
■■ Cognitive: thinking, learning and language
■■ Emotional: feelings and emotions
■■ Social: getting along with others
All of the areas of development are linked and

development in one area affects all the others.
Your child cannot learn and develop on their

own. Their relationships with you and others
are what makes learning and development
happen. For example, your child cannot learn
to read by just being given a book and left
on their own. They need caring adults to help
them read by being with them and providing
warmth and structure (see pages 11–12). So,
when you’re reading with your child, know that
you’re helping them learn about words and so
much more.
language: understanding and using words by listening, talking, singing, reading and writing

You’re also helping your child develop:
■■ enjoyment for reading
■■ coordination of their vision and movement of small muscles (e.g., in their hands and
fingers) when they look at and point to pictures and turn the pages
■■ language skills, creativity and memory when you retell and act out the story together
■■ a strong emotional attachment when you hold them close
■■ enjoyment in being with others when you spend time together
Development may not happen at a steady pace

Your child may sometimes become more emotional or quit doing the things they used to
do for a short time when they’re learning new things. For example, a toddler may cry more
often when they’re learning to walk, while a 4 year old may have trouble sleeping when
they first start preschool.
Some parents feel frustrated at these

times. It helps to remember that this Your child’s development
is a normal part of development, and Find out more about your child’s
it’s likely to get better soon. Be patient development by filling out an Ages and
and try to keep to a predictable Stages Questionnaire (ASQ):
routine during developmental ■■ Get a copy of the ASQ at your local Parent
spurts. This will help your child from Link Centre.
being overwhelmed as they adapt ■■ After answering the questions in the ASQ,
to changes. talk to someone at the Parent Link Centre
about the results.
You know your child best. If you
■■ Your local Parent Link Centre also has
have questions about your child’s
supports and resources for the early years.
development or if you have any
concerns, call Health Link at 811 or talk
with your health care provider.
“ I have a fantastic doctor who went over some development milestones.
”
You need to go with your gut and have some support to know what signs
to watch for.
~ Elena, parent of one child
attachment: a two-way emotional connection between you and your baby

Children with differing abilities
Not all children will follow a typical pattern of development. Some children are born with
medical conditions that may affect their development. Other children’s development may
be affected by an illness or injury before or after birth.
Each child is unique and will develop at

their own rate. Children with differing
abilities may not reach all the milestones
as outlined in the developmental charts in
this book. They’ll move forward according
to their own abilities and timelines, and
each will have their own strengths and
challenges. Each sign of achievement is a
reason for celebration. You may find the
strategies listed in this book helpful and
some may need to be adapted for your
situation. All children need to be provided
with warmth and structure to support their
growth and development.
All parents need a system of supports,

which may include extended family, your health care team and other care providers.
Parents of children with differing abilities may require additional supports such as medical
and educational specialists. Your family, community and others who can relate to your
experience can also provide support and encouragement.
You may be worried about asking for help, but there are many supports and resources
available to help you. The sooner you connect, the sooner you and your child will benefit.
Your child may also be eligible for early intervention supports and preschool programs.
Talk with your health care provider for more information.
To learn about Government of Alberta programs and services for families who have
children with disabilities, call toll-free at 1-877-644-9992 or visit the Links section at

Factors that affect child development
Three main factors affect your child’s
development:
■■ brain development
■■ child’s temperament
■■ care they receive from you and others
The developing brain

Recent brain research has helped us
better understand what kind of care
growing children need. When you
know how the brain works, it’s easier to
understand what you can do to support your child.
Just like a house needs a strong foundation to support the walls and the roof, your child’s
brain needs a good base to support all future development. The most important time for
your child’s brain development is during pregnancy and the early years. This is when the
foundation for future learning, behaviour and health is set.
Things to know about your child’s developing brain:

■■ Their brain starts to form very early in your pregnancy—babies are learning even before
they’re born.
■■ Your child’s brain development is affected by both nature and nurture.
■■ At birth, your baby’s brain is completely formed, but it’s only about ¼ the size of an
adult’s brain.
■■ Even though your newborn’s brain contains billions of neurons, only a small number of
them are connected.
■■ These neurons must be connected (or ‘wired’) together for the many parts of your
child’s brain to communicate with each other, and for their brain to be able to
communicate with other parts of the nervous system throughout their body.
temperament: a person’s nature; it’s present from birth and shows up in the way they behave or react to situations
or people
nature: what your child is born with; their inherited traits and abilities
nurture: what your child experiences, the care they receive, and the relationships they have with people
neurons: nerve cells in the brain and nervous system
nervous system: a system of nerves and cells that carry messages between the brain, spinal cord, and different parts of
the body

■■ Your child’s everyday experiences and relationships
are what creates these brain connections. Messages
are sent to their brain through all of your child’s
senses—sight, sound, taste, smell, touch, balance and
movement. The more often an experience happens,
the stronger the brain connections become.
■■ Simple connections form first. These develop into
pathways that are more complex. The connections
make it possible for your child to grow, think and learn.
© Palix Foundation: Alberta
■■ A natural process removes brain connections that are Family Wellness Initiative,
www.albertafamilywellness.org/
not used often, so your child’s brain can work faster resources/video/how-brains-are-built-
and in a more organized way. This process is called core-story-of-brain-development
synaptic pruning.
■■ The wiring of your child’s brain follows a predictable order and the process takes about
25–30 years. Their brain keeps adapting for the rest of their life.
The early years are critically important because they set the foundation for all the brain
development that follows. A solid foundation is the best start to life.
To learn more about brain development, visit the Videos section at

Serve-and-return
Relationships form through everyday interactions. For healthy brain development, your
child needs positive relationships with you, your partner, as well as other important people
in their lives.
Brain cell connections become healthier

and stronger when you and your child
have positive serve-and-return interactions.
Serve-and-return interactions are like a
game of tennis or volleyball, where the
goal is to ‘keep the ball in the air’.
When your baby is little, they ‘serve the

ball’ when they coo or lock eyes with you.
You ‘return the serve’ when you smile back,
talk gently and return their gaze. This game
continues until your baby loses interest and
turns away for a rest, then starts all over
again when they are ready.

Your child’s serve-and-return interactions with you and other people are important
throughout your child’s life. These type of interactions build and strengthen the brain cell
connections your child needs to learn new skills in all areas of development. When you
take time to:
■■ cuddle and care for them, they learn
to trust
■■ watch, listen and respond to your child,
they learn that they’re important
■■ read, sing and talk to them, they learn
language skills
■■ play with them, they learn social skills
and how to relate to others
Serve-and-return interactions will

naturally become more complex as
your child gets older. In each of the
age-specific chapters in this book, you’ll find a chart with examples of serve-and-return
interactions you might see during your child’s different developmental stages. Once you
know what to look for, you’ll add many more examples of your own.
By spending time with your child, and learning what their cues and actions
mean at every age, you’ll continue to find ways to build a healthy relationship
with them. To learn more, visit the Videos and Printables sections at
Executive function
Imagine an air traffic control centre at an airport that keeps track of all of the incoming and
outgoing planes so that everything runs smoothly. Executive function works just like an
air traffic control centre. Your child needs executive function skills to help them keep track
of everything going on around them, pay attention to things that are important, and keep
them from feeling overwhelmed. As a result, these skills help your child to:
■■ focus their thinking
■■ make sense of and use information
■■ change more easily from one activity to another
cues: movements, sounds and facial expressions your baby uses to communicate their needs and emotions
executive function: the mental processes we need to be able to successfully plan, focus our attention, remember
instructions and juggle multiple tasks

When your child has strong executive function skills by the end of the early years, they’re
typically able to:
■■ take turns
■■ share
■■ calm themselves when they’re upset, so they can think about what to do next
■■ focus their attention and ignore distractions, most of the time
Your child needs help to develop executive function. These skills take years to develop, but
the foundation is set in the early years. As executive function helps your child to think and
learn, having a strong foundation will help them be more successful with all of the learning
that follows.
Healthy executive function skills also depend on your child’s ability to self-regulate. When
your child can stay calm, focused and alert, they’re much more likely to be able to learn.
These skills also develop over time. You can help your child develop executive function
skills by:
■■ making sure your child feels safe and
loved
■■ watching for and responding to their
cues
■■ creating daily routines
■■ playing games where you take turns
■■ helping them learn about their feelings
and how to manage them
■■ helping them learn ways to cope with
stress
■■ making sure they have lots of time to play and be active every day
■■ providing them lots of opportunities to connect with other children and adults to
develop social skills
■■ modelling positive social behaviour, such as smiling, saying hello and helping others
To learn more about executive function, visit the Links and Videos sections at
self-regulate: the ability to monitor, manage and adjust one’s emotions and behaviours in ways that are appropriate for
the situation

Stress affects the brain
Some stress is part of everyone’s healthy development—it’s needed to help your child
learn how to adapt and helps to prepare them for future challenges. A typical example of a
stressful situation for your child may be their toy being taken away by a playmate or when
they receive an immunization. You support your child during times of stress when you:
■■ let them know you love them and are
there to support them, no matter what
■■ help them learn ways to cope
■■ limit your child’s continued exposure to
stress, when possible
Toxic stress is a different kind of stress. It’s

the result of ongoing hardships—things like
abuse, neglect or addiction. Toxic stress can
negatively affect your child’s brain, memory
and life-long health, especially when it’s
constant and intense, and your child has no
support to deal with it.
You and your child need to be supported

during periods of stress and protected from Managing your stress
toxic stress, particularly during pregnancy Taking care of yourself during stresses
and throughout the early years. If you’re in your life helps you and your family.
living with toxic stress, there are people For more information, see page 27.
who can help.
To learn more about how stress affects the brain, visit the Links section at
Call Health Link at 811 or your health care provider if:
! ■■
■■
your family is under stress and it’s not going away
you have limited support to deal with your stress
immunization: t he process by which a person is given a vaccine that will tell their body to develop antibodies to
protect against a disease

“
Temperament
Your child’s development is influenced I wish I’d known how much my
by their temperament. Everyone has a
children’s personalities would
temperament—it’s part of our personality.
influence my parenting. With my
Temperament affects how your child thinks,
behaves and responds to the world around first child, I thought it was so easy
them. It’s what makes your child unique. and that I was an excellent parent.
None of my parenting ‘tricks’
Your child’s temperament starts to show seemed to work with my second
right from birth. Some babies are quiet and
child. I had to start over to try and
don’t cry very often. Others are more vocal
figure out how to work with my
and cry a lot. Some toddlers are always on
”
the go. Others seem happy to stay and daughter’s personality. Each child
play in one place. Some preschoolers greet is so different.
anything new with smiles and excitement.
~ Simran, mom of two children
Others respond with tears and anxiety.
Your child will approach the world in different ways depending on their temperament.
There is no good or bad temperament in children—it’s just who they are. You cannot
change your child’s temperament, but you can help them learn to work with it. For
example, a child who is very persistent (one of the temperament traits) will continue to do
a task, no matter what. This might create a challenge for you when it’s time to go. However,
you may find that same child may have much more patience than other children to stick
with a task until it’s done.
Knowing about your child’s

temperament can help you figure out
strategies to work with them. In the
example above, it would be helpful to let
your child know that it will soon be time
to go, before you actually have to leave.

Your child’s way of approaching the world may be similar
or different from your own. Try to understand their point of
view and learn to work with your child’s temperament rather
than trying to change it. Find different ways to balance your
child’s needs with your needs. Here are a few ideas:
■■ If you like being with people but your child has a hard time
adapting to new situations, give them time to warm up.
Don’t force them to go to someone before they’re ready.
Offer gentle encouragement.
■■ If your preschooler is very regular in their daily routines, such as eating, sleeping and
going to the bathroom, then try to work around their schedule, as much as possible.
Realize that it may take your child time to adjust to any changes in their routine.
■■ If your toddler is very sensitive to textures and touch, even things like a scratchy label on
their shirt will make it very difficult for them to concentrate. You can help by cutting the
labels off of their shirts and waistbands.
Your child’s basic temperament will not change. Value your child for who they are.
Over time, you can help them to learn things they can do to adapt to the world around
them. When you understand and work with their temperament, you’ll create a stronger
relationship with your child.
The care you provide

You influence your child’s development through the care you provide by:
■■ building a strong attachment with your child
■■ role modelling and supporting self-regulation
■■ parenting with positive discipline
Attachment
Your child needs to know they can count
on you. Even before birth, you and your
child started building attachment. When
your child has a secure attachment with
you, they learn to trust. This makes them
feel safe and loved. Trusting you helps
them build trust and form attachment with
others as they grow.

Attachment between you and your child becomes stronger when you:
“
■■ Spend time together.
■■ Respond to their needs with love, Show lots of love, be
”
support and nurturing care. patient…build their
■■ Comfort them when they need you, especially when trust early.
they’re sick, hurt or upset.
~ Nikki, mom of a toddler
■■ Let them know they’re loved, that you’re there for
them and that they’re important to you.
A secure attachment in the early years is much more likely to continue to grow and get
stronger throughout your life together. It will also help your child form attachments with
other important people in their lives in the future.
Role modelling and supporting self-regulation
The stress response

Being a parent can feel stressful
at times. How you handle that
stress matters. When your body
thinks you’re in a dangerous
situation, it prepares you to
react. This is called the stress
response and it starts deep in
your brain. When you feel a
threat, your brain signals your
body to send blood and energy
to your muscles, heart and
lungs so that you can respond
faster. At the same time, it shuts
down the connection between the emotional and the thinking parts of your brain so that
you can make quick decisions. All of these things make it possible for you to fight off or run
away from the threat.
The stress response is helpful in emergencies but it’s not very helpful when it comes to
responding to your child. During stressful times, if you respond automatically, you can
injure your relationship with your child.

When you’re stressed, your reaction can be scary for you and your child. Yelling, hitting or
shaming children will set off their stress response. They may then yell even louder, further
triggering your stress response. The whole situation can quickly spiral out of control and
you may end up saying or doing things you later regret. You can, however, learn how to
respond in a calm and thoughtful way. The first step is knowing when you’re stressed.
It’s helpful to know how your body feels when you’re stressed and when you’re calm. This
chart will help you figure out if your stress response has been triggered.
What’s
happening When you’re stressed When you’re calm
to your
■■ heart is pounding ■■ heart is beating normally
Body ■■ muscles are tense ■■ muscles are relaxed
■■ fists and/or jaw are clenched ■■ hands and jaw are relaxed
■■ breaths are shallow, only going into ■■ breaths are deep, going to the
Breathing the upper chest bottom of lungs or abdomen
■■ breathing is faster than normal ■■ breathing is slow to normal
■■ loud, sharp, high-pitched or yelling ■■ tone is normal

Voice ■■ talking fast ■■ speaking calmly
■■ using harsh words ■■ using kind words
Self-regulation
“
Learning how to manage your stress response
is called self-regulation, and it’s one of the most Keep yourself (as a
important things you can do as a parent. By parent) at the top of your
paying attention to your body, you’ll learn to pyramid—if you need food,
sense when your stress is rising.
rest or relaxation, then find
You can then take action to help get to a calmer a way to get it in your day-
state, so the emotional and thinking parts of your to-day because it will make
”
brain can re-connect. Once you have calmed you a better and more
your body and your mind, you’ll be better able to relaxed parent.
think about what your child needs and what you
can do to help them get calm. Only then can you ~ Mike, dad of two toddlers
solve the problem—whatever it is, together.

Getting to calm
When you’re stressed, take a few moments to calm your body and mind before you
respond to your child.
■■ Stop what you’re doing. ■■ Repeat the breathing and/or stretching
■■ Make sure your child is in a safe place, cycle two or three times until you feel
and find yourself a calm, quiet spot. your body start to calm.
■■ Imagine your mind has a gearshift like a

■■ Find what works for you. Some people
car. Picture yourself shifting your mind find that breathing or stretching work
from ‘drive’ into ‘neutral’. on their own, while others find it works
better to do them together.
■■ Take a slow, deep breath. Breathe in
through your nose and out through
■■ Remind yourself that your child needs
your mouth: you to help them get calm. They’re not
being ‘bad’—they’re upset and need
Fill your lungs to the very bottom. your help. By watching you, they’re
Feel your breathing go right into your learning what to do so that they’ll be
abdomen. able to calm themselves on their own
over time.
As you breathe in, imagine you’re
smelling a beautiful rose. As you ■■ When you have some quiet time, take
breathe out, imagine you’re gently a few minutes to think of other things
blowing on a candle flame, without you can do to take care of yourself.
actually blowing it out. You’ll find lots of ideas in the Taking
Care of Yourself section of each chapter
■■ Bend down with your hands towards
in this book.
the floor, then reach up to the sky,
stretching your muscles.
Children learn by watching you

Your child learns how to manage their energy levels and emotions by watching you and
by what you do to help them. This is how they eventually learn to self-regulate themselves,
which takes many years. You can help your child learn this process by self-regulating to get
yourself calm, then helping your child get calm.
Babies cry to tell you that they need something, and it’s not always easy to figure out
what that is. When you’re able to self-regulate and get calm, you’ll be better able to help
your baby get calm. You’ll find ideas on what you can do to soothe them in the Newborns:
Birth–2 Months, Young Babies: 2–6 Months and Older Babies: 6–12 Months chapters ahead.

Toddlers are often trying to learn
about how things work, and they
don’t always have the words to
tell you what they need. They
may have tantrums because
they’re easily overwhelmed.
Unfortunately, tantrums can be
a real stress trigger for parents.
When you can self-regulate, you’ll
be in a better place to help your
child. The Toddler: 1 and 2 Year Olds
chapter will help you learn how to
work with your child to help them
manage new emotions. Over
time, as they’re able to tell you
what they need, their tantrums
will start to decrease.
Preschoolers are learning to get along with others. They need your help to learn social
skills like sharing and taking turns. When you’re able to self-regulate, you’ll be able to
model and teach these important life skills. The Preschoolers: 3 and 4 Year Olds and Young
Children: 5 Year Olds chapters are full of ideas to help your child learn to self-regulate. This
gets them ready to be able to focus, remember things, learn and get along with others in
the years ahead.
Throughout the early years, your child will learn how to self-regulate with your nurturing
care and support. Help them by making sure they feel safe and loved, and support them to
meet their needs. As they grow, continue to provide warm, nurturing care, and give them
the information, guidance and support they need so they can eventually start to meet
their needs on their own.
Parenting with positive discipline

Positive discipline is an approach to parenting based on the true meaning of the word
discipline—that is, ‘to teach’. Teaching your child in a positive way means always ensuring
your child feels safe and loved, and providing the information, guidance and support that
matches their stage of development. This helps your child learn about the way things work
and how to get along in their world.

You can help your child get off to the best start
when you:
■■ Always keep your long-term goals in mind
(see page 13). Think about what you’re
teaching your child. How will this help them
today? What skills are you building for their
future? If you want your older child to be
respectful, treat them with respect when
they’re young. If you want your adult child
to come to you for advice, listen and talk to
them when they’re little.
■■ Provide warmth and structure (see pages
11–12). This provides the best environment
for learning.
■■ Understand how your child thinks and feels at every developmental stage. When you
think about the world from your child’s point of view and consider their thoughts and
feelings, you’re more likely to respond to situations in a way that teaches.
■■ Respond to problems with teaching instead of punishing. Your child is going to make
mistakes. These are powerful learning opportunities for them. When there’s a problem,
help your child learn to solve it in a positive way so they can learn what to do the
next time.
Babies cannot solve problems so they’re completely dependent on you to solve
their problems for them. You’ll find lots of information in this book about sleeping,
crying, feeding and separation anxiety in the Newborns: Birth–2 Months, Young Babies:
2–6 Months and Older Babies: 6–12 Months chapters ahead.
Toddlers are starting to learn about words and feelings. They can solve little problems
without your help, but still need your help with the big ones. Learn about dealing
with tantrums, toilet teaching and cooperation in the Toddlers: 1 and 2 Year Olds
chapter.
Preschoolers are ready to begin solving their own problems with your help. Learn how
to help them get calm and solve problems in the Preschoolers: 3 and 4 Year Olds chapter.
As your child starts school, they’ll enter a whole new world. Making friends and
getting along with others are skills that you can help them build. Learn how you can
help in the Young Children: 5 Year Olds chapter.
It takes time and lots of practice before a child can solve problems on their own. When
children learn how to solve problems when they’re young, they’ll have the skills that will
last them a lifetime.

What about punishment?
Physical punishment and emotional punishment do not teach children how to behave.
Punishment hurts your child and leads them to connect you with pain and distress, not
love. Many years of research on physical punishment has shown that it has no positive
outcomes for children. In fact, children who are physically or emotionally punished are
more likely to:
■■ feel fearful, angry and powerless
Keep the positive
■■ have trouble deciding what’s right from things from how you
wrong on their own were parented
■■ have unhealthy relationships with their You can choose to keep the positive
parents and other caregivers things that you learned from being
parented as a child—the things
■■ be aggressive, feel anxious or have other
that helped you learn and grow.
mental health issues, both as children and You can also choose to let go of
as adults things that you now realize might
not have been very helpful. For
As a parent, you’re your child’s first and most example, things like spanking are
important teacher. Help them learn the right no longer recommended because
things to do and encourage them when they they put children at increased risk
are trying. of poor mental health outcomes,
just like all other types of physical
Parenting programs can help you learn punishment. Generations ago,
approaches for building healthy relationships parents did not know this, so
with your child. Parenting programs are helpful spanking was quite common.
for everyone. For more information, talk with Choose new ways that are better
for your children’s health today and
your health care provider or visit your nearest
in the future.
Parent Link Centre.
“ If you join a parenting class, get contact information for the other participants.
Being able to talk to other parents going through similar experiences can be
”
very helpful. Other new parents can also make for great walking partners
during parental leave.
~ Kalina, mom of two children
physical punishment: using force (e.g., spanking, hitting, pinching, pulling hair, pinching ears) to cause pain in order to
correct behaviour
emotional punishment: using words or actions (e.g., yelling, criticizing, shaming, isolating the person) to cause
emotional pain in order to correct behaviour

Supporting healthy development
You support your child’s development by helping them meet their needs. In this way,
your child will learn healthy habits so that they’ll be able to meet their own needs when
they’re older.
It’s the things you do every day with your child that make a difference:
■■ Offer a variety of healthy foods.
■■ Encourage play every day.
■■ Help them get enough sleep.
■■ Have lots of serve-and-return
interactions. To find examples of
serve-and-return activities for each
stage of your child’s development,
visit the Printables section at
■■ Hold them and offer comfort.
■■ Be interested in what they’re
interested in at that moment.
■■ Talk, play, read, sing and have fun
together.
■■ Provide warmth and structure.
■■ Take care of yourself so you have the energy to help your child.
When your child has their needs met, they’re more likely to:
■■ feel good about themselves
■■ respect and care for themselves and others
■■ become responsible, confident and caring adults
“ You’re everything for these little people right now. So, if it means that all you
got done today is singing, dancing and baking and you’re still in your pyjamas,
”
that’s okay. It’s about your relationship and how connected you are with
each other.
~ Cate, mom of three children

Your Family Through the Early Years
As a new parent, it’s common to have a wide range of feelings—from joy, excitement and
amazement to fear, sadness and frustration. You may have less sleep, freedom and time
for yourself. Your life has certainly changed! The first few weeks and months are a big
adjustment. The time it takes to adjust is different for every family.
It may help to talk about your feelings with someone you trust. Share your joys and
challenges, and focus on solutions that will work for your family.
Helping an older child adjust

If your new baby is not your first, there
will be even more to adjust to with other
children at home. If you have a toddler,
they may just be learning to share.
Suddenly, with the arrival of a newborn,
they must share the most important
thing to them—your love and attention.
You can help your child adjust to your

new baby by providing warmth and
structure.

■■ Tell and show your older child how much you ■■ Give your older child information about how:
love them. new babies need lots of care
■■ Spend some time alone every day with your
they can help you by doing things like
older child, even if it’s just for a few minutes.
getting you a diaper or singing a song to
■■ Tell your visitors to interact with your older the baby
child first and let your child know how helpful
to be gentle with the new baby
they have been to you and your new baby.
■■ Tell your older child stories about their birth babies cannot do some things until they’re
such as how you felt and what they were like older such as running, playing, climbing
when they first came home. Help them see and reading books
how big they have grown. ■■ Keep your routines such as bedtime and
■■ Read books about babies, big sisters and big mealtime as normal as possible.
brothers with your older child. ■■ You may want to delay toilet teaching with
your older child until you have settled in
with your new baby and things are more
predictable.

When you bring your new baby home, your other child may also have questions about
where the baby came from. Answer your child’s questions honestly and with simple words.
A 3-year-old may be satisfied with, “Babies grow in a special place inside a mom’s body called
a uterus.” A 6-year-old may have more questions about how the baby grows or how it will
come out. You could say “A baby grows in the uterus and is born through the vagina.”
For ideas about talking to your children about where babies come from and about other
sexual and reproductive health topics, visit teachingsexualhealth.ca
Child care
If your family needs child care, there are different types you can choose from. A family day
home is where child care is provided in the private home of a caregiver. Day homes may or
may not be approved by a family day home agency. Approved day homes are monitored
and must meet government standards for things such as:
■■ the number of children in care
■■ space needed
■■ health, safety and nutrition
■■ toys and equipment
Licensed child care programs

offer care in centres for more than
7 children. They include day care,
group child care, out-of-school
care and preschool programs.
Licensed child care programs may
or may not offer care for infants.
These programs are monitored to
make sure they meet government
standards for things such as staff
training, number of children and
staff, activities, safety and health.
If you have any concerns about the conditions of your child’s approved
or licensed child care, call Health Link at 811 or visit the Links section at

What to look for in child care
Choosing child care is an important decision. You’ll want to find a safe and healthy
environment that supports all areas of your child’s development. You’ll feel more
comfortable with your child care decision if you know that your child is safe and happy
with warm and caring adults when you’re not together.
Look for child care that has the best interest of your child as its goal and:
■■ is clean and safe ■■ has a variety of play spaces for indoor and
■■ has enough adults for the number of outdoor activities, as well as for active and
children in care in the centre or home quiet play time
■■ has caregivers who are qualified with

■■ follows a flexible yet predictable routine
training including first aid, CPR and child ■■ respects different languages and cultures
care certification ■■ is free from tobacco and tobacco-like
■■ offers healthy meals and snacks products
■■ has books, toys and activities for
different ages
It’s a good idea to start looking for child care well before you need it. There may be a
waitlist. Meet with your child care provider ahead of time and talk about any specific needs
and considerations. Feeling comfortable with your child’s caregivers makes it easier to work
together as a team.
“
Make sure your child’s immunizations I must have visited five different day
are up to date. Children may have
cares before I found one that worked
more illnesses during their first
for my child and our family. It was
year in child care. Talk to your child
”
care provider about their policy really stressful but we finally found
for children staying home when one that was a great fit.
they’re sick. For more information on
~ Oksana, mom of one child
immunizations, see page 82.
tobacco: any product made from whole or parts of tobacco leaves. This can include cigarettes, cigarillos, cigars, pipe
tobacco, snuff, chewing and dipping tobacco, and shisha or hookah. It does not include any regulated nicotine
replacement therapy (NRT) products.
tobacco-like products: any product that mimics a tobacco product. This includes, but is not limited to, the following
products that are vaped or smoked: cannabis (marijuana, hashish, hash oil), hookah, cigarillos, electronic
cigarettes, vaping pens, tanks and mods.

Choosing
child care
When choosing
child care, trust your
feelings. If it doesn’t
feel right, it probably
isn’t right for you and
your child.
Supports are available

to help you choose
the child care that’s
right for you and your
child. There’s an online
checklist and guide with questions to ask when you’re interviewing child care providers.
To learn more and for help finding child care options, contact the Government of
Alberta, Alberta Human Services toll-free at 1-877-644-9992 or visit the Links section at
Helping your child adjust to child care

Going to child care can be a big adjustment for everyone in the family, but especially for
your child. You can help your child adjust to child care by providing warmth and structure.

■■ Spend time at the child care centre or day ■■ Before you leave, say “Goodbye” and tell your
home with your child as they explore their child when you’ll return. Leaving without
new surroundings. telling them can damage the trust you’ve
■■ Give them time to feel secure in their built with them.
new routine. ■■ Acknowledge their feelings. You may want
■■ Act confident—even if you do not feel it. to say, “I know you’ll miss me. I’ll miss you too.
This helps your child know that they’ll be safe I’ll be back.”
and okay. ■■ When you return to pick them up, tell them
you came back just as you said you would.
This will help build their trust and remind
them that you do what you say.
■■ Have them take something such as a favourite
blanket, stuffed animal or family picture with
them to their child care.

Babysitters
There may be times when you
need someone else to care for
your child for short periods of
time. Choose someone you can
trust and someone who:
■■ is old enough and knows how
to look after a child
■■ has first aid or babysitting
training
■■ can handle an emergency
■■ does not smoke or vape or
will not do it around your child
■■ will not use alcohol or other drugs before or while caring for your child
■■ will not bring over friends unless you’re okay with them to do so
Spend time with new babysitters before they care for your child. Write down your phone
number, full name and address, as well as any other emergency contact information. Leave
this information in a place that is easy to find and show them where it’s kept.
Always supervise
Never leave your baby
unsupervised with other
young children—whether
they are siblings or a
friend’s children.

Taking Care of Yourself
Life is busier with a child in
the family. It’s really important,
however, to take time for yourself
and your relationships. Whether
you parent with someone else
or do it on your own, it can
be easy to forget about your
adult relationships. Having
strong relationships and good
communication with other adults
is important for your mental
health. It also helps create a healthy and supportive environment for your children and
shows them what a healthy relationship looks like.
“ ”
Take time out for each other. A healthy relationship with your partner is very
important to keep your family healthy.
~ Taylor, parent of two children
Your relationships
Having a healthy relationship with your partner and other people in your life is important.
Healthy relationships can offer support, comfort and improve overall health and
well-being. By taking care of your relationships, you’ll help develop a safe and secure place
for your whole family.
All healthy relationships have boundaries. In a healthy relationship, each partner respects:
■■ physical boundaries, such as touching
and personal space Setting examples
■■ emotional boundaries, such as being Your children will see how you are with
able to keep personal information private others and learn by watching you. This
is how they’ll learn about how to have
■■ sexual boundaries, such as being able to healthy relationships with others.
express their needs and limits
Respecting each other’s boundaries is an important part of a healthy relationship. The

next table gives examples of what a healthy relationship looks and feels like. Trust your

instincts. If something doesn’t
feel right in your relationship,
and you feel safe to do so,
think about making changes.
All adults have times when
they disagree, even in healthy
relationships. However, abuse
is not acceptable. There are
many supports and resources
available to help you and your
children if you’re in an abusive
situation (see page 42).
Is my relationship healthy?
Healthy Unhealthy Abusive
■■ You feel safe, comfortable ■■ One person feels ■■ One person feels afraid
Sharing feelings
and strong enough to uncomfortable telling the to tell the other how
tell each other how you other how they really feel. they really feel. They’re
really feel. scared of being rejected,
abandoned, getting
‘put down’ or being
threatened.
You listen to and respect One person ignores One person treats the
Communicating
■■ ■■ ■■
each other’s point of the other and does not other with disrespect.
view. respect their opinions. ■■ One person ignores the
■■ You make decisions other’s ideas and feelings
together. or makes fun of them.
■■ You have equal say in the ■■ Disagreements often turn ■■ One person is afraid to
relationship. into fights that include disagree because they
■■ You show respect to each yelling, criticism or harsh don’t want the other to
other even when you words. get angry or violent.
Disagreements
have disagreements. ■■ The disagreement is used

■■ You work things out as an excuse for abuse.
together, so you both get ■■ One person controls the
what you need. money and prevents the
other from spending
money they’ve earned,
accessing bank accounts,
or being part of financial
decisions.
(continued on following page)

(continued from previous page)
Is my relationship healthy?
Healthy Unhealthy Abusive
■■ You’re honest about how ■■ One person is ■■ One person ignores the
you feel about being embarrassed to say how other’s needs and wants.
Intimacy and sex
physical and having sex. they feel or what they ■■ One person may be
■■ Neither of you feels need. pushed into doing things
pressured to do anything ■■ One person may go that makes them feel
you don’t want to do. along with things uncomfortable, afraid or
that they may not be ashamed.
comfortable with.
■■ You can spend time ■■ One person thinks there ■■ One person doesn’t
alone and think of this may be something let the other spend
as a healthy part of the wrong if the other wants time doing things on
relationship. to do things without their own because it’s
Time alone
them. seen as a threat to the

■■ One person tries to keep relationship.
the other to themselves. ■■ One person may monitor
the other person’s
activities and isolate
them from family and
friends.
■■ You value your ■■ There have been a few ■■ There’s a pattern of

differences and work to times when harsh words increasing or ongoing
be non-judgmental. are used, and one person verbal or psychological
Verbal
■■ You both try hard not to felt at risk of harm. abuse. This may include
talk harshly to or about ■■ There’s no clear pattern damaging belongings,
each other. of abuse. name-calling, and threats
to hurt or kill you, a family
member or pet.
■■ There’s no physical ■■ There have been a few ■■ There’s an increasing

violence or threat times when one person or ongoing pattern
of violence in the felt at risk of harm. of pushing, slapping,
relationship. ■■ There’s no clear pattern shaking, choking,
■■ Neither person feels of abuse or violence. punching or forced
Violence
at risk of being hurt or sexual contact.

harmed.
■■ Both partners behave
in ways that keep the
other safe (e.g., safer
sex practices, being
financially responsible).

What is abuse?
Abuse is any behaviour used to control another person’s actions. Abuse can happen to
anyone, whether you’ve experienced abuse in the past or not. If you grew up with abuse,
this behaviour might seem normal to you. However, abuse puts the person being abused
and their children’s health at risk.
If the violence or threat of violence has happened once, it’s very likely to happen again. It
often gets worse over time, happens more and more often, and is more intense. It often
develops into a cycle of abuse. Not all abuse fits this cycle. Often, as time goes on, the
‘honeymoon phase’ disappears. If the image on this page seems familiar to you, there is
help available.
Cycle of Abuse
Tension building
■ minor incidents of physical/emotional abuse
■ victim feels growing tension
■ victim tries to control situation to avoid violence
■ ‘walking on egg shells’ victim cannot control abuser
■ longest phase
Minimizing the abuse or

acting as if it did not happen.
Denial keeps the cycle going.
Denial
Honeymoon Phase Perpetrators, victims, and Explosion

■ abuser sorry and apologetic
society at large minimize
The actual abuse is:
■ abuser makes promises
abuse in relationships. ■ physical
■ ‘hearts and flowers’ ■ sexual
■ idealized and romantic ■ emotional
■ this phase often disappears ■ verbal
with time ■ financial
It’s okay for adults to disagree, but nobody deserves to be abused or to see abuse. Many
people who are abused stay in a relationship to keep their family and home together.
However, children who see abuse are harmed by it. No one has the right to abuse another
person or child.

If you’re experiencing abuse, talk with someone you can trust like a friend, family member
or your health care provider.
There are programs for families and partners who have experienced abuse and for those
who abuse. There’s help for everyone in the family:
■■ If you’re in danger, call the police at 911.
■■ If you’re hurt or have health concerns, go to your health care provider, urgent care centre
or emergency department. Tell them how you got hurt.
■■ Call Health Link at 811 for your local emergency shelter, available 24/7, when it’s safe for
you to do so.
■■ Call the Family Violence Info Line toll-free at 310-1818, available 24/7 in more than
170 languages. You can also call this number to get information to help you understand
abuse, access financial supports, and find information about a place to stay, if you
need one.
Visit the Links section at healthyparentshealthychildren.ca/resources to learn more

about abuse, staying safe and getting support:
■■ Find a lawyer from the Law Society of Alberta Lawyer Referral Service who will answer
your questions in confidence—the first consult will often not cost you anything.
■■ Call Legal Aid Alberta, toll-free at 1-866-845-3425 to find a lawyer to represent you.
■■ If you’re new to Canada and want to find out about your rights, contact your local
Citizenship and Immigration Canada Office.
What is neglect?
All parents or caregivers have times when they cannot respond to children right away.
This is not neglect. As your child gets older, they’ll learn that people are not always able to
respond right away. When children are well looked after, they’ll learn over time how to care
for themselves and how to problem-solve more and more on their own.
Neglect happens when the people who are supposed to care for children do not:
■■ provide for their children things such as food, clothing, housing, medical and dental care,
and education
■■ pay enough attention to and love them
■■ respond to or interact with them and show them affection
■■ give them the protection they need for their age and stage of development

It’s a very serious problem when children are mostly ignored, given no attention and when
no one knows where they are, what they’re doing, or if they’re safe. Neglect affects how
children grow and develop.
If you and your children are in any of these situations, there are many people and agencies
that can help. Call Health Link at 811 or talk with your health care provider to connect with
people who can support you and your children.
Parenting together
Whether you’re in the same home or live
There are many ways
to raise a child
apart, parenting with someone else is a shared
responsibility. Here are some tips to help you Parenting differs from child to
child, parent to parent and family
parent together:
to family. It can also differ by
■■ Focus on communication. Healthy generation, community, country
communication is important. Try to hear the and culture. How you choose to
other person’s point of view, even when you bring up your child may be similar
don’t agree. Plan ahead and talk about how to or different from how your
parents raised you.
you’ll share parenting responsibilities.
Parenting advice in this book is
■■ Expect an emotional journey. You have your
based on up-to-date information
own physical and mental health and changing about raising children to help
roles to think about. Talk about your successes, guide you in your decisions.
challenges, hopes and fears together.
■■ Appreciate your differences. When sharing parenting, you may not always share
the same views or do things the same way. Even if you have different styles, what is
important is to agree on the overall approach, the expectations you have for your child,
and to be consistent as much as possible.
■■ Talk about your long-term goals for your child. If you have different ideas about a
parenting decision, you can revisit these goals and use them as a way to re-focus the
conversation on what’s important to both of you.
“
Talk it over Be patient with yourself, your child and
If you’re sharing parenting your partner because you’re all on this
with extended family,
”
communication and
journey together, learning as you go. It
relationship building are just as does get easier. It takes time.
important. Be sure everyone is
clear about who is responsible ~ Parth, dad of one child
for what.

Parenting when separated or divorced
A separation or divorce is very stressful for the whole family. Each family member adjusts
to the change in their own way. Although separation and divorce change a family’s
structure, it does not change your responsibilities and feelings for your children. Good
communication becomes even more important when parenting happens between two
families and two homes.
If you’re in this situation, you’ll need to work together to help prevent this from becoming
toxic stress for your child (see page 23). Here are some ways you can support your child to
feel safe and secure:
■■ Assure them that both parents love them

and are still a part of their life. Support for families when
separating or divorcing
■■ Help them understand that it’s not their fault.
Libraries, support groups and
Children sometimes think they’re responsible
community or public health
for their parents’ separation. centres offer a wide range of
■■ Help them understand that they can’t resources for families going
change decisions you and your former through divorce or separation.
partner have made. If you and your family are having
a hard time, call Health Link at 811
■■ Follow your family’s regular routines as much
to learn about agencies that offer
as possible. marriage or divorce counselling.
■■ Talk with your child about their feelings, and
tell them you understand that they may feel
angry and confused.
■■ Make a plan with your former partner on how you’ll both handle transitions as your child
grows, for example moving from a crib to a bed or starting school. Being as consistent
as possible and keeping the best interests of your child in mind will help make it easier
for them.
If you’re concerned about your child, ask for help from other family members or from a
counsellor. Try to keep communication with your former partner as respectful as possible.
If you and your former partner argue or fight often, it can have a serious and lasting effect
on your child. Do not speak negatively about your former partner to your child and other
people. If you need to share negative feelings, speak with a trusted friend or counsellor
when your child is not there.

You may want to have a trained person who doesn’t take sides or make decisions
(mediator) help you make a plan that includes an agreement about parenting or child
support that you and your former partner will be able to keep. To find a
mediator, call the Alberta Family Mediation Society toll-free at 1-877-233-0143
or visit the Links section at healthyparentshealthychildren.ca/resources
“ ”
For those in two parent situations—you need to be on the same page. If you
struggle, you have to open the lines of communication.
~ Jessica, mom of two children

Growing and learning as parents
As a parent, there’s a lot to learn—and children don’t come with a manual! Let this book
be your guide to the most up-to-date information about parenting your child in the early
years. As you get used to being a parent, you’ll learn as you go and you’ll learn something
new with each child you have. No one expects you to have all the answers. When you
have questions or concerns, don’t be afraid to ask for help. Start with the people you trust.
Friends, family, neighbours and your health care providers can all be sources of support
and information.
Parenting programs, groups and classes

are also available and can help you:
■■ learn ways to handle everyday
challenges
■■ meet other parents
■■ share experiences
■■ have a break
Parenting programs are for everyone.

Some programs are available at no cost
to you and others have a cost. Many
agencies offer subsidies for parents
who are not able to afford classes, so
be sure to ask if this is a concern for
you. Ask if there is child care available
while you attend the class. For more
information, call Health Link at 811 or
talk with your health care provider or
your Parent Link Centre.

Healthy Growing
Families

47
Healthy Growing Families
The early years are a time of rapid growth for your child and for you as a
parent. Your family’s health is a precious resource. In this chapter, you’ll find
information that applies to all children over these foundational years—how
they grow, how they communicate and learn, and some of the emotional
and social changes you’ll see. You’ll also find information about eating,
sleeping, other everyday activities and common health concerns, as well as
how to keep your child safe and prevent injuries. There is also information
about taking care of yourself as a parent during your child’s early years.
In the age-specific chapters that follow in this book, you’ll find information
for your child’s specific age and stage of development.
48
Feeding Your Child
H E A LT H Y G R O W I N G FA M I L I E S
Food is important for everyone’s good health. Eating healthy food gives your child
the energy and nutrition they need to grow, learn and play. Their needs will change as
they get older. For the first 6 months, your baby will need breastmilk or infant formula
(see page 145). At about 6 months, your baby will be ready to start eating solid foods (see
page 291) and, before long, you’ll find your family will all be eating the same healthy foods.
The feeding relationship

The way you and your child relate to each other
around feeding and eating is called the feeding
relationship. Developing a healthy feeding
relationship with your child during the early
years is foundational, as it affects their eating
behaviours for their whole life.
Babies are born with the ability to regulate their

appetite, which means they’ll eat when they’re
hungry and eat the amount of food they
need. The feeding relationship starts with your
baby’s first feeding. Your baby connects with
you when you respond to their feeding cues
(see page 149) and take time to relax, snuggle
and talk quietly with them while they feed.
Responding to your baby’s cues helps build a
secure attachment and a trusting relationship.
You’re also teaching your baby to listen to their
body and stop feeding and eating when they’re full.
Your baby: You need to:

■■ lets you know when they’re hungry ■■ help your baby stay calm while feeding
■■ needs to feed and eat when they’re ■■ watch your baby for feeding cues and
hungry respond when they tell you they’re
■■ lets you know when they’re full hungry or full
infant formula: in this resource, infant formula refers to commercial, store-bought infant formula that is bought
in Canada

As your child gets older, the feeding relationship will change. Your child is still responsible
for how much they eat. You’re still responsible for what food to provide for your child.
By the time children are eating a wide variety of foods with different textures (between
6–12 months old), new roles will help your child learn to be a healthy eater.
You decide: Your child decides:

■■ what food and drinks are offered ■■ whether or not to eat
■■ when food and drinks are offered ■■ how much to eat
■■ where food and drinks are offered
In the chapters ahead, you’ll find suggestions about healthy eating for different
age groups.
Family meals
Meals are important times for your family to connect with each other. Even your young
baby will benefit from being with you during meals. Spending time together during meals
helps your family:
■■ build strong family relationships
■■ develop healthy eating habits
■■ develop language and social skills
A strong family relationship helps your child feel secure. Try to have at least one meal
together each day. Set some guidelines around where you’ll eat as a family. Children learn
by watching you—turn off all electronics so you can enjoy each other’s company.

Healthy food for the whole family
Eating Well with Canada’s Food Guide (Canada’s Food Guide) recommends healthy foods
for the whole family and is available in many different languages. Try to serve a variety
of healthy foods and follow Canada’s Food Guide every day. Eating the recommended
amounts and types of food will help
you and your family meet your needs Canada’s Food Guide –
for vitamins, minerals and other First Nations, Inuit and Métis
nutrients and will contribute to your The food guide is available
family’s overall health. in Plains Cree and other
Indigenous languages. To learn
Here are some guidelines for the whole more, visit the Links section at
family based on Canada’s Food Guide. healthyparentshealthychildren.ca/resources
Recommended number of Canada’s Food Guide servings each day

Vegetables Grain Milk and Meat and
Age
and Fruit Products Alternatives Alternatives
1–2 years up to 4 up to 3 up to 2 up to 1
2–3 years 4 3 2 1
4–8 years 5 4 2 1
9–13 years 6 6 3–4 1–2
Female 14–18 years 7 6 3–4 2
Male 14–18 years 8 7 3–4 3
Female 19–50 years 7–8 6–7 2 2
Male 19–50 years 8–10 8 2 3
Female 51+ 7 6 3 2
Male 51+ 7 7 3 3
“ My partner and I find that it’s really important that we are both on the same
page about feeding our daughters. Discussing and agreeing on our own family
”
rules and boundaries for meal and snack times helped to create consistent
expectations related to eating among our daughters.
~ Craig, dad of two daughters

Examples of 1 serving Make each serving count
Vegetables ■■ fresh, frozen or canned vegetables ■■ eat at least one dark green (e.g.,
and Fruit 125 ml (½ cup) broccoli) and one orange vegetable
■■ fresh, frozen or canned fruit (e.g., sweet potatoes)
125 ml (½ cup) ■■ choose vegetables and fruit
■■ raw leafy vegetables 250 ml (1 cup) prepared with little or no added fat,
sugar or salt
■■ choose no more than 125 ml
(½ cup) of 100% juice
Grain ■■ bread 1 slice (35 g) ■■ choose whole grains at least half of

Products ■■ rice or pasta 125ml (½ cup) the time
■■ bannock 6 cm x 6 cm x 2 cm
■■ choose grains that are lower in fat,
(2 ½ inches x 2 ½ inches x ¾ inch) sugar and salt
■■ pita or tortilla wrap ½ small (35 g)
■■ hot cereal 175 ml (¾ cup)
■■ cold flaked cereal 30 g, 250 ml
(1 cup)
Milk and ■■ milk or fortified soy beverage ■■ choose homogenized whole milk
Alternatives 250 ml (1 cup) (3.25% milk fat) for children
■■ cheese 50 g (1 ½ oz) 9 months to 2 years of age (see
page 297)
■■ yogurt or kefir 175 g (¾ cup)
■■ choose skim, 1% or 2% or fortified
soy beverages for children 2 years
and older
Meat and ■■ cooked fish, shellfish, poultry, lean ■■ choose meat alternatives such as
Alternatives meat or wild meat 75 g (2½ oz) or beans, lentils and tofu more often
125 ml (½ cup) ■■ eat at least 2 servings of fish every
■■ 2 eggs week
■■ cooked legumes, such as beans or ■■ choose lean meat and alternatives
lentils 175 ml (¾ cup) prepared with little or no added fat
■■ tofu 175 ml (¾ cup) or salt
■■ peanut or nut butters*
30 ml (2 Tbsp)
■■ shelled nuts and seeds**
60 ml (¼ cup)
* To avoid choking risk for small children, spread peanut or nut butters thinly on bread or crackers and do not serve them
right off a spoon.
** Choking risk for small children, see page 59.
choking: occurs when food (or another object) is inhaled into the airway and causes breathing problems

Offer a variety of foods from the four
food groups, including some choices Vitamin D for all children
that have healthy fat such as fish Vitamin D is an important part of your child’s
and avocados. For young children, nutrition. It helps their body absorb calcium,
servings can be divided into smaller promotes healthy bones and prevents rickets.
Starting at birth, all children need a 400 IU
amounts and given throughout
vitamin D supplement every day.
the day. For example, you can serve
½ of a vegetable or fruit serving at Multivitamins are not recommended for
babies and most children do not need them.
two different snack times to equal
1 full serving.
Some foods that are not healthy for your child are:
■■ Drinks with caffeine, like coffee, tea and energy drinks—these can make children anxious
and make it hard for them to fall asleep.
■■ Herbal teas—not enough is known about how they can affect your child. Some herbal
teas may also have caffeine in them.
■■ Foods with sugar substitutes (e.g., aspartame, stevia and sucralose) and calorie-reduced
foods—these may end up replacing healthier food choices that are needed for your
child’s growth and development.
If you offer foods that are high in unhealthy fats, sugar or salt, limit these to small amounts
and offer them only once in a while to your family. This may include foods like:
■■ sugary cereal and chocolate bars
■■ cookies and doughnuts
■■ sausages, wieners or hot dogs
■■ chips and pickles
■■ sugar-sweetened drinks such as pop, iced tea, sports drinks, fruit punches, fruit cocktails,
fruit drinks, fruit ‘ades’ (e.g., lemonade) and flavoured vitamin or mineral water
To learn more about healthy eating for your whole family, visit the Printables and Links
sections at healthyparentshealthychildren.ca/resources
rickets: a disorder caused by a lack of vitamin D, calcium or phosphorus that can lead to softening and weakening of
the bones

What about fish?
Eating fish has many health benefits.
However, some fish are high in mercury and
should be eaten less often. Young children
are more at risk for mercury exposure.
Choose:
■■ fish that are low in mercury like anchovy,
capelin, hake, herring, Atlantic mackerel,
pollock (Boston bluefish), salmon (farmed
and wild), smelt, rainbow trout, shrimp,
clam, mussel and oyster
■■ canned ‘light’ tuna
■■ low-mercury lake fish caught in Alberta—
some fish caught in Alberta are high
in mercury.
To learn more, call Alberta Environment and Parks toll-free at 1-877-944-0313, or visit the
Links and Printables sections at healthyparentshealthychildren.ca/resources
Tips to think about when feeding your child

■■ Plan regular meals and snacks—aim
for 3 meals and 2–3 snacks per day.
■■ Give your child about 20–30 minutes
to eat meals and 10–15 minutes to
eat snacks.
■■ Offer food and drinks at meal and
snack times. If your child is thirsty
between meals and snacks, offer
water.
■■ Serve drinks in an open cup. Limit the
amount of juice you give to 125 ml
(½ cup) a day at the most.
■■ Your child may not like a new food right away. Sometimes getting used to new foods
takes time. Be patient and let your child explore their food. It may take 15 or more tries at
different times before they accept a new food.
mercury: a naturally-occurring metal that can be toxic in high levels

Limit distractions while eating. Turn off the TV and put away toys, phones and other
■■
electronics. This allows your child to pay attention to their hunger and fullness cues and
learn good eating habits.
■■ Patience works better than pressure—offer healthy foods and let your child decide how
much to eat.
■■ Let your child help—children may be more likely to try foods they help make or choose
at the grocery store.
■■ Let your child pick which foods to put on their plate from the foods you’re serving.
■■ Using food to trick, bribe, punish, comfort or reward your child can cause them to feel
pressured and have negative feelings about eating.
Eating out
Eating away from home is sometimes convenient and can be fun for the whole family. Fast,
takeout and restaurant foods are often much higher in fat, sugar, calories and salt than
food made at home. Eating out may also create some other challenges for children and
they may get:
■■ distracted and pay less attention to their Tips for your family when
cues of hunger and fullness eating out
■■ overwhelmed by excitement, noise or ■■ Choose restaurants that serve
having to wait healthier food choices, such as lean
or grilled meats, poultry or fish,
■■ used to larger servings and foods that are steamed or stir-fried vegetables, and
high in fat, sugar and salt fruit for dessert.
■■ Order from the regular menu, not
Eating out can also help your child learn
just the children’s menu. Ask for a
how to behave in social settings. However, half-serving or share an adult-sized
eating at restaurants often takes longer than meal with your child.
eating at home, so you’ll need to prepare
■■ Encourage your child to try new
yourself and your child so they don’t get foods.
overwhelmed or become impatient. Here
■■ Limit foods that are high in
are some ideas to think about:
unhealthy fat such as pan-fried and
■■ Pretend play or practice at home first. deep-fried foods. Ask for dressings
This helps your child learn what to expect and sauces on the side. Choose
tomato-based sauces instead of
when eating out and what you’ll expect
cream sauces for pasta.
of them.
■■ Choose milk or water. You can make
■■ If your child is tired, let them rest or have a water special by asking for a slice of
nap before going out to eat. fruit to go with it.

■■ Bring a small bag with crayons, a notebook, a
few small toys or books to help keep your child Did you know?
busy while they’re waiting for their food. Choices offered on the
children’s menu are often
■■ Pack vegetables or fruit so your child doesn’t get
higher in fat, sugar and salt than
too hungry before the meal arrives. choices on the regular menu.
■■ Choose child-friendly restaurants that Think about ordering a healthier
understand children’s needs and have high item from the adult menu for
chairs and booster seats. your child and take the left-over
food home.
■■ Be prepared to leave if your child becomes too
overwhelmed.
It may take a few tries to get used to eating in a restaurant. Trying to get your child to
behave or wait in a restaurant when they’re overwhelmed can make things worse. If this
happens, let them know it’s time to go. Remind yourself that they’re just learning. Remind
your child that certain behaviours are expected in a public restaurant and reassure them
that you can try again another day. When your child knows what to expect and what’s
expected of them, eating out will become more relaxed and pleasant for everyone.
Washing hands
The best way to stop spreading germs and to stay healthy is by washing hands often. Most
germs that make people sick can be passed on to others by people touching each other or
by touching things that a sick person has touched, like handles and doorknobs.
Everyone in the family, including your

child, should follow these steps when Antibacterial soaps
washing their hands. There are very few situations where
antibacterial soaps or waterless hand gels
1. Use warm running water and plain such as the ones used in a hospital are
soap—you don’t need to use needed. What makes the difference for
antibacterial soap. handwashing is rubbing your hands with
regular soap for at least 20 seconds. This
2. Rub the insides and backs of both
will remove the germs that can make you
hands and between fingers until or your child sick.
there are a lot of soap bubbles. This
Waterless hand gels are not recommended
should be at least 20 seconds or long
for children under 6 years of age.
enough to sing the ‘Happy Birthday’
song twice.
3. Rinse hands under warm, running water.
4. Dry hands with a clean towel.

Anyone in the family who is sick should use their own separate, clean cloth and towel.
Wash bathroom and kitchen towels often to prevent spreading germs.
Everyone in your family needs to wash their hands:

■■ before holding or feeding your baby
■■ before preparing or eating food
■■ after using the bathroom, changing a diaper
or helping a child use the toilet
■■ after sneezing, coughing or wiping your nose
or your child’s nose
■■ after touching any animal or pet, cleaning a
litter box or cage, or cleaning up animal and
pet waste
■■ after working in the garden or handling pesticides or manure
■■ after coming back from a public place such as the mall, school or work, or coming
indoors after being outside
Food safety
Keeping food safe
Food can carry germs such as bacteria, parasites and viruses
that can make your family sick. Handling, preparing and
storing food properly can reduce the chance of getting sick
with food poisoning (food-borne illness). Food poisoning
is very serious for any person, however, it can be especially
harmful in early childhood.
Wash hands when handling food

Everyone in your family, including your child, should
wash their hands properly before and after handling
any food.

Here are some things you can do to help prevent food poisoning:
■■ Wash your hands with warm water and ■■ Wash vegetables and fruits under cold,
plain soap before and after handling any running water.
food. You don’t need to use antibacterial ■■ Refrigerate or freeze perishable food,
soap. prepared food and leftovers within
■■ Wash your hands again after handling 2 hours.
food such as raw meat, poultry and fish. ■■ Check the temperature in your
■■ Wash and sanitize any surface that is in refrigerator using a thermometer to make
contact with raw meat, poultry or fish. To sure it's at 4 °C (40 °F) or below.
sanitize, use a solution of 2 ml (½ tsp) of ■■ Check the temperature of your freezer
household bleach in 1 L (4 cups) of water. to make sure it’s at least -18 °C (0 °F)
After sanitizing, change the dishcloth and or colder.
wash your hands.
Keep food safe by cooking meat, poultry and fish to a safe internal temperature using a
probe thermometer:
■■ ground beef 71 °C (160 °F)
■■ wild game (deer, elk, small game) 74 °C (165 °F)
■■ poultry 74 °C (165 °F)
■■ fish 70 °C (158 °F)
To learn more about food safety, visit the Printables section at

Water from a well

It’s a good idea to test your water for bacteria twice a year to make sure
it’s safe to drink.
To learn more call Health Link at 811 or visit the Links section at
probe thermometer: a thermometer that has a metal stem to check internal temperature of foods

Choking hazards and foods to avoid
As your child’s chewing and swallowing skills keep developing into the preschool years,
you’ll need to be cautious with certain foods as they can cause choking. Some foods need
to be modified for children under 4 years old to help prevent choking.
Foods that may cause choking How to make them safer

Stringy or chewy foods, such as meat, long ■■ Cut them up into small pieces.
pasta or cheesy toppings
Foods that stick to the roof of the mouth, such ■■ Spread them thinly on bread or crackers and
as peanut butter, cream cheese and cheese do not serve them right off a spoon.
spread ■■ For babies, mix with applesauce or infant
cereal to make them less thick.
Small and round fruits, such as grapes or ■■ Remove pits or seeds.

cherries ■■ Cut them into bite-sized pieces, such as into
4 parts.
Foods such as sausages, wieners or hot dogs ■■ Cut them lengthwise and then cut them
again into bite-sized pieces.
Raw vegetables ■■ Cook to soften them or grate them into

tiny pieces.
■■ Cut them into narrow strips.
These foods should not be offered to children under 4 years of age since they can cause
choking:
■■ foods or candies that are hard, small and ■■ fish with bones
round or that are smooth or sticky ■■ snacks with toothpicks or skewers
■■ whole nuts and large seeds ■■ raisins
■■ popcorn or marshmallows ■■ gum

These are some examples of foods that can contain certain bacteria that can make your
family, and especially your young child, sick and should not be offered:
■■ raw or cooked sprouts such as alfalfa,
radish or bean sprouts Homemade canned foods
■■ any food that has raw eggs in it such If giving your child homemade canned
foods, ensure they are prepared
as cookie dough or Caesar salad
properly as they can carry the
dressing
bacteria that causes botulism.
■■ unpasteurized fruit juice, milk or To learn more about home
cheese canning safety, visit the Links section at
■■ undercooked meats, poultry, fish healthyparentshealthychildren.ca/resources
or eggs
■■ food that hasn’t been stored properly
Everyday Care
Helping your child develop good sleep habits and teaching them personal care will help
them stay healthy. At first, they’ll need you to help them. Gradually, they’ll learn these skills
for themselves.
Sleeping
Your child needs good sleep habits to grow,
develop and be healthy. Our bodies are busy when
we’re asleep. The body heals and repairs itself
and our brain uses this time to organize and store
information. When your child sleeps, their body
makes a growth hormone and releases chemicals
that make their immune system stronger.
Babies and children need different amounts of sleep at different ages. Young babies wake
and sleep throughout the day and night to meet their needs for food and rest. As they
grow, they sleep longer and develop a more predictable daytime and nighttime pattern.
Every child has their own sleep pattern. You can help your child learn good sleep habits by
understanding typical sleep and wake patterns and how they change.
botulism: a serious illness caused by a toxin that is produced by bacteria that can grow in food and can grow inside the
body of an infant
unpasteurized: not put through a heat process to destroy harmful bacteria

Bedtime rituals are an important part of a
sleep routine as they help your child gradually Getting ready for sleep
shift from their busy day to getting ready for To help your child get calm
sleep. These rituals may include a bath, getting and ready for sleep, turn off all
into pyjamas, brushing teeth, singing a song electronics 1 hour before bedtime.
Turning TVs and electronic devices
or reading a story, and cuddles before saying
off tells the brain it’s time to go
goodnight. Screen time before bedtime can
to sleep. For more information on
disturb your child’s sleep patterns as the light screen time, see page 72.
from the screens can make it harder for your
child to fall asleep or stay asleep.
There are special considerations for babies under 1 year of age to make sure they’re safe
while sleeping (see page 218). For more information on how much sleep your child needs
at each age, see the sleep information in the age-specific chapters.
Teeth and mouth

Babies are born with teeth, but they’re hidden under the gums. Your child’s baby teeth
(primary teeth) started to form in the first trimester of your pregnancy. Start good oral
health habits right from birth to protect your child’s mouth from tooth decay.
This chart tells you when you can expect your child’s teeth to come in. It may be helpful
to keep track of when your child’s teeth come in. Use the chart below to note when each
tooth first appears. You can bring this information to dental visits if you have any questions.
dd/mm/yy central incisors 7–12 months dd/mm/yy
dd/mm/yy lateral incisors 9–13 months dd/mm/yy
dd/mm/yy canines (cuspids) 16–22 months dd/mm/yy
dd/mm/yy first molars 13–19 months dd/mm/yy
dd/mm/yy second molars 25–33 months dd/mm/yy
dd/mm/yy second molars 20–31 months dd/mm/yy
dd/mm/yy first molars 12–18 months dd/mm/yy
dd/mm/yy canines (cuspids) 16–23 months dd/mm/yy
dd/mm/yy lateral incisors 7–16 months dd/mm/yy
dd/mm/yy central incisors 6–10 months dd/mm/yy

Preventing tooth decay
Role model good dental care
Start brushing your child’s teeth with
Set an example by flossing and
fluoride toothpaste when they get their
brushing your own teeth with fluoride
first tooth. Fluoride is a safe way to prevent toothpaste so your child learns the
tooth decay. We also get fluoride from some importance of looking after their
foods, dental products and city and town teeth. Get regular dental care for your
drinking water. Children who use fluoride whole family.
have healthier teeth as adults.
Here are some tips for healthy teeth and gums for
your child:
■■ Brush their teeth twice a day.
■■ Use a small amount of toothpaste with fluoride.
■■ Floss their teeth once a day when their teeth start
to touch each other.
■■ Visit the dentist by 12 months of age.
The amount of toothpaste you use with your child will change as they grow. You’ll have to
put the toothpaste on their brush and teach them to spit it out, not swallow it when using
the pea size amount. Keep toothpaste out of reach when it’s not being used.
Amount of toothpaste to use Keep fluoride

For children younger toothpaste out of reach
than 3 years, use fluoride Swallowing too much fluoride
toothpaste the size of a toothpaste while teeth are
grain of rice. developing can cause lacy
white marks on children’s
For children 3 years permanent teeth (fluorosis).
and older, use fluoride Therefore, different amounts
toothpaste the size of of fluoride toothpaste are
a pea. recommended for children of
different ages.
Most children don’t need fluoride tablets or drops to prevent tooth decay. If you have
any questions or concerns about your child’s teeth, talk to your dentist or your health
care provider.
fluoride: a mineral that helps prevent tooth decay

Mouth and teeth injuries
Mouth and teeth injuries are common in children. Teeth can be injured during a fall
or sport activity. Use a mouth guard to help protect your child’s teeth against injury
during sports such as hockey, ringette, football and lacrosse. See your dentist right
away for all tooth injuries. Bring any broken pieces or knocked out teeth with you. To
find out what to do with this tooth or broken pieces, call your dentist’s office or Health
Link at 811.
Checking for tooth decay

Tooth decay is the most common preventable chronic
disease in childhood. Untreated tooth decay can:
■■ cause pain and infection
■■ affect your child’s sleep, learning and eating
Healthy teeth
■■ lead to problems with their permanent teeth
Be on the lookout for the first signs of tooth decay. Once a month, after brushing your
child’s teeth, gently lift their upper lip and look at the top and bottom teeth. Check along
the gum line, where the teeth and gums meet. When your child has their back teeth
(molars), also look at the chewing surfaces.
Lift the lip to check

for tooth decay.
If you see What it means What to do
White lines on the First sign of See a dentist—prevention at

teeth close to the tooth decay this point can stop tooth decay.
gum
Brown areas or black Tooth decay See a dentist as soon as

spots that don’t go possible for dental treatment.
away after brushing
Untreated tooth decay can lead
the teeth
to pain and infection.
Any swelling in the Sign of dental See a dentist immediately for

mouth or face infection diagnosis and treatment.
To learn more about oral health, dental care

and fluoride facts, visit the Links section at

Growing and Learning Together
All areas of your child’s development are interconnected—one area cannot develop
without the others. Your child’s development is guided by their brain.
Your child grows and learns in many

Physical
ways through the early years. They
learn when they communicate and
play. They learn through their emotions
Emotional
Cognitive
and by interacting with other people.
Understanding how your child grows
and learns and giving them love and
nurturing care, such as using warmth
and structure (see pages 11–12), will
Social
help give your young child the strong
foundation they need for a lifetime of
When you know how the brain works, it’s easier to
learning and optimal health. understand what you can do to support your child.
Communicating with your child

Speech, language, reading and writing skills develop in stages starting at birth:
■■ Even before your child uses words, they give you cues to tell you what they need. They
cry when they need something, they gurgle and coo when they want to play, they yawn
and rub their eyes when it’s time for sleep.
■■ Early ‘coos’ and ‘goos’ become babbles, then words. Words grow into sentences, then
stories.
■■ At first your child will just understand the tone of your voice. Soon, they’ll know what a
few words mean. With time, they’ll understand directions and conversations.
■■ As their muscles and coordination
develop, your child’s scribbles turn into
drawings, then letters and words.
■■ At first, your child will understand that
pictures stand for objects, people and
places. Later they’ll realize that printed
words do too.
speech: the ability to pronounce sounds and words

Your child learns language from the words you use during everyday activities such as
eating and getting dressed. They learn to read by sharing books and stories with you.
Your child also learns through their own

experiences. They need you to:
■■ talk, sing, play and read with them
■■ give them lots of chances to scribble
and draw
■■ talk to them often so they can hear and
practice the language or languages
around them
To learn more about speech, language

and hearing, visit the Links section at
Learning more than one language

If you speak more than one language, use the language you’re most comfortable with
when talking with your child. You don’t have to speak English with your child if it’s not
your strongest language. You’ll likely speak and read more to your child when you use a
language that you know well. This interaction will give your child the strong foundation
they need to learn and use language.
Children can learn more than one language at a time. When your child is learning more
than one language:
■■ It’s normal for them to use words from all

the languages they’re learning, even in the Hearing can affect speech
same sentence. Healthy hearing will help your
child interact with you and others
■■ It does not affect their first-language skills. and learn speech and language
■■ It boosts their mental ability and improves all (see page 81). If you have concerns
areas of learning. about your child’s speech or
hearing at any age, talk with your
health care provider.

Let’s play
Children are born curious—they want to learn
and know about their world.
Play is one of the most important ways children

learn. When your child plays, they learn about
their world, themselves and others. By having
time to play, their skills become stronger and
they get ready to learn new ones. When you
join your child in play, they learn new things.
As your child plays, you can help them think
of new ways to do things and solve problems.
They learn best when you follow their lead and
build on their interests.
Types of play
Children need time
Play has an important role in building healthy bodies to play
and healthy minds. Letting your child take the lead
Play every day! Set aside time
to create, build and explore through play helps their daily for your child to play
brain cells connect. Play lets your child learn: with you and others.
■■ how their body moves Play is the foundation
that helps your child build
■■ to solve problems, cooperate and share
life-long skills and positive
■■ to use language and be creative relationships with others.
■■ to think and use their imagination
Child’s play includes active, creative and pretend play:

■■ Active play involves active, whole body
movements such as tummy time, running, jumping,
kicking, throwing and catching.
■■ Creative play uses hands and minds to build and
create. This includes arts, crafts, blocks and puzzles.
■■ Pretend play uses language and thinking skills to
learn about the world, develop imagination and
solve problems. This includes acting out real-life
and imaginary situations.

“ My kids love exploring everyday
things and coming up with new
ways of using them. We have a
few bins with different materials
(wood items, shiny items, natural/
outdoor items, noisemakers) that
”
both my kids love to play and
pretend with.
~ Dara, mom to two children
Your child plays and explores their world through their senses (sensory play)—sight,
sound, taste, smell and touch. When they use their senses, it helps them build strong brain
connections and lays the foundation for play as they grow and develop.
We all have certain sounds, smells, sights,

tastes and textures that we like better than Children learn
others. Your child may like some sensations through play
and not others, such as loud or quiet places The more your child plays, the more
and they may enjoy and engage in different they learn about themselves and the
types of play. As your child plays you’ll get to world around them. It helps build a
know what they prefer. These preferences are healthy body and healthy mind.
often influenced by your child’s temperament
(see page 24).
There are no set rules for

play—it should be unplanned,
fun and led by your child. Keep
it simple and fun. Let your child
decide what they want to do
and follow their lead. Watch
what your child does, then
wait and listen as they show
you what to do. Play helps your
child balance daily routines
with the chance to unwind.

Play with your child every day. They want to spend time with you—they look up to you
and want to learn from you. Playing together also makes the bond between you and your
child stronger. Play is fun for the whole family and it helps you see the world through your
child’s eyes.
Hearing safety
Some toys may harm your child’s hearing if they’re too loud or used too close to their
ears. If a noise is loud enough that you have to raise your voice to be heard, then it’s too
loud. Turn down the volume and reduce the time your child plays with noisy toys.
Active play
Basic movement skills develop in stages.
In just a few short years, your child will go
from movements they can’t control to being
able to:
■■ move their arms, legs and bodies with
purpose
■■ roll, sit and crawl
■■ pull themselves up to stand and walk,
then run, jump and kick
■■ put all these skills together to begin to
play games and sports
Babies and children explore through active

play by moving their arms, legs and bodies.
They need many chances to grasp, crawl,
walk, run, throw, kick and climb. These skills
are the building blocks that give them the
confidence to be active.
Active play can help your child:

■■ develop balance and strength
■■ cope with stress and learn to solve
problems
■■ develop social skills such as flexible
thinking, sharing, taking turns and learning
to get along with others

You show your children how important it is
to be active when you’re active with them.
Children of active parents are more likely to be
active themselves. This is the foundation for
life-long health.
“ Obstacle courses are easy to set up

inside or outside with items on hand like
pillows, ropes, hoops, balls and pylons.
My daughter and her friend love racing
”
around the obstacle course and it’s a
great way to tire them out.
~ Sean, parent of one child
Active play guidelines

Active play can occur many times throughout the day. It’s recommended that babies
and children are active every day:
■■ Babies need to be active throughout the day with floor-based play like tummy time.
■■ Children 1–4 years old need 180 minutes (3 hours) of active play like crawling, fast
walking or dancing every day.
■■ Children 5 years and older need 60 minutes (1 hour) of energetic, active play, like
hopping, skipping and bike riding every day.
To learn more, visit the Links section at

Creative play
Your child learns about their world by
playing with the objects around them such
as books, food, furniture, dishes, arts, crafts
and toys. Creative play helps develop fine
motor skills. Fine motor skills are finger and
hand skills such as writing, cutting, opening
lunch boxes and tying shoelaces. It also
helps their hands and eyes start to better
work together (hand-eye coordination).

Creative play can help your child learn how objects:
■■ look, move, taste, feel, smell and sound.
Once your child notices how objects can
be the same or different, they’ll sort them
into groups such as shapes and colours.
■■ can be used to do different things.
At first, your child will bat, grasp and
squeeze things to see what they do. As
they get older, they’ll learn to turn pages
in a book, roll a ball, pour water and
comb their hair.
■■ can be put together. At first, your child will stack or fit things together. Then they’ll make
towers and puzzles.
■■ are meant to be used. At first, your child will push buttons on toys, then roll balls and
push cars. Later, they’ll play cards, board games and sports.
■■ can be used creatively. Your child may create a picture with leaves, build a city with
boxes, or make their favourite food.
■■ can be described, sorted and compared using words
Stories help your child talk about and solve problems in their world. This helps them learn
how to prevent and solve problems in the future. Storytelling develops in stages. Over
time, your child will:
■■ share their own stories by telling others what they did today or what they’ll do tomorrow
■■ share detailed stories about their favourite storybook
■■ make up their own stories about real or imaginary people
Pretend play
Toddlers and preschoolers learn about life and develop their imagination and social skills
by pretending. Your child may pretend to take a nap, feed their stuffed animals or give
their doll a bath. At first, they use objects that look like the real thing, such as using a toy
broom to sweep the floor.
Before long, your child’s pretend play becomes more advanced, and objects can be
anything they imagine them to be, like a broom becoming a horse. Then, they’ll start to
include adults and other children in their pretend play by taking and giving out roles such
as, “You be the baby and I’ll be the grandpa.”

You may notice your child talking to
themselves as they play. Talking out loud:
■■ helps your child start to organize their
thinking
■■ helps your child learn to solve problems
and cope with emotions
■■ becomes the inner speech (self-talk)
that will help your child think things
through
“ ”
We used a large cardboard box and cut doors and windows out of it. My sons
and I love playing in their ‘house’.
~ Krystina, mom of two boys
Tips to encourage play

■■ Make the time: Set aside time through- ■■ Give encouragement: Notice and
out the day for your child to play alone, comment on what your child is doing. If
with you and with others. they’re playing with a red car, instead of
■■ Follow their lead: Let your child decide telling them what to do with the car, you
what they want to do and follow their could say, “You put the toy inside the red
lead. Watch what they do, then wait, car. Where is it going?” Noticing, com-
listen and respond as they show you menting and giving encouragement
what to do next. helps to improve children’s self-esteem,
imagination and language skills.
■■ Meet them at their level: Get close to
your child and make eye contact when
■■ Make a play box: Fill it with clothes,
you play together. This shows them shoes, hats, gloves, purses, wallets and
you’re interested in what they’re doing. other household items your child can
If they’re playing on the floor, sit beside safely play with. Adult clothes are fun
them. When you take part in child-led items for children to dress up in.
play, it increases your child’s self-esteem ■■ Keep a list of play ideas and supplies:
and confidence. The variety helps keep your child inter-
■■ Have fun: Focus on having fun and ested and helps them practice different
letting your child see how much you skills. Different play activities will help
enjoy play time. Try to focus on playing your child use their senses to explore.
with your child—even if you have a Try turning socks into hand puppets or
million other things to do. into balls to play catch.
inner speech: the use of words in thinking without saying them out loud
self-esteem: a feeling of having respect for yourself and your abilities

Sit less, play more
When children are sitting or lying
down for a long time when they’re
awake (being sedentary), it affects
their growth and development.
This includes effects on their
language skills, ability to learn and
sleep patterns.
Research tells us that children

do best when they’re active
throughout the day and not
sedentary for more than 1 hour at
a time, unless asleep. Sedentary
behaviour could include using
things that have a screen (screen
time), such as watching TV, playing video games or being on the computer, mobile phone
or tablet for fun. Sedentary behaviour can also include sitting in a stroller or high chair for
more than 1 hour at a time.
Some activities like playing with toys, reading, drawing or doing crafts are encouraged to
help with your child’s development, even though they’re done while sitting or lying.
Age of your child Screen time recommendation

Under 2 years old No screen time
2–4 years old Less than 1 hour every day
5 years and older 2 hours or less every day—this does not include time spent
doing homework on a computer
When you’re active, your child is more likely to be

active too. Some things you can do to be more Role model screen time
active as a family: Your child will learn screen time
use and habits from you. Talk
■■ Play together. about screen time and develop a
■■ Walk or bike to where you’re going. family plan together.
■■ Spend time outside playing and exploring.

■■ Limit the use of playpens and infant seats.

Set limits on the amount of screen time for
■■
Internet safety the whole family.

When your child is using a ■■ Keep TVs, computers, tablets and electronic
computer or cell phone, always
games out of bedrooms.
monitor and guide how they
use them. Keep these devices in
To learn more about sedentary behaviour,
areas where everyone has access
play and screen time, visit the Links section at
and where using them will not
interfere with other activities like healthyparentshealthychildren.ca/resources
sleeping and eating.
Learning about emotions

Your child shows their emotions
right from birth. It takes time
for children to understand their
emotions—and a lot of patience
from parents. The skills your
child learns in the early years
are the basic building blocks for
their life-long mental health and
problem-solving skills.
To be emotionally healthy, your

child must be able to:
■■ Experience all emotions so they know what emotions feel like, such as very happy and
excited or feelings that might make you uncomfortable, such as anger, disappointment
or jealousy.
■■ Learn how to show their emotions in ways
that do not hurt themselves or others. Be a positive role model
Yelling, screaming, hitting and slamming If you have trouble managing your
doors are not healthy ways to cope. emotions, your health care provider
can give you information about
programs and supports that can help.

With your help, your child can:
■■ learn about their emotions and how
to show them in healthy ways
■■ learn to care about others
■■ develop healthy self-esteem, which
is what they think and feel about
themselves
You’re a powerful role model for your

children. Your child learns how to
manage their emotions by watching
you and seeing how you interact with
them and with other adults. If you yell
and hit, your child will learn that yelling and hitting is the way to show their anger. You may
feel frustrated and angry, but when you self-regulate to become calmer (see page 26), you
can then solve problems with your child. Your child will learn these healthy coping skills by
watching you and learning what it feels like to be calm and solve problems.
The way you respond to your child’s

emotions affects how they: Caring for others
Your child’s emotional and social development
■■ get along with other children
helps them begin to understand and care
■■ manage their emotions now and about how other people feel. This is called
as adults empathy, a quality needed to get along with
and care about others.
Living in a social world

As they grow, your child develops a sense of who they are and how they can get along
with others. This social development happens in stages.
■■ Newborns begin to connect with
you when you look into their eyes,
talk gently and smile. Soon, they’ll
look into your eyes, and smile and
coo back at you. This important
connection gets them ready to
interact with others. At this stage,
they don’t know that you’re separate
from them.

Babies use sound, touch and sight to
■■
explore and play with their mouths,

voices to make noises, their fingers,
toes, arms and legs and when they
make eye contact with you. Using their
senses to explore and play are the
building blocks for learning to play and
interact with others.
■■ Toddlers will often play by themselves.
This stage is called solitary play.
■■ Preschoolers will play beside other
preschoolers, but usually not with
them. They’re starting to learn to share
and do things with others. This stage is
called parallel play.
■■ Young children start to spend more
time with others, like to share ideas,
and play with a common goal, such as
‘let’s pretend’ games as well as games
using simple rules. This stage is called co-operative play.
Sexual Health and Development

Your child sees you as a role model and a valuable source of information. They want to get
health information from you because of the loving and trusting relationship you have with
them. Teaching your child about sexual health, not just about sex, is part of your role. This
will help them have the knowledge, skills and ability to protect their health and the health
of others, now and when they’re older.
Sexual health includes topics like hygiene,

healthy relationships, sexuality and consent. Your child’s body
You’ve been teaching your child about these belongs to them
things from the day they were born. Young Teach your child that their body
children learn about love and trust through belongs to them. They have the right
touching and holding and by living in a home to tell people they do not want to be
where healthy relationships are modelled (see touched, kissed, hugged or tickled—
even if it’s by a friend or relative.
page 38). They’ll soon realize that males and

females are different. They may be very curious about their own body and other people’s
bodies. Talk with your child about the different body parts as they discover them. Your
family may have names for body parts, however, it’s also important for them to know their
correct names like penis, testicles, breasts, vagina and vulva.
It’s normal for your child to explore and touch their own body parts, including their
genitals. This helps them discover how their body works. As your child becomes more
curious, they may ask questions like “Where do babies come from?” or “Why don’t I have
a penis?” or “How do girls go pee?” You can answer their questions with simple, honest
answers. For example, “Babies grow in a special place inside a mom’s body called a uterus.”
Some parents sometimes feel unsure or uncomfortable talking about sexuality with
their children. There are helpful tips and information available. To learn more, visit
teachingsexualhealth.ca
Health Checkups
Regular health checkups and routine immunizations are important for your child’s health.
There are many health care providers who will work with you to keep your child healthy.
Many of these health care providers will be able to continue to provide care through
infancy, early childhood, adolescence and even adulthood. Returning to the same health
care provider for each visit will help them to get to know your child and your family and
you’ll get to know your health care provider too.
Help your health care providers care for your child and your family by:
“
■■ keeping notes about medical histories,
problems and illnesses My daughter and I played ‘doctor’
■■ bringing a list of questions you want to ask before going to her 3 year old
■■ asking about things you don’t understand
checkup. By acting out all the
various procedures in a fun way,
The following section will introduce you she was ready for the checkup
”
to some of the health care providers who and was excited to show the
will provide health checkups for your family
doctor her own stethoscope.
throughout the early years.
~ Isla, mom of two children
vagina: the birth canal that connects the uterus to the outside world
vulva: the female external genitals, including the clitoris, labia and vaginal opening
genitals: sexual organs which include the male’s testicles and penis and the female’s vulva (labia, clitoris and vaginal
opening); the vagina is part of the female reproductive system and is inside the body

Doctor
Your doctor will want to see your
child regularly. They’ll monitor your
child’s health and development. Talk
with your doctor about booking a
health checkup the first few days
after their birth and then again when
they’re 1–3 weeks old. At these visits,
ask your doctor about how often
your child should come for regular
health checkups.
If you need help finding a doctor:

■■ ask friends, neighbours and your family for suggestions
■■ call Health Link at 811
■■ call the College of Physicians & Surgeons of Alberta toll-free at 1-800-561-3899
To find a doctor in your area, visit ahs.ca/options
Call Health Link at 811 or your health care provider if

you notice that your child has any of the following:
■■ loses skills they’ve already learned such as words or
movements
!
■■ repeats the same actions over and over again such as
flapping hands, rocking and twirling
■■ doesn’t seem to connect with other people, such as
no eye contact, smiling or back and forth interactions
■■ keeps their head to one side more than the other
■■ has any other health or development issues that
concern you

Public health nurse
In Alberta, all regular childhood
immunization is provided by public health
nurses at the well child clinics at your local
community or public health centre. Public
health nurses will offer immunizations to
you and your child as well as other services
for your family that promote wellness and
prevent disease.
A public health nurse will call you soon

after your baby is born. They’ll talk with
you about your health, your baby’s health and how your family is doing. They can suggest
community resources and arrange for follow up care if you need it.
You’ll also visit with a public health nurse each time your child is immunized (see page 82).
Call your community or public health centre to book your immunization appointments
at least 4 weeks in advance. At your first visit, the public health nurse will also ensure that
you’re adjusting to all of the changes a new baby brings and will offer to screen you for
postpartum depression (see page 261).
Like your family doctor, public health nurses support your family’s health and can answer
questions about many health topics including:
■■ your health after birth
Living on a low income
■■ health of and caring for your
baby and children If you’re living on a low income, contact the
Alberta Supports Contact Centre for information
■■ breastfeeding and nutrition and referrals for social benefits and services
■■ growth and development including the child care subsidy. Call toll-free
at 1-877-644-9992 or visit the Links section at
■■ sleep and crying healthyparentshealthychildren.ca/resources
■■ preventing injuries You can also call Health Link at 811 or talk with
your health care provider to find out more
■■ adjusting to being a parent
about resources
■■ attachment and your family’s and programs in
mental health your area.
■■ sexual health, including birth
control
■■ resources in the community like information or referrals to parenting classes, programs
such as tobacco reduction, and other supports like food banks

To find a community or public health centre near you, call Health Link at 811 or
visit the Links section at healthyparentshealthychildren.ca/resources
Dentist
Your baby should see a dentist by
the time they’re 12 months old or Financial support for dental care
within 6 months of their first tooth If you’re living on a low-income
coming in. During regular visits, the and need support, you can apply
dentist will check the health and to the Alberta Child Health Benefit.
development of your child’s mouth Call toll-free at 1-877-469-5437
or visit the Links section at
and teeth. They’ll also talk with you
about ways to prevent tooth decay.
They’ll answer any questions you
have and let you know how often your child should come in for a checkup.
To find a dentist in your area, visit the Links section at

Optometrist
Your child learns a lot by watching you and the world around them. Their development
can be affected when they’re not able to see well. Vision problems can often be corrected
or reduced if they’re found early. Your child’s doctor will check your child’s vision during
their regular health checkups.
Your child should have their vision checked by a doctor who provides eye and vision care
(optometrist) by the time they’re 3–5 years old, before they start kindergarten, and each
year after that. Vision will need to be checked by an optometrist earlier in children:
■■ who have problems with their vision
■■ if there is a family history of childhood eye problems
For children 18 years and younger, eye exams by an optometrist are covered by Alberta
Health. You can call and book an appointment. You may also be referred to a medical
doctor who specializes in eye care (ophthalmologist) if needed.
If you’re worried about your child’s vision or think that your child may have an
eye infection, talk with your health care provider. To find an optometrist in your
area, visit the Links section at healthyparentshealthychildren.ca/resources

Call Health Link at 811 or your health care provider if you notice your
child has any of the following:
■■ unusual eye movements, such as jiggling or wobbling
■■ an eye or eyes that cross either inward or outward, either some of the
!
time or all of the time
■■ pupils that are not the same size or look white instead of black
■■ eyelids that are droopy, swollen, have discharge, or have bumps or sores
around them
■■ does not fix on or follow faces or objects and explores by touch, without
looking at objects
■■ does not like bright lights and squints, tears or closes their eyes
Other health care providers

Depending upon their health needs, you may meet many other health care providers over
your child’s life. Often these health care providers specialize in a particular area of children’s
health. A speech language pathologist, for example, can support your child’s speech and
language development and an audiologist can test your child’s hearing.
If you have any concerns, you may want to discuss these concerns with your family
doctor or public health nurse and they may recommend visits to these other health care
providers. You can also self-refer to many of these other health care providers.
Recommended checkups
Birth–2 2 4 6 12 18 2 3–4 5 years and
months months months months months months years years beyond
Check with your doctor to find out the

Doctor √
checkup schedule at their office
Immunization √
with public √ √ √ √ √ (at 4
health nurse years old)
Regular checkups as
Dental √
recommended by your dentist
√
Vision Early vision checkups with your doctor (with optometrist
at 3–5 years old)
Other health
As needed
care providers

Hearing
Your child’s hearing is important for many areas of development. Hearing loss can delay
your child’s speech, language and learning skills. Finding a hearing problem early can
help give you and your child the care and support you both need.
No one is too young to have their hearing tested by a professional. Your baby may
have had their hearing screening done soon after their birth. Even if their hearing was
screened after birth, have your child’s hearing re-checked by an audiologist as soon as
possible if your child:
■■ does not seem to like sounds (e.g., they cry or cover their ears)
■■ does not respond to sounds and voices most of the time
■■ has any signs you’re concerned about
Hearing tests are covered by Alberta Health. To learn more about hearing,
call Health Link at 811, talk with your health care provider or visit the Links
section at healthyparentshealthychildren.ca/resources
Helping your child during procedures

You play a key role in helping your child cope with stress or pain that might happen during
appointments such as dental visits, vision checkups and immunizations.
Collect information you need about

your child’s procedure and ask Talk to your child ahead of time
questions ahead of time. Find out Children have active imaginations and
the steps, order and timing of the may make up their own reasons for why a
procedure and ask how you can best procedure needs to happen. It’s common
support your child before, during and for your child to believe that they did
afterwards. Talk with your health care something wrong and that the procedure is
a punishment. Reassure your child that this
provider if you have any concerns.
is not the case:
For babies, breastfeeding and skin-to- ■■ Listen to their concerns.
skin cuddling may help reduce pain ■■ Let them express positive or negative
during procedures such as heel pricks emotions before, during and after the
and immunizations. procedure.
■■ Let them know that it’s okay to cry—it
Tell your child ahead of time about
can be a healthy way to relieve strong
the procedure they’re having. You can emotions and tension.
use pictures, stories and words if they
cannot yet fully understand.

Children are usually less afraid when they know what to expect and what’s expected of
them. You know your child best and will be able to judge how much time your child will
need to think about the procedure or ask questions before it happens.
Use simple words to explain what to expect. Let them know:

■■ why they’re having the procedure
■■ where you’ll be during the procedure
■■ that it’s okay for them to ask questions at any time
Many children are worried that immunizations or other procedures will hurt. Let them
know what to expect and that you’ll be there for them—don’t tell them it will not hurt if
it will.
It helps your child feel more confident and secure when you reassure them. Research
is clear that it can help and comfort your child when you distract them during stressful
times. For example, it may help to use a favourite book or stuffed animal, or to sing or talk
with them. Cuddling, comforting or encouraging your child may also help to reduce their
discomfort, fear and anxiety. Plan to do something special together after the procedure,
such as playing a favourite game or doing something you both enjoy.
Immunizations
Getting immunized helps protect you, your family and the people around you from
becoming sick with a communicable disease. The more people who keep their
immunizations up to date, the less chance there is for vaccine-preventable communicable
diseases to spread. This will help fewer people get sick. By getting your child immunized,
you’re helping them to build their own natural protection (immunity) against these
diseases before they’re exposed to them.
Immunizations are effective and benefit

your child’s health throughout their lives. Influenza (flu) immunization
Other than having safe drinking water, no Get the seasonal influenza vaccine every
other health intervention works as well year for you and your family.
as immunization to reduce disease and Your baby can start getting their seasonal
death rates. influenza immunization at 6 months old.
communicable disease: infectious disease that can be passed from one person to another
vaccine: small amount of a weakened or killed virus or bacteria given during an immunization that helps the immune
system develop antibodies to protect against a certain disease

Immunization is not just for children
Common adult vaccines include:
■■ Influenza* ■■ Varicella*
■■ Measles, mumps and rubella (MMR)* ■■ Shingles
■■ Pneumococcal* ■■ Human papillomavirus (HPV)
■■ Tetanus, diphtheria and pertussis*
Many of the routine immunizations are available at no cost for adults

who live, work or go to school in Alberta.
To learn more about adult immunizations, visit immunizealberta.ca
* Routine adult immunizations available at no cost
Vaccine-preventable diseases still exist. Some of these diseases are happening more
often now because some people are choosing not to get themselves or their children
immunized. Red measles, mumps and pertussis (whooping cough) are a few examples
of vaccine-preventable diseases making a comeback in Canada. Many of these diseases
have no treatment or cure if your child gets infected. Some of these diseases could lead
to a life-long disability or even death. Vaccine-preventable diseases can cause severe
health issues such as hearing loss, paralysis and brain or heart damage. In Alberta, routine
childhood immunizations are available at no cost. For more information about vaccine-
preventable diseases, see page 86.
To learn more about immunization and your child’s immunization schedule, visit
immunizealberta.ca
Vaccine safety
Vaccines are safe. Like all medicines, vaccines
go through many steps to be approved for use Measles, mumps and
in Canada. They must be shown to be safe and rubella (MMR) vaccine is
to prevent the diseases that they target. Health not linked to autism
Canada is responsible for this approval process, Research has shown no link
which is done carefully and takes many years. between the MMR vaccine and
autism. Rates of autism are no
Once a vaccine is approved, health care providers different in children who have
monitor it to make sure it’s safe. Children’s hospitals been immunized and those
across Canada review hospital records for any who have not.
serious illness with a possible link to immunization.

Public health nurses also monitor if there are any reactions to the vaccines. They report
reactions to Alberta Health. Alberta Health reports any severe or unusual reactions to
Health Canada.
Vaccines that are used together (combination vaccines) have also been tested. Research
shows that combination vaccines work and are safe. It’s also safe for your child to get more
than one vaccine at the same clinic visit. Your baby’s immune system can respond to
millions of different viruses and bacteria. Giving them more than one vaccine at the same
time keeps your child safe by protecting them against more diseases sooner.
Immunization schedule
Public health nurses give vaccines according to a schedule which is based on scientific
research. It’s developed to make sure vaccines are given in a safe and timely way, giving
your child the best protection.
Most vaccines need to be repeated (boosted) more than once to help your child’s body
build immunity. Vaccines protect best when they’re given on time.
Immunizations are scheduled when your

child is:
■■ 2 months
■■ 4 months
■■ 6 months
■■ 12 months
■■ 18 months
■■ 4 years old
If your child hasn’t been immunized or their

immunizations are not up to date, it’s never
too late to catch up. Do not put off or change your child’s immunization schedule, unless
it’s recommended by your health care provider for medical reasons. The immunization
schedule is designed to give your child the best protection and to build immunity
that lasts.

Checklist for your child’s immunizations
Call your community or public health centre at least 4 weeks ahead of time to make
❑
an appointment.
To learn more about the immunizations your child will get, visit immunizealberta.ca
❑
and go to Routine Immunization Schedule.
Bring your child’s Alberta Personal Health Care card. If you’re getting an
❑
immunization, bring your card too.
You’ll get your child’s immunization record at their first appointment. Bring it with
❑
you to each future appointment.
If possible, set a date for your child’s next immunization before you leave the
❑
community or public health centre.
If you can’t make your appointment, call the community or public health centre to
❑
cancel and book another appointment.
If your address or phone number changes, let your community or public health
❑
centre know.
Expected side-effects from a vaccine

Reactions to vaccines are usually mild and go away within a few days. Some of the most
common reactions include, redness, swelling or pain where the needle was given. These
reactions can last up to 3 days.
In some cases, your child may:

■■ be fussy No Aspirin®
■■ have a low fever Do not give Aspirin® (ASA or acetylsalicylic
acid) to children 18 years old and younger. It
■■ be sleepy can cause serious health problems.
■■ have vomiting or diarrhea
Your public health nurse will talk to you about possible reactions to the vaccines. As with
any immunization or medicine, unexpected or unusual side-effects can happen, including
a severe allergic reaction. This, however, is very rare.
If you think your child needs fever or pain medicine, talk with your pharmacist or doctor.
If you’re not sure or think your child is having a reaction, call Health Link at 811 or talk with
your health care provider.

Vaccine-preventable diseases
Being immunized is much safer than getting the disease that it prevents. This table
provides information on vaccine-preventable diseases and what they can do.
What could happen if my child

Quick facts
gets the disease?
Diphtheria
■■ A bacterial infection easily spread through ■■ Thick coating can form on the back of the
sneezing or coughing and by direct contact throat which causes breathing problems.
with someone who is infected. ■■ Can damage the heart and nervous system.
■■ Serious disease for babies and children. About ■■ Can cause paralysis or even death.
1 in 10 people who get diphtheria die.
■■ Babies are at more risk of complications from
diphtheria than older children.
Tetanus
■■ The bacteria lives in dirt, soil, manure or ■■ Causes very painful muscle spasms that are so
human stool. bad that bones could break.
■■ The bacteria gets into an open cut or wound. ■■ Attacks breathing muscles.
■■ Can also be spread by animal bites. ■■ Can cause speech and memory problems.
■■ Can cause seizures and even death.
Pertussis (whooping cough)
■■ A bacterial infection easily spread through ■■ Causes very bad coughing spells in babies
sneezing or coughing and by direct contact and children that can make it hard for them to
with someone who is infected. breathe or eat for weeks or months at a time.
■■ The whooping cough bacteria can live for ■■ Can cause pneumonia and convulsions.
2–5 days on dry objects like clothes, glass or ■■ Can cause brain damage and even death.
paper.
■■ Is most dangerous for children less than
12 months old, especially if they have not
been immunized or are behind on their
immunizations.
Polio
■■ A viral infection spread mainly through ■■ Can cause breathing problems and paralysis.
contact with human stool or food and ■■ Can cause permanent disability and
water that has been contaminated with even death.
human stool.
■■ Most common in children under 5 years old.
■■ No longer a problem in Canada. There’s still
a risk that the virus may be brought here
by travellers.

Quick facts
gets the disease?
Haemophilus influenzae Type B (Hib)
■■ A bacterial infection easily spread through ■■ Can cause meningitis.

sneezing or coughing and by direct contact ■■ Can cause pneumonia and swelling of the
with someone who is infected. opening to the windpipe.
■■ Before immunization, Hib infected more than ■■ Can cause infections in the blood, joints,
500 people in Canada each year. It was the bones, body tissues or in the outer covering
most common cause of bacterial meningitis of the heart.
in children.
■■ Can lead to deafness, life-long disabilities and
even death.
Hepatitis B
■■ A viral infection spread by contact with ■■ Can cause long-term (chronic) infection
infected blood or body fluids. which can lead to liver damage, liver cancer
and even death.
■■ People with chronic infection can have the
disease forever and can spread it even if
they don’t look or feel sick. However, chronic
Hepatitis B is now treatable and the ability to
spread it can be reduced with treatment.
■■ Hepatitis B is the leading cause of liver cancer.
Rotavirus
■■ A viral infection that is easily spread through ■■ Fever, followed by very bad vomiting and
contact with the stool of someone who watery diarrhea that can last up to 1 week.
is infected. ■■ Children could become so dehydrated that
■■ Also spread by touching toys, change tables they have to be admitted to the hospital.
or other surfaces contaminated with the stool
of someone who is infected.
■■ Often spread through diaper changing if
proper hand washing and cleaning of the
diaper change area are not done.
■■ 95% of children who are not immunized will
get rotavirus at least once by the time they're
5 years old.
■■ In Canada, rotavirus infections are more
common between December and May, but
there is a risk of infection all year long.
meningitis: infection of the covering of the brain and spinal cord

Quick facts
gets the disease?
Pneumococcal disease
■■ A bacterial infection easily spread through ■■ Can cause respiratory and middle ear
sneezing or coughing and by direct contact infections, pneumonia, meningitis and blood
with someone who is infected. infections.
■■ Also spread through saliva found on food, ■■ Can cause permanent damage to the brain,
toys or other objects. ears and major organs.
■■ Serious disease for babies and young
children.
Meningococcal disease
■■ A bacterial infection spread through direct ■■ Can cause an infection of the covering of
contact with bacteria in droplets from the the brain and spinal cord (meningococcal
nose or throat of someone who is infected. meningitis) and blood infections.
■■ Can be spread by saliva when sharing things ■■ If not treated right away, brain damage and
such as water bottles, drinks and food as well death could happen within a few hours.
as by direct contact such as kissing.
■■ Babies and children under 5 are most often ■■ Can cause deafness, brain damage, seizures
affected. and problems that could result in amputation.
Red measles
■■ A very contagious viral infection that is easily ■■ Fever and red blotchy rash.
spread through the air by sneezing, coughing ■■ Can cause a severe inflammation of the brain,
and contact with someone who is infected. which can lead to seizures and hearing loss.
■■ Complications and deaths are most common ■■ Can cause pneumonia.
in babies less than 12 months.
■■ Increases the risk of miscarriage and
premature delivery in pregnant women.
Mumps
■■ A very contagious viral infection that is easily ■■ Swelling and pain in the head, neck, and
spread through sneezing, coughing and the glands that are in the cheeks and below
contact with someone who's infected. the jaw.
■■ Serious infection of the lining around
the spinal cord and brain and severe
inflammation of the brain.
■■ Can cause deafness.
■■ Can affect your child's ability to have children
in the future.

Quick facts
gets the disease?
Rubella (German measles)
■■ A very contagious viral infection that is easily ■■ Fever, swollen glands and in some cases, a
spread through sneezing, coughing and rash.
contact with someone who is infected. ■■ Painful, swollen joints and, in rare cases, a
bleeding disorder or a severe inflammation of
the brain.
■■ Pregnant women could have a miscarriage or
give birth to a child with severe complications
including deafness, blindness, or heart or
brain damage.
Varicella (chickenpox)
■■ A very contagious viral infection that is easily ■■ Itchy rash and permanent scarring.
spread through air by sneezing, coughing or ■■ Can cause skin infections and pneumonia.
contact with the lesions on someone who is
infected. ■■ Severe cases are rare but can cause swelling
of the brain. This can lead to seizures, hearing
loss or even death.
Influenza (flu)
■■ A viral infection that is very contagious and ■■ Severe tiredness, cough, fever and no
easily spread through sneezing, coughing appetite.
and contact with someone who is infected. ■■ Seizures or convulsions.
■■ Also easily spread through saliva on food, toys ■■ Can lead to trouble breathing, pneumonia
or other objects. and even death.
■■ Risk of getting influenza is highest between ■■ Babies and children are more likely than
November and April. adults to get very sick and have to be
admitted to the hospital.

Travel Safety
Travelling with children takes some planning. Help
lower your stress and make your family’s trip more
enjoyable by planning ahead.
Think about how you’ll travel, where you’ll be staying,

who you’ll be travelling with and what you’ll be doing
throughout your trip. Thinking about all of these
things before you leave home will help manage stress
and can also help prevent any injuries or new health
conditions that could affect you and your family. Remember to plan ahead for the entire
trip, starting from the time you leave your doorstep to the time you return home. This
includes any stop overs that you have before you reach your destination.
If you’re planning on travelling out of the country, know the risks that can affect you and
your family’s health and safety. Other countries may have different standards of safety,
sanitation and healthcare than in Canada. There may not always be safe food or clean
water available.
Talk with your health care provider about any

Bring a travel
health conditions you or your child have to
bag for your child
make sure that you can manage your health
Bring a bag with healthy snacks, a while you’re away from home. If you or your
change of clothes, toys, music and
child take prescription medicine, make sure you
books. These will help your child if
there are unexpected delays. have the supply you need. Check your health
insurance coverage.
There may also be other health risks to think about when you travel, such as local diseases
and health conditions, the climate, and access to clean drinking water. Contact a travel
clinic at least 2 months before you travel out of the country so that you and your family
have time to get ready and think about information or services you may need such as:
■■ immunization against hepatitis, typhoid and other illnesses
■■ medicine to prevent malaria, gastrointestinal illnesses and other illness
■■ other actions or precautions that you can take to help prevent illness or disease
(e.g., protection from mosquito bites, such as using netting, covering up, using repellent
on exposed skin; thinking about where you’ll stay ahead of time)
To learn more about travel safety and find a travel clinic, visit the Links section at

Common Health Concerns
In this section, you’ll learn about
a number of health concerns Call 911 NOW for any of the
for your child. Babies under following:
6 months may need different ■■ your child’s skin looks grey or blue
or earlier treatment for health ■■ your child is wheezing or having
!!
concerns because of their trouble breathing
age and size. If you have any
■■ your child is breathing much faster
questions or concerns about
or slower than usual or has stopped
your child’s health at any time,
breathing
call Health Link at 811 or talk with
your health care provider. ■■ your child is sleepy and not
responding when you try to wake
them
Caring for a sick
child
When your child is sick, reassure them that you understand how they’re feeling and calmly
explain what you’re doing to make them feel better. Here are some things that might help
your child when they’re sick:
■■ Wash your hands frequently when caring for your child (see page 56).
■■ Keep them comfortable, they’ll need plenty of rest and sleep.
■■ Offer plenty of fluids so they don’t become dehydrated.
■■ Give your child their normal diet—you may need to give them smaller amounts.
Children who are fed normally get better faster than those who are given only liquids
while they’re sick.
■■ If they have a fever, see page 94.
■■ If your child was recently immunized and now has a fever, follow the instructions that
were given by the public health nurse during your appointment (see page 85).
■■ Talk with your health care provider before using any medicine for your child and use it
exactly as directed. Do not give Aspirin® (ASA or acetylsalicylic acid) to children 18 years
old or younger. It can make them very sick.
To learn more about how to care for your sick child, visit the Links section at

Body temperature
A child’s body temperature rises and falls within a normal range depending on the time
of day, activity, their age and other factors. A body temperature higher or lower than the
normal range can be a sign that your child is sick.
Type of thermometer Ages Normal ranges
Underarm (armpit, axilla) All ages 36.5–37.5 °C (97.8–99.5 °F)
Rectal (bum) Birth up to 2 years of age 36.6–38 °C (97.9–100.4 °F)
Ear (tympanic) Children over 2 years of age 35.8–38 °C (96.4–100.4 °F)
When to take your child’s temperature

Take your child’s temperature if they:
■■ feel cool to the touch ■■ are sleeping more or less than usual
■■ feel warm to the touch ■■ have diarrhea
■■ look red and warm (flushed) ■■ are vomiting
■■ are fussier than usual ■■ look or seem sick
■■ are not eating well
How to take your child’s temperature under their arm

One way to take your child’s temperature is in their armpit with a digital thermometer. If
they’ve just had a bath, wait at least 15 minutes before taking your child’s temperature.
Follow the manufacturer’s instructions for using the thermometer. If there are no
instructions, follow these simple steps and use simple words to calmly explain what you’re
doing to your child.
1. Clean the thermometer according to the manufacturer’s instructions. If there are no

instructions, clean the thermometer with warm, soapy water and rinse with cool water.
2. Loosen your child’s clothing to the waist.
3. Turn on the thermometer by pressing the on/off
button. You should hear a beep.
4. Place the thermometer horizontally under your
child’s arm with the tip in the centre of their
armpit and the other end sticking out front.

5. Tuck your child’s arm in snugly but gently against
their body.
6. Leave the thermometer in place until you hear
the beep. This can take up to 1 minute.
7. Remove the thermometer and read the
temperature. Write down the temperature and
the date and time you took it so you can tell your
health care provider if they ask.
8. Turn off the thermometer by pressing the on/off button.
9. Clean and dry the thermometer.
How to take your child’s temperature in their ear

When your child is 2 years or older, you can take their temperature using an ear (tympanic)
thermometer. An ear thermometer is not recommended for children under 2 years as it
may not give an accurate reading.
If your child has just had a bath or has been playing outdoors in cold or hot weather, wait
15 minutes before taking their temperature. Follow the manufacturer’s instructions for
using the thermometer. If there are no instructions, follow these steps as a guide.
Calmly talk with your child about what you’re going to do.
They can either sit on their own or on your lap.
1. Put a new, clean lens filter on the tip of the

thermometer.
2. Turn the thermometer on by pressing the on/off
button. It’s ready to use once the ‘ready’ symbol
appears.
3. Use your fingers to gently pull your child’s ear up and
back to straighten their ear canal and gently place the
tip of the thermometer into their ear canal.
4. Leave the thermometer in place until you hear the
beep. It only takes a few seconds.
5. Remove the thermometer, read the temperature and write it down. Note the date and
time you took the temperature so you can tell your health care provider if they ask.
6. Turn off the thermometer by pressing the on/off button.
7. Throw the used lens filter away after use.

Fever
Body temperature is one way to
tell if a person is unwell. When your Learn how to take rectal temperature
child is sick, it’s common for them You can take a rectal temperature using a
to have a temperature that’s higher suitable thermometer.
than normal (fever). To learn more about how to do this safely and
the normal temperature range when taking a
A fever is not an illness. It’s a sign rectal temperature, visit the Links section at
that your child’s body is trying to healthyparentshealthychildren.ca/resources
fight an infection. A fever usually
goes away after about 3 days.
How high a temperature is Glass and strip thermometers
does not tell you how serious
A glass thermometer to take your child’s temperature
your child’s illness is. The way is not recommended as it may break. The broken
your child is acting is a better glass and mercury inside it are both dangerous.
sign. A child with a mild illness
A plastic strip thermometer is also not recommended
can have a high fever, while as it may not give an accurate reading.
a child with a serious illness
might have no fever at all.
“ For me I found that calling Health Link was very helpful. I would say ‘here’s what’s
”
happening, what should I do?’ They are really good about assessing, giving you a
game plan and helping you out.
~ Daeun, mom of two children
When your child has a fever:

■■ Keep them comfortable and offer plenty of fluids.
■■ Take off extra blankets and clothing so that heat can leave their body. This can lower
their body temperature.
■■ Do not take off all their clothes or give them a lukewarm bath. This can make them too
cold and start to shiver. This will create more body heat, making their temperature go up.
■■ Do not give your child alcohol baths or rubs as these can cause serious side-effects.
■■ If your child was recently immunized and now has a fever, follow the instructions that
were given by the public health nurse at the visit (see page 85).

Medicine is not usually needed to treat a fever but it may help to relieve aches and pains.
■■
Do not give Aspirin® (ASA or acetylsalicylic acid) to children 18 years old and younger. It
can make them very sick. Talk with your health care provider about using medicine and
use exactly as directed.
Babies under 6 months with a fever need to be seen by a health care provider right away
because they can become sick very quickly. Children over 6 months old with a fever need
to see a health care provider if their fever:
■■ does not go down and you’ve tried the
suggestions above Check before using
■■ lasts more than 72 hours Talk to your health care provider before
giving any medicine, supplements or
■■ includes any other symptoms that natural health products to your child.
concern you
Vomiting (throwing up)

It’s common for your baby to spit up a bit of milk after feeding. It’s not common for a baby
to vomit milk with force—enough that the milk hits the wall or is very forceful. A child
who suddenly starts vomiting may be sick. Keep track of how often your child is vomiting.
Vomiting can be very serious in a baby or young child as they can get dehydrated (see
page 96) very quickly.
If your child is vomiting and showing signs of becoming dehydrated, call Health Link at 811
or talk with your health care provider.
Diarrhea
Diarrhea stools look much different from your child’s
usual stools. They can be very runny, watery with If your child is sick
mucous or blood or be a different colour. Diarrhea If your child has vomiting or
bowel movements can happen more often, smell bad diarrhea, wash and disinfect
or come out with a lot of force. any soiled surfaces and
bathroom fixtures until the
Some children need special attention when they have illness is over. Use a solution
diarrhea because they can easily become dehydrated: of 100 ml (just under ½ cup)
of bleach mixed with 1 L
■■ babies, especially those younger than 6 months (4 cups) of warm water.
Wear gloves to mix and use
■■ children with health risks
the solution.
■■ a child who has had repeated bouts of diarrhea—
one after another

If your child has diarrhea and showing signs of becoming dehydrated, call Health Link at
811 or talk with your health care provider.
Dehydration
Babies and small children can get dehydrated more easily than adults. It can happen
quickly and can be dangerous.
Here are some signs that your baby or child may be dehydrated:
■■ dry mouth or tongue
■■ no spit (saliva) or tears Call Health Link at 811 or your
health care provider NOW if you
■■ eyes look sunken
notice your child has any of the
■■ peeing (urinating) less often following:
■■ weak or sleepy and does not want to
do anything
If your child is showing signs of

! ■■
■■
■■
signs of dehydration
vomiting with a rash or a fever
a lot of pain in the abdomen or
dehydration, call Health Link at 811 or pain that is not going away
talk with your health care provider. ■■ any other signs that concern you
Constipation
Constipated stools are hard, dry and can hurt or be difficult to pass. Do not give your baby
or child laxatives, suppositories, enemas, medicine or home remedies for constipation.
By the time your baby is 4–6 weeks old, they may have fewer stools. This is normal as long
as their stools are soft and do not hurt to pass. Breastfed babies rarely get constipated.
If you think your baby or child is constipated, make sure they’re getting enough to drink
and call your health care provider.
To learn more about constipation, visit the Printables section at


Skin rash
Children’s skin is very sensitive, so rashes can develop easily. Most rashes will go away on
their own in 1 week and don’t require any special treatment or medicines. Rashes can be
caused by:
■■ overheating ■■ diapers worn for too long
■■ illness or allergy ■■ insect bites
■■ products with perfume in them ■■ bath soaps
■■ laundry soap, bleach or fabric softeners
in clothing
Call Health Link at 811 or your health care provider if you notice your
child has any of the following:
■■ a rash that:
!
does not start to get better in 2 days
is bright red and in the deepest folds of the groin and buttocks
looks like blisters
comes with signs of infection, such as a temperature higher or lower
than normal or your child being fussier than usual
■■ a cough or red eyes

Diaper rash
Diaper rash is the most common skin rash for babies and young children. It’s often caused
by leaving a wet or dirty diaper on too long or by the diaper rubbing against the skin. It
can be very uncomfortable.
If your child develops a diaper rash:

Call Health Link at 811 or
■■ Change their diapers often.
your health care provider if
■■ Use warm water and a clean cloth to gently you see a diaper rash that:
and thoroughly clean and dry the area.
!
■■ lasts longer than 2 days
■■ Avoid using baby wipes unless you ■■ looks like blisters
absolutely need to, such as when you’re not
at home. ■■ looks like a burn or is
bright red
■■ Try a different brand of disposable diapers.
■■ looks like red dots or
■■ Use plastic pants (diaper cover) made from bumps
a breathable material, if you’re using cloth
diapers.
■■ Expose their diaper area to air for 10–15 minutes at least 3 times a day.
■■ Put on a thin layer of barrier cream before putting on a diaper.
■■ Wash your hands before and after each diaper change.
Thrush
Thrush is a type of yeast infection that’s common in babies. If your child has thrush, you’ll
see white patches on their mouth and tongue. These patches can look like milk curds.
Thrush can make your child’s mouth sore and affect how well they feed.
If your child’s mouth or tongue are covered with a white coating that can’t be gently wiped
away with a wet cloth, call Health Link at 811 or talk with your health care provider. To learn
more about thrush, visit the Links section at healthyparentshealthychildren.ca/resources

Colds
Colds are caused by many different viruses and are common in children. They cause runny
noses, sneezing, coughing and fevers. Children often get a lot of colds when they’re very
young and fewer as they get older.
Colds get better on their own. Keep your child comfortable and hydrated. If your child has
a cold:
■■ Wipe their nose if it’s runny. ■■ Keep feeding your baby based on their
■■ Dress your child in comfortable clothing feeding cues.
and help them get lots of rest. ■■ Give your older baby or child extra fluids.
■■ Wash your hands often, as the germs
that cause colds are spread easily.
Respiratory syncytial virus (RSV) is both a common cause of colds and a cause of more
severe colds that includes fevers, red eyes, sore ears, runny or stuffy noses, wheezing and
fast breathing. If your baby is under 12 months old, was premature or has heart or lung
disease, they may become much sicker with RSV. Most children have a mild cold caused by
this virus by the time they’re 2 years old.
To reduce the chances of your child getting RSV:

■■ Wash your hands with soap and water ■■ Stay away from crowded places.
before touching your child or preparing ■■ Keep your child away from smoke and
anything for them. vapour from tobacco.
■■ Keep people with a cold or fever away
from your child.
Cough
Cough is a common cold symptom and there is no
medicine to make it go away faster. Coughing gets rid of
mucous in the throat and lungs. The cough will get better
as your child feels better. Teach your toddler to cover their
mouths when they cough. When they’re a little older,
they can learn to cough into their inner arm so they do
not spread the germs to others. Cough medicine is not
recommended for children under 6 years of age—it can
have harmful side-effects.

Call Health Link at 811 or your health care provider NOW if your child
has a respiratory illness and any of the following:
■■ does not get better in a few days ■■ sounds noisy, wheezy or different
or is coughing all the time than usual when they breathe
! ■■
■■
does not get better from one cold
before getting another
is not able to sleep or do their
■■
■■
is under 6 months old and has a
fever
seems to have a stiff neck or cries
normal daily activities when turning their head
■■ works hard to breathe or catch ■■ has any other signs that concern
their breath you
Croup
Croup can start suddenly, often after Call Health Link at 811 or your
a cold or a runny nose. Children who health care provider NOW if
get croup make a barking noise when your baby or child has any of
they cough and have to work hard the following:
!
to breathe. It’s caused by a virus, so ■■ a fever
antibiotics do not work on it.
■■ breathing that doesn’t get better
Croup can be scary for parents, but after 15 minutes of cool air
it’s usually mild and can be managed ■■ breathing, coughing or other
at home. Try wrapping your child in a symptoms that are getting worse
warm blanket and take them outside— ■■ any other signs that concern you
the cool air may help settle the cough.
Ear infections
Ear infections are caused by an infection behind the eardrum in the middle ear. They’re
very common in children and not all ear infections need to be treated. They often happen
after your child has had a cold. Children with an ear infection may have a fever. If they have
an ear infection, your child may:
■■ seem generally unhappy ■■ pull at their ears
■■ have trouble sleeping ■■ cry or show signs of pain when their
■■ have fluid coming from the opening of position is changed, such as when they
their ear lie down

Ear infections are a common cause of short-term
hearing problems. While these hearing problems
don’t last long, even a short-term
hearing loss can affect how your child
listens and learns. To learn more about
ear infections, visit the Links section at

Second–hand smoke
your health care provider
When children are exposed to second-
!
if you think your child has
hand smoke, their risk of ear infections,
an ear infection or if you
asthma, bronchitis and pneumonia
think they’re having trouble increases. Make sure no one smokes
hearing. Some ear infections around your child. For information on
may need to be treated. quitting tobacco, see page 141.
Nosebleeds
Nosebleeds are common in children and are not usually serious. They’re often caused by
dry air. A cool mist humidifier can help if you have one. You can also increase the setting
on your home humidifier if you have one.
If your child has a nosebleed:

Call Health Link at 811 or your health
1. Have them sit down and lean
care provider if your child has any of
forward in a chair.
following:
2. Use a tissue to pinch the soft,
lower part of their nose, not the
nostrils.
! ■■
■■
a nose that looks broken or will not
stop bleeding
4 or more nosebleeds in a week
3. Pinch for about 10 minutes
without releasing, firmly but ■■ any other signs that concern you
gently. Pinching on and off will
not stop the bleeding.

Head injury
Young children cannot control the movement of their heads as well as adults can. Because
of this, your child may be likely to hit their head as they become more active. If your child
hits their head, check for other injuries to the face, mouth, or teeth to see if you need more
medical attention.
A concussion is a brain injury that can result from an impact to the head, but also to the
face, neck, or body. Concussions can result from activities, such as sports, household or
playground falls, and motor vehicle crashes.
To learn more about head injuries and concussions, visit the Links section at
Healthy Homes
Cleaning and sanitizing
Keep your home clean with ordinary household cleaners. You do not need to use anti-
bacterial products. Read labels on your household cleaners and follow the instructions for
using, storing and disposing of them. If the label says to use the cleaner in a well-ventilated
area, open a window while you use it. Inhaling the fumes can be dangerous for you and
your child. Make sure cleaning products are securely stored in an area where your child
cannot reach them.
To clean and sanitize household surfaces and toys:

1. Wash with a detergent and warm water 2. Spray or soak for 2 minutes to kill germs.
or mix 2.5 ml (½ tsp) household bleach 3. Rinse with clean, warm water.
in 1 L (4 cups) of water.
4. Let air dry.
Air quality
A clean and dry home helps limit contaminants in the air. Mould can cause many health
problems such as wheezing, coughing or allergic reactions. Children are more sensitive to
poor air quality then adults, this includes exposure to second-hand smoke.
Keep the humidity levels in your home no higher than 50% to reduce the risk of mould.
Change your furnace filters as needed.
contaminants: things that make a place or substance such as water, air or food not pure

Carbon monoxide is a harmful gas that can cause health problems before
people even know they’re being exposed to it. It can cause headaches and
make you feel tired. At higher levels it’s more serious and can even cause
death. Use a carbon monoxide detector to help protect your family.
To learn more about the air quality in your home, visit the Links section at
Lead
Lead is a chemical found naturally in the environment. It can also be found in some
manufactured products, household building materials, toys and jewellery. Lead can be
dangerous for pregnant women, babies and young children. Lead is no longer used in
water pipes but it may still be present in old pipes or soldered joints.
Here are some things you can do to help make sure your family is not exposed to lead:
■■ Read the manufacturer’s labels on products you give to your child. Toys and jewellery
made outside Canada or the United States may contain lead. If you’re not sure, don’t let
your child play with the toy or wear the jewellery.
■■ Run the tap before using water that hasn’t been run for a number of hours—especially if
you live in an older home.
■■ Use cold tap water for drinking and cooking. It has less lead than hot tap water.
■■ Older homes may have lead-based paints in them. Look for and follow
recommendations on how to complete renovations safely.
■■ Dusting, vacuuming and wet-mopping your house regularly will help keep down levels
of dust that may contain lead.
■■ If anyone in your family works with or does hobbies with lead, such as working with
stained glass, showering and changing their clothes afterwards will help reduce the
amount of lead on their body.
■■ Store food or liquids in containers that are lead-free. Some food containers, such as
crystal glass or glazed and ceramic dishes may also have lead in them.
To learn more about lead exposure, visit the Links section at


Preventing Injuries
More children die each year from injuries than from all childhood diseases combined.
Most injuries happen at home and can be prevented. Young children are at a higher risk
of getting injured than adults. This is because young children do not have the physical or
thinking abilities to understand and stay away from dangers.
Once your baby starts moving, they’ll want to go everywhere and do everything. They’re
trying to figure out the world around them. They’ll also explore by putting things in
their mouth. Encourage your baby to discover, but watch closely while they explore to
help them stay safe. As they grow older, keep your child safe by making sure they wear
the right protective gear and get the right training for any sport or recreational activity
they’re doing.
It will take time for your child to learn how to stay safe and follow safety rules. Look for
chances to talk about risks and to teach and model safety rules every day, such as looking
both ways before crossing the street with them. Do not expect your child to follow these
rules on their own right away or all the time—you’ll need to repeat them many times and
for many years. This is how children learn.
To learn more about keeping your family safe from injuries, visit the Links and Printables
sections at healthyparentshealthychildren.ca/resources
First aid
Many childhood injuries and common problems at home may just need basic first aid.
It can help to be prepared. Taking a first aid and cardiopulmonary resuscitation (CPR)
course will help you learn how to respond.
Keep first aid supplies such as bandages, gauze and tweezers on hand.
Put emergency numbers in a place where everyone in your family can find
them. To learn more about first aid, call Health Link at 811 or visit the Links
Falls
Falls are the leading cause for injury-related hospital visits for babies and children. Falls can
be prevented.
Falls can happen before your baby can move much, even if you’re in the same room.
Babies can easily fall from furniture and other surfaces when they kick, wiggle, roll and
push against things with their feet. Since a baby’s head is large compared to their body
their head will often hit the ground first and take the impact.

To keep your baby safe:
■■ Be by their side. Always be at your
baby’s side—never leave them alone
on a raised surface. If you need to
step away, even for a moment, take
them with you or move them to a
safe place such as their crib, cradle,
bassinet or playpen.
■■ Be hands-on. Keep one hand on
your baby when they’re on any high
surface, such as a change table, bed
or counter, even if they’re in a safety strap.
To be safe, you can also change your baby’s Supervise for safety
diapers on a clean pad on the floor instead Supervision is one of the best ways
of a raised surface. When carrying your to prevent injuries in children.
newborn, use both hands and hold them
close to your body.
■■ Keep car seats and infant chairs off of raised
surfaces like furniture, counters or dryers.
■■ Use safety straps. Use the safety straps in your
baby’s stroller, high chair, change table, car seat,
baby seat and baby swing as well as in shopping
carts. Straps that go around your baby’s waist
and through their legs are the safest type,
especially when your baby is learning to stand,
as they cannot slide through.
■■ Lay them down. If you’re holding your baby
and feel sleepy, make sure you lay them down in
a safe place so they don’t fall if you fall asleep.
■■ Stay awake while feeding or holding your
baby. To help you stay awake, try chewing gum,
wiping your face and neck with a wet cloth or Reproduced with permission from KidCo Inc.
(2016).
keeping the room lights, TV or music on.
■■ Use the floor. Place car seats, baby chairs and
bassinets on the floor—not on a counter, bed
or sofa.

Falls can also happen when your baby and
child are climbing the stairs, on furniture or
at the playground. To keep them safe:
■■ Install sturdy, mounted stair gates
at the top and bottom of each stairwell
before your baby starts to crawl. At
the top of the stairs, use a gate that is
permanently attached to the wall or
banister. It’s not recommended to use
gates that stay in place using pressure
(pressure gates) at the top of stairs. Your
baby’s weight could cause a pressure
gate to fall over if they lean on it. Use
pressure-mounted gates only at the
bottom of stairs—never at the top.
■■ Install and use window safety devices on all windows higher than ground level.
These windows should not open more than 10 cm (4 inches). Choose window safety
latches that an adult can quickly open in an emergency.
■■ Move furniture away from windows. This includes your child’s crib, bed and other
furniture such as dressers.
■■ Secure furniture. Make sure furniture like dressers and bookcases are secured to the
wall. Put the TV far back on a low, stable stand, attach it to the stand, or secure with
a safety strap. Do not place items that may appeal to your child on top of the TV or
furniture.
■■ Move your baby’s crib mattress to its lowest position once your baby can sit.
■■ Move your toddler from a crib to a bed
before they’re tall enough to climb over Falling from windows
the crib rails when the mattress is at its Falling from an open window can
lowest height. seriously injure or even kill a child. The
screens on windows are not strong
■■ Do not use bunk beds until your child is
enough to keep your child in. Be sure
at least 6 years old. to move furniture away from windows,
■■ Keep furniture off of balconies so your use window safety devices and close
child cannot climb on them and fall over and lock all windows at all times.
the railings.

Choking and poisoning
Your baby explores and plays by putting
things in their mouth, which increases their
risk of choking and poisoning. If something
goes into your baby’s hands, you can
expect it to go into their mouth. Food is
the most common cause of choking for
children. To learn about foods to avoid, see
page 59.
If an item can fit inside an empty toilet

paper roll, it’s too small for your baby or If an item can fit in a toilet paper roll, it’s too small for
young child—they could choke on it. your baby or young child.
To help prevent them from choking or

being strangled:
■■ Keep small toys, latex balloons and items such as coins
and jewellery away from them. Balloons
Latex balloons or pieces
■■ Do not put a necklace, string, ribbon or chain of any
of broken balloons can
kind around the neck of a child under 3 years old. be inhaled and block the
■■ Do not use clothing with drawstrings or cords as these airway. Keep them out
can get caught around your child’s neck or on other of your child’s reach—
objects and strangle them. whether they’re inflated
or not.
■■ Do not use clothing with fixed hoods—choose
clothing with break-away hoods instead.
You can find other potential dangers by looking at your home environment from your
child’s point of view. Get down on your hands and knees and crawl on the floor or walk
around the room to look for possible safety concerns. Remove any tiny toys or objects
from all of the rooms that they may be able to get into. Lock or install childproof latches on
drawers in the kitchen and other rooms, as needed.
Young children are naturally curious and have the highest risk of poisoning from
swallowing, inhaling or eating toxic substances, or getting them on their skin. Here are
some things you can do to help prevent poisoning:
■■ Keep all prescription and over-the-counter medicine, alcohol, tobacco and tobacco-
like products, cannabis and other drugs locked up, out of sight, and in their original
containers. Child-resistant caps on medicine bottles help but they’re not childproof.

■■ Keep items such as household cleaners,
!!
dishwasher and laundry detergents, garden Call 911 NOW if you
products and cosmetics locked away and out of have a poisoning or
reach for your child. choking emergency.
■■ Keep houseplants out of your child’s reach.
■■ When family or friends come to visit, put their purses, backpacks and coats out of your
child’s reach. This will help prevent your child from getting into things that are not safe.
If you have any questions or are not sure about a product’s safety, call the Poison and Drug
Information Service (PADIS) 24/7 toll-free at 1-800-332-1414 or visit the Links section at
Blinds and curtains

If you have window coverings with cords, always keep them short, secured and well out of
your child’s reach. Cords and loops can get around your child’s neck and strangle them.
Cordless window coverings are the safest. If you cannot replace all of your window
coverings with cordless ones, replace the window coverings in your child’s bedroom
and play spaces. If this is not an option, you can:
■■ Cut the loops on window blinds, drapery and curtain cords.
■■ Keep cords short, secured and well out of reach.
■■ Install a cleat or tie-down device up high on the wall to keep cords out of reach.
Button battery safety

Button batteries are found in watches, hearing aids, remote controls, musical greeting
cards, and other small electronic devices. These batteries can be an attractive object to a
young child, and because of their size and candy-like appearance, are a risk for swallowing.
Swallowing these batteries can make your child very sick and may even cause death. To
help prevent injuries caused by swallowing button batteries:
■■ Keep batteries locked up, out of reach and out of sight of your child.
■■ Only buy and use products with secure battery compartments that your child cannot
open. Use the screws provided and tape to seal battery compartments.
■■ Supervise your child when they use products that have button batteries.
■■ Look for loose batteries on floors, tables and counters. Dispose of batteries so that your
child cannot find them. Be careful when storing and disposing of batteries. Even dead
batteries can cause harm if swallowed.
If your child swallows a button battery, do not try to remove the battery by causing your
child to vomit (inducing vomiting). Go to the Emergency Department NOW if your child
has swallowed a button battery.

Burns and scalds
Babies and children have thin, sensitive skin that burns easily. Burns are one of the most
common injuries among children under 6 years of age. They can be caused by scalding,
chemicals and contact with flames, hot objects and electrical sources.
To help prevent burns and scalds:

■■ Turn the temperature of your hot water heater down to no more than 49 °C (120 °F) or to
the warm setting. Always test the water before putting them in the bath.
■■ Install safety gates around fireplaces. When outdoors, keep your child away from
barbecue grills and campfires.
■■ Keep chemicals such as toilet cleaner, bleach, oven cleaners and drain cleaners locked
away, out of reach and out of your child’s sight.
■■ Use safety covers on all electrical outlets and unplug items in your child’s reach.
■■ Do not use electric blankets, heating pads or
hot water bottles on your child.
■■ Keep hot liquids away from your child. Use lids
on your hot drinks, even at home.
■■ Cook on the back burner of the stove and turn
pot handles towards the back of the stove.
■■ Do not hold your child while cooking.
To learn more about preventing burns and scalds, visit the Links section at
Fire safety
Here are some things you can do to help prevent fires and keep your family safe:
■■ Install a smoke and carbon monoxide detector on every level of your home. Test the
batteries every month and change the batteries twice a year if the detector is not
hardwired. It’s easier to remember to change the batteries if you pick dates that are
meaningful, such as when you change the clocks in the spring and fall.
■■ Keep lighters and matches locked up and out of your child’s reach.
■■ Always monitor candles that are being used.
■■ Do not use items such as space heaters when you’re asleep or away from home.
■■ Close bedroom doors at night to protect your family from fire and smoke.
scalding: injury caused by very hot liquid or steam

■■ Use safety covers on all
electrical outlets. Keep Safer sleepwear
electric cords out of Children’s sleepwear sold in Canada must meet
children’s reach. strict flammability requirements to be safe for sleep.
■■ When choosing your child’s Requirements for daytime clothing are not as strict
so these are less safe for your child to sleep in.
sleepwear, make sure it’s
made from materials that
are harder to catch fire and burn slowly such as polyester or nylon fabrics. Tight fitting
pyjamas are less likely to catch fire than loose fitting pyjamas. Day clothes for sleeping,
like t-shirts, may not protect your child from getting burned so it’s better to dress your
child in actual sleepwear.
As your child gets older, they’ll learn how to respond to fires through fire drills at school.
Help your child learn about fire safety at home too. Plan and practice how your family will
get out of the home if there’s a fire as well as where to meet so that you’re out of danger.
Teach your child to:

■■ Follow your family’s fire plan.
■■ Get low and go—crawl along the floor to stay below the smoke.
■■ Climb out of a window safely.
■■ Stop, drop and roll if their clothes are on fire.
To learn more about general fire precautions, visit the Links section
at healthyparentshealthychildren.ca/resources
Reproduced with permission
from Allred, A. (2017).
Nightlights
A nightlight may be an attractive object to a young child. Some decorative nightlights
such as a ‘bubble’ nightlight have dangerous chemicals inside that can be harmful for
your child if they break.
If you use a nightlight, ensure that you protect your child from fire, electrical shock or
poisoning by:
■■ using the nightlight as instructed by the ■■ unplugging the nightlight when it’s not
manufacturer being used and covering the electrical
■■ buying a nightlight that does not have outlets after removing the nightlight
decorative shapes or cartoon characters ■■ buying a nightlight that says it’s ‘cool’
■■ using a nightlight with child-safety and ‘does not overheat’
features

Water safety
Babies and children should never be left
Never leave your child
unattended in, around or near water, not even
alone near water
for a few seconds. This includes bathtubs, toilets,
Even if your child knows how to
pools or wading pools or even a bucket of water.
swim, never leave them alone
Children under 5 years old can drown in as little as
near water. Supervision is the
2.5 cm (1 inch) of water, and this is especially true best way to prevent drowning.
for babies as they do not have good head control.
Here are some ways you can help protect your child from drowning:
■■ Stay with your child when
you’re bathing them.
■■ Never leave your baby
alone in the bathtub with
an older sibling. Bathtub
rings are not safe for
babies.
■■ Be within arm’s reach
when swimming—
lifejackets and water wings
are not a replacement for
supervision.
■■ Keep toilet lids down and
make sure that they’re
never left alone around
toilets.
■■ Supervise children closely around water including lakes, rivers, ponds, wells, open
postholes and irrigation or drainage ditches.
■■ Store coolers out of your child’s reach. Empty coolers after you’re done with them.
■■ If you have a backyard pool, install gated fencing around it. Fencing should be at least
120 cm (4 ft.) high.
■■ Learn how to swim, if you don’t know how.
■■ Teach your child how to swim—swimming lessons alone will not prevent drowning.
Supervision is always needed.

Pet and animal safety
Children can learn a lot about
life and caring for others from
having a pet. Teach your child
to treat all animals gently and
with respect—you’ll need to
remind them frequently to do so
as it takes a long time for them
to learn responsibility. Always
supervise your child around pets
and other animals.
Some pets such as turtles, snakes

and lizards can carry salmonella, a
bacteria that can make your child
sick. Other pets and animals, such
as cats, can pass on a parasite
that can make your child sick
(toxoplasmosis). Here are some
ways to reduce the risk of your
family being exposed:
■■ Make sure you and your child
wash your hands well after
touching and handling any pet
or animal.
■■ Do not feed your pet raw meat.
■■ Do not let your child handle
turtles, ducklings, baby chicks or small pets—
they may want to kiss or lick them and could get Wash hands well
very sick. Everyone in the family should
wash hands well with soap and
■■ Cover sandboxes so that cats and birds don’t use water after:
them as litter boxes.
■■ touching or handling pets or
■■ Wear gloves when gardening so you don’t animals
touch pet or animal stool. Wash your hands well ■■ doing any gardening
afterwards.
■■ scooping a cat’s litter box
■■ Scoop your cat’s litter box every day and wash
your hands well after.

For more information on tips to help your pet adjust to a newborn, see
page 257. To learn more about staying healthy around pets and animals, visit
the Links section at healthyparentshealthychildren.ca/resources
Children are more at risk for dog-related injuries including dog bites. Teach your child not
to tease or touch dogs in a way that might hurt them. Never let your child pull a dog’s ears,
tail or fur. They should not disturb dogs while they’re sleeping, eating, chewing a bone, or
playing with a toy.
Help protect your child from being bitten:

■■ Do not allow your dog to sleep with your child.
■■ Socialize and train your dog. Ask your veterinarian about dog training classes.
■■ Do not play aggressive games with your dog.
■■ Make sure you have a quiet and comfortable place for your dog to go to if they want to
get away.
In addition, teach your child to:

■■ Always ask a dog owner if they can approach or pet their dog.
■■ Approach a dog cautiously and let the dog sniff them before they pet.
■■ Never run or scream if a dog comes up to them. Tell your child to stand still like a statue
or a tree.
■■ Roll into a ball, be still and cover their face if a dog knocks them over.

Playing outdoors
Children are naturally drawn to playing outside. It
helps them explore their surroundings, problem-
solve, use social skills and build self-confidence.
It also gives them a chance to practice skills,
challenge themselves and be creative.
Your child can connect with nature by exploring

playgrounds, climbing, jumping in puddles,
building snowmen, running in open spaces or
digging in the sand or dirt. They need to play in
safe surroundings to reduce their risk of injuries
while playing outdoors. Make sure your child
dresses appropriately for the weather and wears
protective gear for whatever sport or recreational
activity they do.
Be ready for the weather

Protect your baby and child from Be safe when doing winter activities
the heat, cold, sun and insects when There are lots of fun winter activities you
they’re outside. Since children have can do as a family, such as tobogganing and
smaller bodies, they’re more at risk skating. To learn more about being safe while
than adults of becoming too cold doing these activities, visit the Links section at
(hypothermia) or too hot (heat healthyparentshealthychildren.ca/resources
stroke). Make sure all of your outside
doors are secure so that your child cannot get out on their own.
When it’s cold outside

Children, especially babies, are more likely to
suffer an injury from being exposed to the
cold because they:
■■ have a large body surface area compared
with their weight, which means they lose
body heat faster
■■ do not regulate their body temperature
well, which means they’re not able to shiver
■■ do not have much fat under their skin,
which means they cannot stay warm

In cold weather:
■■ Dress your baby or child in
layers. Do not bundle them
too tightly. As it gets warmer,
remove layers.
■■ Use a hat.
■■ Wear a neck warmer instead
of a scarf. Scarves are not
recommended as they
can hang down, catch and
strangle your child.
■■ Put a blanket over your child
for warmth after they’re
buckled into their car seat—
be sure not to cover their face.
Keep children inside when the temperature or the wind chill drops to below -27 °C (-16.6 °F)
or when the weather is extreme, such as during a snowstorm. At these temperatures
exposed skin will freeze.
When it’s warm outside

Try to stay out of the sun when the sun’s ultraviolet (UV) rays are strongest—between
11 am and 3 pm. Before going outside, check the weather forecast for the daily UV index.
Be extra careful to protect your
child’s skin on days when the UV
The sun and vitamin D
Index is 3 (moderate) or more.
Even though our body makes vitamin D when
Babies under 12 months old are we’re in the sun, it’s not a safe or sufficient
especially sensitive to the sun. way to meet your child’s vitamin
D needs. Starting at birth, all
They have thin skin and can
children need a 400 IU vitamin D
burn easily. Keep them out of supplement every day. To learn
the sun. more, visit the Printables section at

To protect your child when it’s warm outside:
Hot vehicles can kill
■■ Keep them out of direct sunlight when
Never leave your child alone in a
possible. car. Every year, there are children
■■ Teach your child to play in the shade. in Canada that die from being left
inside a car that has become too hot.
■■ Use a light blanket to create shade over
your baby. Be sure the blanket doesn’t
touch their face to prevent them from being
smothered. Wash it off
■■ Keep your child cool and protected with loose When sunscreen or insect
repellent are not needed
fitting and light coloured clothing. Keep their
anymore, wash them off the skin
arms and legs covered when possible. well with soap and warm water.
■■ Use a wide-brimmed hat to protect their face
and neck.
■■ Make sure your child drinks extra water to prevent dehydration. Younger babies may
need to feed more often.
■■ Use UV blocking sunglasses to protect your child’s eyes from the sun’s harmful UV rays.
If you’re travelling to warmer climates, these precautions are even more important. It may
be even warmer there and the sun may be more intense, making it more dangerous for
your child.
Never leave your child alone in the car. Your car can heat up quickly, even on days that do
not seem very warm. The temperature can quickly become high enough to cause death.
Sunscreen
Using sunscreen on babies younger than 6 months old is not recommended. For babies
over 6 months old, ask your health care provider before using sunscreen.
All children over 1 year old need to use sunscreen:
■■ Choose a broad spectrum sunscreen with a sun protection factor (SPF) of 30 or higher.
It should protect from UVA and UVB rays and be water resistant.
■■ Put on sunscreen 20 minutes before going outside.
■■ Use an SPF 30 lip balm on your child’s lips.
■■ Re-apply sunscreen every 2 hours and after any activity that gets your
child wet or sweaty.
To learn more about sun safety, visit the Links section at

Insect repellent Combined
Depending on your child’s age, you can use insect protection
repellent to lower their chances of being bitten by When using both
an insect. There are many different kinds available sunscreen and insect
and some work better than others. DEET gives the repellent:
longest-lasting protection against mosquito bites.
1. Put on the sunscreen.
■■ Do not use on babies under 6 months old. Use
2. Wait 20 minutes.
mosquito netting and try not to be outside when
insect activity is high. 3. Put on the insect
repellent.
■■ For children 6 months to 2 years old, use insect
repellent only when there’s a high risk of insect Combination sunscreen
bites that can spread infections and diseases. Do and repellent products are
not use more than once a day. not recommended. The
sunscreen or the repellent
■■ For children over 2 years old, you can use insect
may not work as well when
repellent up to 3 times a day.
it has been combined.
When using insect repellent for your child, use just
enough of the least-concentrated formula of DEET
(10% or less) on their exposed skin and clothing.
Keep insect repellent away from their
face, hands and any irritated skin.
To learn more about insect
repellents, visit the Links section at

Helmets
Bike helmets reduce the risk of head injury in a crash
by 80%. In Alberta, anyone under 18 years old must
wear a helmet when riding a bicycle or tricycle or
when in a bike trailer or carrier—it’s the law. Helmets
are also strongly recommended for adults. Wearing
your own helmet protects your brain and models the
safety behaviour you want your child to learn. Make
helmets a habit for your whole family.
Helmets are also recommended for activities such

as tobogganing, skiing, snowboarding, and activities
on ice such as hockey and skating. Use helmets that
are designed for the activity, such as a hockey helmet
when you’re skating or a bike helmet when you’re riding a bike. Wear helmets that meet
approved helmet safety standards—look for a CSA, Snell or an ASTM sticker.
Your child’s helmet needs to be worn properly.

It needs to be checked often to make sure Protect your head too!
it still fits—children grow quickly. To learn You’re a role model. When you wear
more about bike helmets and to take the a helmet, you help make it a habit
Bike Helmet YES Test, visit the Links section at for your entire family.
Bike safety
Most children are ready to ride a push bike or tricycle by age 3. By age 5 or 6, children may
have the physical skills to ride a bicycle. Fenced areas such as a backyard or a park are the
safest places to ride. Driveways are dangerous because drivers may not see your child
when they’re pulling in or backing out. Children
should always be accompanied by an adult
Bike trailers and carriers
when riding a bike, especially near traffic.
Children less than 1 year old don’t
Your child is not ready to ride on the road have the neck and head control to
until they’re able to judge traffic and safety ride safely in a bike carrier or trailer.
risks. Their ability to ride on the road is Do not put your child under 1 year
of age into a bike trailer or a carrier.
based on their experience, environment and
For children over 1 year old, always
development. Before they can ride on the road use a properly fitting helmet and
they will need to learn the rules of the road and make sure they’re safely secured.
to judge traffic safety.

They’ll also need to learn to:
■■ Pay attention to where
they’re going.
■■ Watch for cars and traffic
safety signs.
■■ Use brakes and signals.
■■ Pass pedestrians.
■■ Stay away from major risks
such as busy intersections or
hidden driveways.
Remember, children under

10 years old should always
ride with you or an adult, even
if they take the same route several times a week (e.g., between home and school). Ride
with your child to teach them the safety rules they’ll need to know, such as watching for
pedestrians and stopping at all stop signs, even when they’re on the sidewalk. Make sure
they have basic skills before going on the road with them.
Is your child’s bicycle in good condition?

If you think your child is ready for a bicycle, make sure it’s in good condition. Here are
some questions to ask:
■■ Is the bike the right size for my child? ■■ Does the bike have a light, reflectors and
Bikes that are too big or too small are a horn or a bell?
dangerous. ■■ Have I checked the ABCs?
Can my child touch the ground with Is there Air in the tires?
their feet? Have your child sit on the
bike. Adjust the height of the seat Are the Brakes clean and working?
until their toes can touch the ground Is the Chain tight and oiled?
on both sides.
■■ Does my child use a helmet every time
Can my child reach the handlebars? they ride?
■■ Does the bike helmet fit properly?

Pedestrian safety
Walking is great exercise and a fun family activity. As soon as you begin walking with
your child, start teaching them the skills they need to be safe whenever they cross the
street. When you teach your child about pedestrian safety, base it on your child’s level of
development. Children under 6 years old will not have the skills, awareness or judgment to
understand the traffic around them
and know when it’s safe to cross the
street. Continue to teach them as they
get older.
As your child reaches the preschool

age, they can be impulsive and may
not want to hold your hand. Insist
that they do and that they stay close
to you around traffic, when crossing
roads and in parking lots. While you’re
crossing the street, talk with your
child about how you’re crossing safely
and what’s happening on the street
around you.
Teach and model pedestrian safety skills

■■ Walk with your child often and role ■■ Make it a rule to cross the street at
model safe walking. pedestrian crosswalks or corners only,
■■ Make sure that your child walks on the and to cross railway tracks at designated
sidewalk. If there is no sidewalk, be sure crossings only.
that they walk far away from the road ■■ Talk to your child about the dangers
and are able to see the oncoming traffic. of being distracted while walking such
■■ Teach your child to recognize traffic as talking to friends while crossing the
safety signals and the signals of a street.
crossing guard. ■■ Make sure that your child knows that
■■ Stop before stepping onto the road. they should never play on the street or
around or between parked cars.
■■ Look for traffic—left, right and left again
before stepping onto the road.
■■ Wait to cross until traffic has stopped
or the road is clear, even if there’s a
crossing guard, pedestrian signal or
other traffic signal.

Playground safety
Children enjoy and learn on
different types of playground
equipment depending on their
age and stage of development.
You can help prevent injuries at
the playground by:
■■ making sure the playground
equipment is the right size for
your child—they should be
able to reach and climb the
equipment on their own
■■ checking the ground under the equipment—it should be wood chips, rubber surfacing,
sand or pea gravel (round, not crushed)
■■ checking the barriers and handrails of the play structure—make sure they’re secure
and strong
Young children are still developing their balance and climbing skills. A general rule is that
they should play only on equipment that they can reach by themselves. If they cannot
reach it, they should not be on it.
Keep your child safe at playgrounds

■■ Dress your child for safe play. They ■■ Have them take turns on a slide—one
should never wear items that can cause child at a time—and to go down feet
a fall or get caught and possibly strangle first.
them. This includes items such as hel- ■■ Ask them to use equipment and toys
mets, scarves, clothing with drawstrings, only as they’re meant to be used.
loose fitting clothing and backpacks.
■■ Make sure your child plays with proper
■■ Teach your child to watch out for footwear on.
moving objects including other children
on swings, coming off of slides, and on ■■ Ask them to respect others on the
bikes and scooters. playground—no pushing, shoving or
tripping.
■■ Ask your child to hold on with both
hands when swinging or climbing. ■■ Supervise your child and be close
enough that you can help if you have to.
To learn more about playground safety and to take the Playground Safety YES
Test, visit the Links section at healthyparentshealthychildren.ca/resources

Trampolines
Trampolines are not recommended to be used for play at home by children of any age.
They can cause serious and permanent injuries and even death. Trampolines are not safe
even if they have a net, padding and an adult is watching. Backyard trampolines are not
recommended for children of any age.
Trampolines can cause:

■■ sprains, bruises and cuts
■■ broken bones
■■ injuries to the head, neck and back
To learn more about trampolines, visit the Links section at

Play safe in rural areas

If you live in or visit a rural setting or a farm, be sure to:
■■ supervise children at all times ■■ clearly mark electric and wire fences with
■■ create a safe play area for your child flags or signs and teach your child to stay
away from them
■■ stay next to your child in animal pens or
when around any animals
■■ properly ventilate root cellars
■■ put up barriers to keep your child out

■■ always supervise your child around fire
of swamps, dugouts, septic tanks, wells, ■■ use a fire-safe container that has a grate
lakes, grain storage areas and sand pits on top when burning materials
■■ not let your child play on farm machinery
such as trucks, tractors and grain wagons
To learn more about farm safety, visit the Links section at

No ATVs or
snowmobiles
Children under 16 years old
should not operate any size
of ATV (all-terrain vehicle) or
snowmobile.
Once they are 16 years old,
they should only ride as
passengers on models made
for passengers.

Car seats and booster seats
A properly installed car seat is the best protection for your baby or child in a sudden stop
or crash. Holding them in a vehicle, even when travelling at slow speeds, is not safe, no
matter what their age.
Which car seat to use and when to use it:
Rear-facing car seat

■■ Your baby is safest in a rear-facing car seat until they’re at least 2 years old or reach
the manufacturer’s recommended maximum weight or height limit of the rear-facing
car seat.
■■ As your child gets older, you can get a larger car seat with higher rear-facing height and
weight limits, if needed. This can keep your child in the safer rear-facing position beyond
2 years of age.
Forward-facing car seat

Did you know?
■■ Once your child outgrows the rear-facing
Buying a used car seat is not
seat, move them to a forward-facing
recommended. Used car seats may
car seat. be missing parts, damaged, recalled
■■ Once your child reaches the maximum or expired and may not meet current
weight or height limit of their forward- safety standards. If you’re thinking
about borrowing a car seat, make
facing car seat, move them into a
sure you find out its history. If it was
booster seat.
involved in a crash, it should not
Booster seat be used. There may be no signs of
damage, but small cracks or weakened
■■ Once your child moves to a booster areas can make the car seat unsafe.
seat they’re safe until they reach the
maximum weight or height limit of the
booster seat as recommended by the
manufacturer. Winter clothing
and car seats
Seat belt
Bulky winter clothing could affect the
■■ A child is ready to sit in the vehicle harness system of your car seat. In the
without a booster seat when the vehicle winter, use thin, warm layers like fleece
seat belt fits them correctly. This is usually or a light snowsuit. Once your child is
in the seat, and the straps are secure,
when they’re at least 145 cm (4 ft. 9
a blanket or cover can be placed over
inches) tall and between 8–12 years old.
them. Check that the straps are snug
Children under the age of 13 are safest in each time.
the back seat.

To install your child’s car or booster seat, follow the car or
booster seat instructions and your vehicle’s owner’s manual. Using public
The YES Tests can help you to choose the proper seat and transportation
make sure you’re using the seat correctly. If you have any
questions about safety
There are three YES Tests included in this chapter: rear-facing when travelling using
car seat, forward-facing car seat and booster seat. Each YES public transportation,
Test has a list of questions that will help you properly install call Transport Canada
the car or booster seat in your vehicle and buckle your child at 1-800-333-0371.
correctly every time.
To learn more about properly installing a car seat or booster seat,

visit the Videos and Links sections at

Rear-facing Car Seat YES Test
A rear-facing seat provides the best protection
for a child’s head, neck and back in a sudden stop
or crash. Using a car seat properly is required
by law in Alberta. Use the YES Test to help you
properly install the car seat in your vehicle and
buckle up your baby correctly every time.
Push, pull and adjust the seat until you can

answer ‘Yes’ to each item that applies to your child’s car seat.
Who should be in a rear-facing car seat?

■■ A child is safest in a rear-facing car seat until they’re at least 2 years old or reach
the maximum weight or height limit for the rear-facing seat (as stated by the
manufacturer).
■■ Rear-facing car seats that have higher weight and height limits are preferred and will
keep your child in the safer, rear-facing position beyond age 2.
Getting ready
❑ I’ve read the instruction booklet that came with the car seat.
❑ I’ve read the instructions in my vehicle’s owner’s manual on how to install a car seat.
❑ I’ve checked the labels on the seat to find the maximum rear-facing weight and
height limits. My child’s weight and height are under the limits.
❑ My child’s car seat is in the back seat.
❑ I never place the car seat in front of an airbag.
❑ My child’s car seat is approved to be used in Canada and has a Canada Motor
Vehicle Safety Standards (CMVSS) label.
Securing the car seat

There are 2 ways to secure the car seat:
Either
❑ I’m using the Universal Anchorage System (UAS) to secure the car seat.
❑ I’ve checked my vehicle’s owner’s manual for the correct UAS anchor locations.
❑ The UAS belt goes through the rear-facing belt path on the car seat or base and
is attached to the UAS anchors.

Or
❑ I’m using the seat belt to secure the car seat.
❑ I’ve checked my vehicle’s owner’s manual for how to lock the seat belt for use
with a car seat.
❑ The seat belt goes through the rear-facing belt path on the car seat or base and
is buckled up.
❑ If the seat belt does not lock, I’ve used a belt lock or locking clip.
For either UAS or seat belt installation

❑ I’ve pushed down on the car seat or base and pulled the UAS belt or seat belt tight.
❑ The car seat moves less than 2.5 cm (1 inch) in any direction when pushed or
pulled.
Buckling your child in the car seat

❑ The slots that the harness straps go through are at or just below my child’s shoulders.
❑ The chest clip is at the level of my child’s armpits.
❑ The shoulder harness is lying flat with no twists.
❑ The harness is snug—I cannot pinch a fold in the harness strap.
Being safe
❑ My child rides in the car seat every trip.
❑ If the car seat has a carry handle, I put it in the travel position.
❑ I’ve sent in the registration card for my child’s car seat and checked for recalls.
To learn more about car seats and recalls, call Transport Canada at 1-800-333-0510
or, visit the Links section at healthyparentshealthychildren.ca/resources
❑ If needed, I’ll get a larger car seat, with higher rear-facing weight and height limits,
so I can keep my child rear-facing as long as possible.
❑ When my child outgrows their rear-facing seat, I’ll move them to a forward-facing
car seat.
✓ If you answered “YES” to all of the statements, you’re ready for travel! If not, check
the instruction booklet for your car seat as well as your vehicle’s owner’s manual for
the exact installation instructions.

Forward-facing Car Seat YES Test
Proper use of a car seat can reduce the chances of your
child being injured or killed in a crash by as much as
71%. Using a car seat properly is the law in Alberta. Use
the YES Test to help you properly install the car seat in
your vehicle and buckle up your child every time.
Push, pull and adjust the seat until you can

answer “Yes” to each item that applies to your
child’s car seat.
Who should be in a forward-facing car seat?

■■ A child who is at least 2 years old or has reached the maximum weight or height
limit of the rear-facing seat (as stated by the manufacturer).
■■ A child should stay in the forward-facing car seat until they reach the maximum
weight or height limit of the seat (as stated by the manufacturer).
Getting ready
❑ I’ve read the instruction booklet that came with the car seat.
❑ I’ve read the instructions in my vehicle’s owner’s manual on how to install a car seat.
❑ I’ve checked the labels on the car seat to find the maximum forward-facing weight
and height limits. My child’s weight and height are under the limits.
❑ My child’s car seat is in the back seat.
❑ My child’s car seat is approved to be used in Canada and has a Canada Motor
Vehicle Safety Standards (CMVSS) label.
Securing the car seat

There are 2 steps to install the forward-facing car seat in your vehicle.
1. Secure the bottom of the car seat.
Either
❑ I’m using the Universal Anchorage System (UAS) to secure the car seat.
❑ I’ve checked my vehicle’s owner’s manual for the correct UAS anchor locations.
❑ The UAS belt goes through the forward-facing belt path on the car seat and is
attached to the UAS anchors.
❑ I’ve pushed down on the car seat and pulled the UAS belt tight.

Or
❑ I’m using the seat belt to secure the car seat.
❑ I’ve checked my vehicle’s owner’s manual for how to lock the seat belt for use
with a car seat.
❑ The seat belt goes through the forward-facing belt path on the car seat and is
buckled up.
❑ I’ve pushed down on the car seat and pulled the lap belt tight.
❑ If the seat belt does not lock, I’ve used a belt lock or locking clip.
2. Always use the tether strap

❑ My vehicle came with a tether anchor or I had a tether anchor installed by my
vehicle dealer.
❑ The tether strap is hooked to the tether anchor in my vehicle. The tether strap
is tight.
❑ The car seat moves less than 2.5 cm (1 inch) in any direction when pushed
or pulled.
Buckling your child in the car seat

❑ The slots that the harness straps go through are at or above my child’s shoulders.
❑ The chest clip is at the level of my child’s armpits.
❑ The shoulder harness is lying flat with no twists.
❑ The harness is snug—I cannot pinch a fold in the harness strap.
Being safe
❑ My child rides in the car seat every trip.
❑ Recall information is available from Transport Canada at 1-800-333-0510, or visit

the Links section at healthyparentshealthychildren.ca/resources
❑ When my child outgrows their forward-facing seat, I’ll move them to a booster seat.
✓ If you answered “YES” to all of the statements, you’re ready for travel! If not, check
the instruction booklet for your car seat as well as your vehicle’s owner’s manual for
the exact installation instructions.

Booster Seat YES Test
A booster seat provides the best protection for your
child. An adult seat belt alone does not fit a child’s
body properly. Without a booster seat, an adult seat
belt rides too high on your child’s abdomen and
neck. This can cause serious internal injuries to your
child in a crash.
Use the YES Test to help you decide when your

child is ready for a booster seat, and to learn
how to use one correctly.
Who should be in a booster seat?

■■ A child who has reached the maximum weight or height limit of their car seat (as
stated by the manufacturer).
■■ A child is safest in a booster seat until they reach the maximum weight or height
limit of the seat (as stated by the manufacturer).
Getting ready
If you check YES to all of these points, your child is safest in a booster seat:
❑ My child has reached the manufacturer’s weight or height limit for their forward-
facing car seat.
❑ My child weighs more than 18 kg (40 lbs).
❑ My child is less than 145 cm (4 ft. 9 inches) tall.
Choosing a booster seat

A booster seat can only be used with a lap-shoulder seat belt. To find the best
booster seat for your child, decide where in the back seat your child will sit. Check to
see if that vehicle seat has a head rest (head restraint):
❑ The vehicle seat DOES NOT have a head rest.
Choose:
■■ a high back booster to give your child head and neck support. Some car seats
convert from a forward-facing seat with a 5-point harness to a high back booster
seat. Some high back booster seats have a head and neck support that can be
adjusted as your child grows.

❑ The vehicle seat HAS a head rest.
Choose:
■■ a high back booster
or
■■ a backless booster that has a seat base with arm rests. This style of booster
works well in a vehicle seat with a head rest.
Using a booster seat correctly

Use the booster seat for every ride. You’re using the booster seat correctly when you
can check YES to all of these points:
❑ I’ve read the booster seat instructions in my vehicle’s owner’s manual.
❑ My child’s booster seat is in the back seat of the vehicle.
❑ The shoulder belt is across the centre of my child’s chest and the lap belt is across
my child’s hips.
❑ My child’s booster seat is never in the front of an airbag.
Moving to a seat belt

Your child is safest in a booster seat until they reach the maximum weight or height
limit of the booster seat (as stated by the manufacturer). A child is ready to ride in the
vehicle without a booster seat when the vehicle seat belt fits properly. This is usually
when a child is 145 cm (4 ft. 9 inches) tall and between 8 and 12 years of age.
The seat belt fits your child properly when:

❑ They’re at least 145 cm (4 ft. 9 inches) tall.
❑ Their knees bend comfortably at the edge of the seat when sitting all the way
back.
❑ The lap belt stays low and snug across the hip bones.
❑ The shoulder belt crosses the chest and stays between your child’s neck and
shoulder.
❑ They can sit like this for the whole trip without slouching.
Until you can check all 5 boxes, your child should continue to use a booster seat.

Things to know about booster seats
■■ Booster seats are the safest choice for children who have outgrown their forward-
facing car seats.
■■ Using a booster seat until the vehicle seat belt fits properly provides the safest ride.
■■ A child is 3 ½ times more likely to be hurt in a crash when using an adult seat belt
alone than when buckled in a booster seat.
■■ All children under the age of 13 are safest riding in the back seat.

Being a parent can be a wonderful time of your life. It can be an amazing experience to
watch how children change over time as they grow and develop. Like other big changes
in your life, however, it can also be challenging. You may find that you feel more tired—it
takes a lot of energy to be a parent of young children. Some parents feel energized
and excited while others may feel irritable or confused. Most parents, in fact, say they
feel a little bit of both most of the time. Parenting is often an emotional journey so be
kind to yourself. When you take care of your own needs, it helps create a healthy family
environment for you and your child to grow and thrive in.
In the An Overview of Being a Parent chapter,

there’s information on how you can
Living on low income
manage the stresses of having a young If your family is living on a low
income, you may qualify for supports
family so you can be the parent your child
for certain health services such as
needs (see page 26). In the chapters to
dental care, eyeglasses, ambulance
come, you’ll find other ways for self-care as services, diabetic supplies and
you grow into your parenting role. Look in prescription medicine. Contact
the Taking Care of Yourself sections at the the Alberta Adult Health Benefit
end of each chapter for ideas. program toll-free at 1-877-469-5437
To become a parent is to sign up for a healthyparentshealthychildren.ca
lifetime of learning—and you’ll learn as You may also qualify for other resources
you go. Be sure to access supports in your and programs in your area.
community. Parenting programs are for To learn more, call Health
Link at 811 or talk with
everyone and they’re a great way to get
new ideas and meet new friends.

“ Every so often, my husband and I will eat a later dinner together after our kids
are in bed. While we like our meals as a family, it’s nice to connect with one
”
another without the distraction of cleaning messes, making sure our kids are
eating, and getting them to bed on time.
~ Alyssa, mom of two children
Healthy eating
Eating regularly and following Canada’s Food
Guide will help give you the energy you Vitamin and mineral
need to care for yourself and your growing supplements
family. Eating a variety of foods from each It’s still important for women to keep
food group every day supports your health taking a daily multivitamin with folic
acid (0.4 mg) and vitamin D (400 IU).
and well-being. Having a healthy, balanced
pattern of eating can help support a healthy It’s also recommended that men
weight and decrease your risk for certain take 400 IU of vitamin D from a
supplement each day.
health conditions such as obesity, diabetes,
heart disease, cancer and osteoporosis. For
more information about making healthy food choices, see page 51. If you’re breastfeeding,
you may feel more hungry and thirsty. For more information on healthy eating when
you’re breastfeeding, see page 172.
folic acid: folic acid (folate) is a vitamin added to foods (fortification) or vitamin supplements. It’s also naturally found in
foods, and helps to prevent neural tube defects

Staying active
Doing fun activities that move your muscles (raise your breathing and heart rate), help your
body stay healthy. Getting enough regular physical activity and breaking up periods of
sitting can improve your health and well-being.
Physical activity has many benefits, it:

■■ improves your strength ■■ lessens the symptoms of postpartum
■■ gives you more energy depression or anxiety (see page 262)
■■ helps you cope with stress

■■ can help you reach or stay at a healthy
weight
■■ improves your mood
■■ helps you sleep
It’s recommended that adults get at least

150 minutes of activity every week. Aim for Be a good role model
activities that are moderate (e.g., brisk walk) You show your children how important
to vigorous (e.g., jogging) intensity for at it is to be active when you’re active
least 10 minutes at a time. with them. Children of active parents
are more likely to be active themselves.
To learn more about physical
activity, visit the Links section at

Protect your back
Taking care of and playing with your baby and child mean you’ll be bending, lifting,
carrying and moving in all sorts of different ways than your body may be used to. To help
prevent injuries and keep your back safe, here are some things to consider.
Lift and carry safely

Take care when you carry your baby or child:
■■ Keep your back straight and try not ■■ Change your position often when you’re
to twist. carrying your child on your hip or over
■■ Hold your baby as close to your body your shoulder.
as possible, in an upright position in the ■■ Take your baby out of their car seat before
centre of your chest. carrying them, whenever possible.
■■ Keep your movements smooth. ■■ Never lift anything heavy above your
shoulders.
Take care when you lift your baby or child:

■■ Keep your feet shoulder-width apart, with ■■ Keep good posture. Look straight ahead,
one foot slightly ahead of the other. keep your back straight, your chest out
■■ Squat down, bending at the hips and and your shoulders back.
knees only. If needed, put one knee to ■■ Slowly lift by straightening your hips and
the floor and your other knee in front of knees, not your back. Keep your back
you, bent at a right angle. straight and do not twist as you lift.
Be at the right height

The best height for a work surface such as a
change table is near the level of your hip bone.
To help prevent injury:
■■ Set your stroller or baby carriage handles high
enough so you can stand up straight.
■■ Kneel or squat when working at floor level.
Bend your knees, not your back.
■■ Keep supplies close by so that you can reach
them easily.

Baby and child carriers
Using carriers properly will help prevent back and
neck strain and will keep your baby safe. Follow
the manufacturer’s instructions carefully. During
the first few months, when your baby has poor
head control, they need to be carried on the
front of you. After that, you may want to use a
back carrier.
When carrying your baby on your front using

a sling:
■■ Have someone help you the first few times.
■■ Choose a sling that holds your baby upright—
they’re safest in this position.
■■ Make sure your baby’s face is not covered.
When carrying your baby on your front using

a carrier:
■■ Have them sit high on your chest, with their
head under your chin.
■■ Carry them up higher to prevent yourself from
Bike carriers and trailers
being pulled forward and down. Bike carriers and trailers are not
safe for babies under 1 year old
■■ Make sure nothing covers your baby’s face. because of their poor neck and
head control.
Your baby needs to have good head control
For children over 1 year old,
before you can use a back carrier. When carrying
make sure they’re safely secured
your baby on your back, place them low around
and always use a properly
your waist, close to your centre of gravity. You’ll fitting helmet.
be more stable and it will put less strain on
your muscles.
Some slings and carriers have been recalled and are not safe. To learn more,

Mental health
Good mental health is important for your
well-being and for your child’s healthy
development. Parenting is a 24/7 job on
top of all your other work and activities.
Your health can become a lower priority
when you’re a busy parent. Balance your
needs and care for your relationships with
the amount of care your child needs—it
helps to take good care of yourself.
Encourage and support your partner to
do the same.
For more information about finding your

balance, see page 258. Here are some
more ideas that may help:
■■ Take a break. Take some time to do

things you find fun and relaxing such
as reading a book or soaking in the
bathtub. Use relaxation (see page 260)
or meditation techniques, try yoga or
play calming music.
■■ Get some fresh air. Take your child
along or leave them with a caregiver.
■■ Make a date. Try setting aside a time each day for yourself or with your partner. Start
small—even going out for a short walk can be a welcome break.
■■ Laugh. Watch a funny movie. A good laugh can ease tension and improve your mood.
■■ Accept help. Ask for and accept offers of help from others.
“ Make sure you explore strategies with your partner to help you connect with
your old self. Whether that is through exercise, alone time, going to the movies,
volunteering, or spending time with friends, make sure you make a realistic
plan that you and your partner can commit to. Oh, and leave the guilt at home.
”
Feeling guilty about leaving your children will simply ruin your time out and
defeats the purpose of the break.
~ Safina, mom of two children

Connecting with others
While being a parent can be very
rewarding, sometimes parents can feel
lonely. Meeting and talking with others
gives you a chance to talk about your
interests and share your parenting joys and
frustrations, which can help you feel more
connected and manage your daily stresses.
“
There are many ways you can connect:
■■ Reach out. Start with people who are Find a support program. You can
”
most likely to be supportive, such as get so much help and a network
family, friends or neighbours. to help you.
■■ Keep in touch. Take time to connect
~ Liela, parent new to Alberta
with friends. Spend time, do things and
have fun together.
■■ Look for programs. Check with your community or public health centre, place of
worship, family resource centre or family service agency about parenting and other
community programs near you. Ask if there’s child care available.
■■ Sign up. Parenting can be much easier when you talk to other parents about it. Alberta
Health Services, Parent Link Centres and many community agencies have group
programs for families. These programs are a great way to get out, meet other parents
and make new friends.
■■ Go online. There are many blogs and online discussion forums with other parents. Look
for reliable and unbiased sources. Try to be cautious about the information that is shared
and remember everyone experiences parenting differently. Use all the information you
learn to decide what makes sense for you and your family. If you’re in doubt, check with
someone you trust such as a family member or your health care provider.
■■ Look for programs. Many libraries and bookstores offer family story time and programs
for all ages.
“ You’re going to have down days, mediocre days, and great days as a new (or
experienced) mom. When you’re feeling blue, talk to another mom friend.
The social connection will help you move through the challenging days.
”
Also, this will not last forever. Know that you’re normal and that people care
about you.
~ Morgan, mom of two children

To find out about programs or services, call Health Link at 811, talk with your health care
provider or visit the Links section at healthyparentshealthychildren.ca/resources
Be kind to yourself. If you feel sad, upset or if you’re having mood changes, talk to
someone you trust or your health care provider to get the help you need to be able to
enjoy these early years. For more information, see page 258.
Alcohol, tobacco and tobacco-like products,

cannabis and other drugs
Alcohol
For both males and females, alcohol can affect your overall health. Following
Canada’s Low-Risk Alcohol Drinking Guidelines can help reduce the risk of
long-term health problems. To see the guidelines, visit the Printables section at
Drinking alcohol can affect your ability to properly Small steps matter
care for and supervise your child. Ask for help
Making changes in your life can
and support if you have concerns about yours or take time. You may need to try
someone else’s alcohol use. Here are some things many times. Each time you try,
you can do: you’ll learn new things that will
help you for the next time. This
■■ Talk with your partner and make a plan to cut
may include learning what your
down or quit together. triggers are. Just keep trying!
■■ Talk with your health care provider.
■■ Call the Alberta Health Services Addiction Helpline toll-free, 24/7 at 1-866-332-2322 or
Tobacco and tobacco‑like products

All tobacco and tobacco-like products,
such as e-cigarettes or vapes, water Quitting tobacco
pipes and cannabis (often mixed with Quitting tobacco and tobacco-like
tobacco) are harmful. Tobacco and products can be very challenging and
tobacco-like products affect the health takes time. Believe you can do it! If you
don’t think you can stop it all at once, start
of those who use the products and
by cutting back the amount you use daily.
also affect those who are exposed
through second- and third-hand smoke
or vapour.

The harmful chemicals in tobacco and tobacco-like products can affect your baby’s
growth and development before birth and can cause them to be more likely to have
health problems after they’re born. These can include respiratory illnesses, ear infections, or
behavioural concerns and learning disabilities like attention deficit hyperactivity disorder
(ADHD). Being exposed to smoke before and after birth greatly increases your baby’s risk of
sudden infant death syndrome (SIDS).
Nicotine from tobacco and e-cigarettes affects the developing brain of babies, young
children and teens. It also puts you at risk for gum disease and affects how well your body
can heal itself. The best way to protect your family from being exposed to the harmful
effects of nicotine and other chemicals is to keep your home, vehicle and workplace
tobacco-free.
Different forms of tobacco and tobacco-like products have many health effects:
■■ Smoke from tobacco, like cigarettes contains about 7,000 different chemicals that
cause illness such as heart and lung disease. At least 172 of these chemicals are toxic
(poisonous). About 70 of these chemicals cause cancers, including lung and breast
cancer.
■■ Smokeless tobacco (moist snuff, dip or chew) and tobacco that’s used up the nose
(dry snuff or snus) have more than 4,000 chemicals in it. Of these chemicals, more than
30 cause cancer, including mouth and throat cancers. Snuff products also have more
nicotine in them than cigarettes. The average cigarette has 8.4 mg of nicotine while the
average snuff product has 14.5 mg of nicotine.
■■ Electronic cigarettes (e-cigarettes)
are battery-powered vapourizers that Is vaping safe?
use liquid vapour to deliver mist into It’s not yet known how safe e-cigarettes
the body. This mist is often a mixture or any other tobacco-like vaping
of chemicals and sometimes contains products are. However, we know that
nicotine. E-cigarette vapours have at least they’re not harmless. It’s clear that vaping
products, especially those containing
10 chemicals that are linked to cancer
nicotine, put you and your family’s
and birth defects. E-cigarettes could put
health at risk for nicotine poisoning,
you at risk of nicotine addiction and are addiction or other harmful effects on
not recommended as an aid to quitting health—the long-term impact of these
tobacco. products on health are not known. It’s
also not proven whether or not these
products help with quitting tobacco.
sudden infant death syndrome (SIDS): a sudden and unexplained death of a seemingly healthy infant under 1 year
old during sleep
nicotine: a chemical found in tobacco or tobacco-like products that is colourless and toxic

Second‑hand smoke or vapour
Second-hand smoke is the smoke that’s exhaled or that comes from the burning end of
a cigarette, cigar or pipe. Being exposed to second-hand smoke is a known risk for breast
cancer, asthma and heart disease. For babies, being exposed to smoke from tobacco
before and after birth is also a major risk factor for SIDS and other health problems such as
respiratory illnesses and ear infections in childhood.
Second-hand vapour is the mist produced by e-cigarettes. The mist that comes from
an e-cigarette or vaping device has a mixture of chemicals that are toxic to you and
your family. Although the toxins are lower than with tobacco smoke, there are at least
10 chemicals that cause cancer and birth defects.
Inhaling second-hand smoke and vapour is especially harmful to babies and young
children because they:
■■ breathe faster
■■ have smaller lungs that are more easily damaged by these toxic chemicals
■■ have less developed immune systems
Here are some ways to protect your child from second-hand smoke or vapour:
■■ Do not smoke or vape in your home or your car—even if your children are not there
with you.
■■ Ask people not to smoke or vape in your home, your It’s the law
car or near your children.
As of November 2014, the
■■ Put up ‘no smoking or vaping’ signs in your home and Tobacco and Smoking
vehicles. Reduction Act states
that it’s illegal to smoke
■■ Choose child care that’s free from smoking, vaping or in a vehicle with anyone
using other tobacco products. If this is not possible, ask under 18 years old in it.
caregivers not to smoke or vape around your children.
Keep tobacco and nicotine products away from children and pets
Eating tobacco, tobacco-like products or vaping products can cause poisoning because
of nicotine or other chemicals they contain. Nicotine replacement therapy (NRT)
products such as gum or lozenges can also make children and pets very sick and may
even cause death. Lock up these products or throw away used products safely so your
child cannot get to them.

Third-hand smoke
Airing out is not enough
Third-hand smoke is the residue and gases
Opening a window, using air purifiers
that are left behind and build up over time in
or ventilation systems or smoking
vehicles and on surfaces such as upholstery,
in another room are not enough
clothing, draperies and carpets after a to protect you and your child from
cigarette has been used. Babies and young the harmful effects of second- and
children are more at risk of being exposed to third-hand smoke or vapour.
third-hand smoke. This is because they crawl
on the floor, touch surfaces with their hands and put their hands in their mouths. Although
we do not yet know the impact of vaping related to third-hand exposure, early research
suggests that it’s a concern for children living in homes with e-cigarette use. For example,
nicotine is a cancer causing chemical often found in e-cigarettes and has been shown to
collect on surfaces in homes where children live and play.
If you have smoked, vaped or have been around smoke or

vapour, here are some things you can do to limit your children’s
exposure. Before you hold or cuddle your child:
■■ Wash your hands and face to remove the smoke and chemicals.
■■ Change your shirt or jacket if you were smoking in it. It might
help to keep a jacket that you can use outside to smoke in,
away from your family. This way, the jacket can be left outside
on the balcony, porch or garage to air out the toxins.
Support for quitting

Quitting tobacco and tobacco-like products improves
your health right away and reduces your risk of cancer Getting ready to quit
over time. It also reduces your chances of getting When you’re ready to quit,
other diseases caused by using these products. you may want to have your
teeth cleaned to remove
Quitting these products can be very challenging. You tobacco stains. This will help
may need to try many times. It took a while to learn your gums heal and may
this behaviour, so it will likely take some time to work even help motivate you to
your way back out of it. There are more people who stay tobacco-free.
quit using tobacco than who use it—so you can do it.
Counselling is the first recommended treatment for quitting tobacco. There are also safe
products to help you with cravings. Using NRT can help with the physical and emotional
side-effects of quitting. There is also some non-nicotine prescription medicine that
may help.

If you’d like help changing your tobacco use:
■■ Talk with your health care provider.
■■ Visit albertaquits.ca for online support, or call the AlbertaQuits helpline toll-free at
1-866-710-QUIT (7848) to talk with trained counsellors.
■■ Find a support person.
■■ Go to a tobacco cessation group in your area, like QuitCore.
Sometimes it’s challenging to stay motivated and stick with your decision to quit. If you
want to stop using these products or have quit already, it may help you stay on track if you:
■■ Think about why it’s important for you and your family’s health.
■■ Remember what you don’t like about using tobacco or tobacco-like products.
■■ Know who you can count on for support.
■■ Try to limit time with the people, places or feelings that make you want to use tobacco
or tobacco-like products.
■■ Find ways to cope with stress.
■■ Think about the financial benefits of quitting.
To learn more about quitting tobacco, visit the Links section at

Cannabis
Using any type of cannabis (marijuana, hashish, hash oil), including edibles, affects the
health of those who use it. The dried flowers, leaves, stems and seeds of cannabis are
called marijuana, weed, pot and other
names. Hashish and hash oil also Keep out of your child’s reach
come from the cannabis plant. The
If your child eats or drinks cannabis, you
cannabis plant contains more than need to seek medical attention right away.
400 chemicals. Tetrahydrocannabinol They could have problems with walking,
(THC) is the main active chemical in sitting up or breathing, or they could
the cannabis plant that gives people become confused and sleepy. They could
a ‘high’. THC affects areas of the brain also have more serious problems such as
that control memory, concentration and breathing difficulties, seizures and coma.
coordination. Cannabidiol (CBD) is an Call 911 if it’s an emergency or the Poison &
active chemical in the cannabis plant Drug Information Service toll-free, 24/7 at
that’s used for medicinal purposes. 1-800-332-1414.

The levels of THC and CBD vary depending on the type
(strain) of cannabis plant used. Some forms of cannabis It’s never too late
can have very high levels of THC. If alcohol, tobacco,
cannabis or other drugs
Using cannabis can also have other side-effects such as: are part of you and your
partner’s life, encourage
■■ impairing short-term memory each other to cut down
■■ affecting coordination and quit.
■■ decreasing ability to notice or recognize things
■■ increasing anxiety or paranoid thoughts
These effects can lead to poor decision-making and impact your ability to care for your
children, creating an unsafe environment. Using cannabis while breastfeeding is also not
advised as it could affect your baby’s developing brain. For more information, see page 175.
Marijuana smoke contains many of the same harmful chemicals that are found in tobacco
smoke. Breathing in second-hand smoke from cannabis can cause your baby and young
child to be sick and it can affect their level of alertness, understanding and judgment. If
someone around you uses cannabis, don’t let them smoke or vape cannabis in your home,
vehicle or any closed spaces around your children.
People who use cannabis may also drink more alcohol or smoke more tobacco, which can
lead to serious health effects. There may also be increased risk of other unsafe situations
that can lead to physical injury and harm.
For information about cutting down, quitting or finding a safer alternative if you use
cannabis for medical reasons, talk with your health care provider.
Thinking and decision making

Cannabis and other drugs can affect how you think and make decisions. There may also
be an increased risk of overdose and unsafe situations that could lead to physical injury
and harm.
To learn more about cannabis and other drugs or cutting back and quitting,
call the Addiction Helpline toll-free, 24/7 at 1-866-332-2322 or visit the Links

Other drugs
Other drugs such as ecstasy, methamphetamines, cocaine, heroin and fentanyl can be
harmful, both mentally and physically and are not recommended. Using these drugs
can affect a person’s ability to think and make decisions, which can affect their ability
to provide proper care for children. Using these drugs can create an unsafe family
environment for your child.
If you’re concerned about your own or someone else’s use of other drugs, there is
confidential help available at no cost to you. For information about cutting down and
quitting, talk with your health care provider.
Ready or not for another baby?

Planning to become pregnant—or not—is a big decision. Your body needs time to recover
from a pregnancy and birth before you get pregnant again. Taking time to think about a
Reproductive Life Plan will help you to be more ready, both physically and emotionally, if
and when you decide to have more children.
There is no ‘magic number’ or amount of time to wait between pregnancies that will work
for everyone. Talk to your health care provider about the factors that are important for you
to think about. If you’re planning to become pregnant again:
■■ Continue taking a multivitamin with 0.4 mg of
folic acid daily.
■■ Try to get to or maintain a healthy weight by
eating well and being active.
■■ If you’re using alcohol, tobacco, cannabis,
or other drugs, cut down and quit. If you’re
having trouble quitting, talk with your health
care provider. They can help.
■■ Talk with your doctor or pharmacist about the
safety of any medicine you’re on, and whether
you should continue to take it.
To learn more about preconception health and

planning (or not planning) another pregnancy,
talk with your health care provider and visit
readyornotalberta.ca

Feeding
Your Baby

145
Feeding Your Baby
Feeding gives your baby the nutrition they need every day to grow and
develop. In this chapter, you’ll learn about breastfeeding and feeding with
infant formula. It’s the only food your baby will need until they’re about
6 months old, when they’ll be ready to start eating solid foods.
You can find information about introducing solid foods in the Older Babies:
6–12 Months chapter.
146
Deciding How to Feed Your Baby
FE E D I N G YO UR BABY
Deciding how you’ll feed your baby is a personal choice that depends on many things,
including your beliefs. It also depends on support from your partner, family, friends, and
health care providers. Your feeding decision may also change depending on both your
needs and your baby’s needs at different stages.
Learn about your options and ask questions. You may decide to breastfeed, feed your
baby infant formula, or both. Talk about it with your partner, friends, family and health care
provider. Whatever your questions or feeding decision, there is information and support
available. Attending parenting classes or a breastfeeding support group will also give you
more information and help answer your questions.
There are many things to consider when deciding to What is

breastfeed, formula feed or both. Even if you’re not recommended?
planning on exclusively breastfeeding your baby, you Breastfeeding your
may choose to breastfeed or hand express colostrum baby exclusively for
so your baby can receive its protective benefits (see the first 6 months with
page 153). Colostrum has antibodies and gives your baby continued breastfeeding
up to 2 years of age and
protection against infections and diseases.
beyond is recommended.
For more information about breastfeeding, see page 151.
For more information about formula feeding, see page 193.
Choosing how to feed your baby is your decision. If you decide not to breastfeed, feeding
with infant formula can also provide your baby with the nutrition they need.
Vitamin D for all babies

All babies whether they are breastfed,
infant formula-fed or both, need 400 IU of
a liquid vitamin D supplement every day.
Vitamin D helps your baby’s body absorb
calcium, develop healthy bones and
prevents rickets.
exclusively breastfeeding: no other liquids or solid foods except breastmilk, vitamins, vaccines and medicine are given
colostrum: a high-calorie, thick, yellow breastmilk that’s produced during the first few days after birth

These questions may help you think about options
for feeding your baby
What types of things are you wondering about when it comes to feeding your baby?
Write down any questions about feeding your baby that you would like to ask your
health care provider. The answers can help you make an informed decision.
What is important to you about feeding your baby? Discuss this with your health care
provider so they can understand how to best support you.
How do you feel about breastfeeding? Only you know your own thoughts and feelings
about breastfeeding. This is an important part of making this decision.
Is there anything about home, work, school or your community that could affect
your decision? Your health care provider can help you create a realistic plan for feeding
your baby.
Do you know someone who can support you in your feeding goals and decisions?
Whatever you decide, your health care provider can help, but it’s also good to think
about family members and friends who can support you as well. Breastfeeding can take
time and practice for both you and your baby to learn.
How would you like to feed your baby? With information and support that meets their
needs, most women who want to breastfeed are able to do so. However you decide to
feed your baby, your health care provider can support you in your feeding decision.
Copyrighted material adapted with permission from Healthwise, Incorporated.
To learn more about deciding how to feed your baby, visit the Links section at

Feeding Relationship and Cues
Your baby is born with the ability to regulate and eat the amount of food they need. In the
beginning, your role as a parent is to decide what your baby eats and to follow their cues
for hunger and fullness (satiety). Your baby’s role is to let you know when they’re hungry
and when they’re full. By having a healthy feeding relationship right from the start, you’ll
help your baby develop healthy eating habits for life.
The early months with your baby are a time of learning for all of you. When you respond to
your baby’s cues, you’re helping to build a secure attachment and a trusting relationship.
You’re also teaching your baby to listen to their body and to stop eating when they’re full.
Watch your baby for early hunger cues—babies feed best when they’re quiet and alert. If
you’re having trouble reading your baby’s cues, talk with your health care provider.
Babies need to eat day and night. Your baby feeds in their own way to meet their needs.
For the first 6 months, your baby will likely wake up to feed during the night. Keep your
baby close when they sleep—in the same room as you (room sharing), but on a separate
sleep surface such as a crib, cradle or bassinet. This will make it easier to feed your baby,
especially at night. It also makes it easier to learn and respond to your baby’s cues. Once
your baby is done feeding and is ready to sleep, always place them on their back in their
crib, cradle or bassinet.

Baby feeding cues (signs)
Early cues “I’m hungry.”
Stirring Mouth opening Turning head, seeking/rooting
Mid cues “I’m really hungry.”
Stretching Increasing physical movement Hand to mouth
Late cues “Calm me then feed me.”
Crying Agitated movement Colour turning red
Time to calm crying baby

■■ cuddling
■■ skin-to-skin on chest
■■ talking
■■ stroking
CPN / 840
For morePartnering
information refer
with Consumers to the
National Queensland
Standard 2 (2.4) Health booklet Child Health
To view the termsInformation:
of this licence, visit: Your guide to the first twelve months
http://creativecommons.org/licenses/by-nc-nd/3.0/au/deed.en
Consumers and/or carers provided feedback on this publication. For permissions beyond the scope of this licence email the Intellectual Property Officer: [email protected]
Visit the Queensland Health breastfeeding website: http://www.health.qld.gov.au/breastfeeding/
Version 4.0 Effective: 05/2015 Review: 05/2018 © State of Queensland (Queensland Health) 2010
CPN / 840
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When your baby has had enough, they’ll stop
showing feeding cues and show signs of
fullness that may include:
■■ slowing down or stopping their sucking and
swallowing
■■ letting go of or turning their head away
from your nipple
■■ looking relaxed (e.g., extending their arms
and legs, extending or relaxing their fingers)
■■ pushing or arching away
■■ falling asleep at the end of the feeding
Breastfeeding Your Baby

Breastfeeding provides food, security and comfort for
your baby. Your health care providers are there to help Breastfeeding goals
you with your breastfeeding goals, whatever they are. Think about your
breastfeeding goals and
You can breastfeed whether you’ve had a vaginal or what support you need to
caesarean birth and no matter what size your breasts meet them.
are. If you’ve had breast surgery, have concerns about
your breasts or have a medical condition, talk with your health care provider.
Exclusive breastfeeding for the first 6 months of life

and continued breastfeeding up to 2 years of age and
beyond is recommended. At about 6 months, you can
start giving your baby solid foods (see page 291).
Learning to breastfeed takes time and practice. You

may find breastfeeding easy or you may find that
sometimes it’s not as easy as it looks, especially in
the first few weeks. Take it one day at a time. It can
sometimes take 4–6 weeks for you to feel comfortable
and confident with breastfeeding.
“ Breastfeeding might take longer than you expect it to in the early days.
~ Ayesha, mom of a toddler ”

Getting encouragement and support from your partner, family, friends, and your health
care providers can help you feel more confident and make breastfeeding easier. You can
also get support by talking with other women who are breastfeeding or by joining a
breastfeeding support group. Ask for help early and as often as you need it. To find out
about programs in your area call Health Link at 811 or talk with your health care provider.
Breastfeeding benefits
Breastfeeding is healthy for you and your baby. Breastmilk has all the nutrition your baby
needs in their first 6 months other than vitamin D. Give your baby a liquid vitamin D
supplement of 400 IU every day.
Breastfeeding has many benefits for you and your baby. For your baby, breastmilk:
■■ is self-adjusting and changes to meet their needs, even during growth spurts
■■ is easy to digest
■■ gives them antibodies that may reduce the risk of
Skin-to-skin
some types of illnesses, infections and diseases Cuddling skin-to-skin with
your baby is a great way to
■■ may reduce the risk of SIDS help you get started with
breastfeeding. For more
For you, breastfeeding: information, see page 209.
■■ helps your uterus contract to its pre-pregnancy size
■■ may lower your risk of breast and ovarian cancer—the longer you breastfeed, the lower
your risk
■■ may help you lose some of the weight you gained during pregnancy
■■ may stop menstrual periods during the first 6 months, and sometimes even longer, if
you’re exclusively breastfeeding
■■ helps you feel closer to your baby
There are also other benefits of breastfeeding. These include:

■■ having readily available food for your baby that is always the right temperature and
concentration
■■ being an environmentally-friendly feeding method—you don’t need containers or
packages
■■ possibly saving you money because you don’t need to buy infant formula, bottles or
artificial nipples
growth spurt: a time when your baby is growing faster than usual and they may suddenly want to feed more often
or longer

Breastfeed anytime,
anywhere
You can breastfeed wherever
you want. It’s legal to
breastfeed in public. Many
shopping malls have parent
rooms for breastfeeding and
changing babies, if you’re
looking for comfortable
chairs and more privacy.
If you want, you can also put
a scarf or blanket over your
shoulder for privacy or if your
baby gets distracted.
How breasts make milk

Breasts are made up of clusters of milk-producing
cells (milk glands) connected by a network of ducts.
Milk glands This network is close to the nipples, which have
Ducts
many tiny openings. Milk flows from the milk glands,
Nipple
through the ducts and nipple openings.
Areola
When your breasts release milk it’s called a let-down

or milk ejection reflex. Muscles around the milk
glands contract to push milk into your ducts and
out through your nipple.
You may feel tingling or pressure in your breasts as your milk is released. Not everyone feels
this. You may also have a let-down when you hear your baby cry. When this happens, milk
may leak from your breasts.
Your milk will change to meet your baby’s needs. The milk you make in the first few
days after your baby is born is called colostrum and you’ll make very small amounts of it.
Because colostrum has antibodies, it gives your baby protection against infections and
diseases. Along with having important nutrients, colostrum also acts as a natural laxative
to help your baby pass meconium. Colostrum is the only food your baby needs in the first
few days.
meconium: greenish-black, sticky stool usually passed within the first 48 hours of birth

Your milk will gradually change from colostrum to transitional milk to mature milk over the
first 2 weeks after your baby is born. You’ll notice your breasts becoming fuller and heavier.
They may also feel more tender. The colour of your milk will change from clear or yellowish
(colostrum), to bluish-white or white (mature milk).
Breastmilk supply
Feeding your baby often and for as long Babies feed often
as they want to feed, day and night, will
Your baby will feed often because:
help you establish your milk supply and
meet your baby’s needs. Your baby’s breastmilk is digested more easily
■■
stomach is small and they can only drink at birth, your baby’s stomach is small—
■■
small amounts at a time at first. The it can only hold around 20 ml (4 tsp)
amount your baby drinks changes at each
feed, sometimes they’ll want a ‘full meal’ and other times a ‘snack’.
Your baby’s sucking tells your body to make as much milk as they need. The more your
baby feeds at the breast, the more milk your body makes. Nighttime feeds may seem
challenging, however, these feeds play an important role in keeping your milk supply up.
Your breasts will feel full between 2–6 days after your baby’s birth. After this time, it’s
normal for your breasts to start to feel softer. For the first 6 weeks, you’ll notice your breasts
feel full before feeds, become softer after feeds and begin to fill again between feeds.
This is a good sign that your body is making milk to meet your baby’s needs. Full breasts
produce milk slower and drained breasts make milk faster. Feeding your baby as often as
needed, and not delaying or timing feeds, will help keep your breasts soft and comfortable.
It will also make sure that your baby gets the amount of milk they need. This also helps
your baby develop healthy eating patterns and supports growth and development.
You may also find that your baby suddenly wants to feed more often, wants to feed longer
or cries more. Babies who need to feed more often may be having a growth spurt. This
usually happens when they’re around 2–3 weeks, 6 weeks
Twins, triplets and 3–4 months old. Growth spurts only last a few days. As
and more your baby breastfeeds, you’ll make the amount of milk that
matches what your baby needs.
Many moms are able to
breastfeed more than It’s common to wonder if you’re making enough milk. For
one baby at a time.
more information on how often and how long to feed your
Talk to your health care
baby, see page 161. Your health care provider will also help
provider if you have
any questions. you to understand the signs that your baby is receiving the
amount of breastmilk that they need.

If your baby is not able to breastfeed or is not
breastfeeding well, make sure you ask for help. Your
baby feeding at your breast is the best way to increase
your milk supply and remove milk from your breasts. If
your baby is not able to do this, you can establish and
maintain your milk supply by removing the milk from
your breasts often, either by expressing by hand or
with a breast pump (see page 168).
You can feed your baby your expressed breastmilk (see

page 166). If you supplement with infant formula, and
don’t express or pump your own milk, your breastmilk
supply will decrease.
What about herbal products?

Some herbal products such as teas may claim to increase your milk supply. They
may not be safe for you and your baby. To find out more about herbal products
and if they’re safe, talk with your health care provider or call the Medication
& Herbal Advice Line toll-free at 1-800-332-1414. To learn more, visit the Links
Breastfeeding basics
With time and practice, you and your baby will become more comfortable with
breastfeeding. Early skin-to-skin cuddling with your baby is important for getting
breastfeeding started and will help you learn to read your baby’s feeding cues. For more
information on skin-to-skin cuddling, see page 209.
Your health care provider will

encourage you to breastfeed
your baby soon after they’re
born. They will help you with
positioning and latch. Some
babies want to breastfeed right
away and others may just want
to cuddle. Most babies will have
their first feed within the first
hour after they’re born.
© Belle Verdiglione Photography. www.perthbirthphotographer.com.au

If you’re a partner
A baby needs a lot of attention during the
first few months of life and they’ll spend
a lot of time breastfeeding. You can help
support your breastfeeding partner by:
■■ giving her time to learn to breastfeed
■■ giving her time to cuddle together
skin-to-skin
■■ having her rest when your baby sleeps
■■ bringing your baby to her for
breastfeeding
■■ asking if you can help her with
■■ preparing healthy foods and going
positioning your baby at the breast
grocery shopping
■■ doing diaper changes, burping and
■■ finding her support if needed
bathing your baby
■■ staying awake while she’s feeding
■■ doing extra household tasks
your baby, especially if your partner is
■■ limiting visitors and phone calls tired or laying down, and help them
as needed by returning your baby to their crib or
■■ bringing her water to drink cradle when she’s done feeding
Health care providers like public health

nurses have information and skills to
“
help you learn about:
■■ your baby’s feeding cues Have supportive people around
■■ breastfeeding positions you who know what your plan is
”
for breastfeeding and who are able
■■ correct latch
to help set you up for success.
■■ how to tell if your baby is getting
enough breastmilk ~ Jasminder, mom of a toddler
■■ what you can do if you have
breastfeeding challenges

Positioning
You may need to try several positions before you find one that works for both you and
your baby. Whatever position you breastfeed your baby in, make sure you use good
posture and:
■■ Have the supports you need (e.g., cushions and pillows) to sit, lie or stand in a
comfortable position.
■■ Bring your baby to your breast—not your breast to your baby.
■■ Keep your baby’s hands free—their hands help them find their way to your breast.
■■ Support your baby across their shoulders and behind their ears at the base of their head
with your arm and hand.
‘C’ Hold ‘U’ Hold
‘C’ and ‘U’ hold

Depending on the position you choose for breastfeeding, you may need to support your
breast. You can use a ‘C’ hold or a ‘U’ hold:
■■ For the ‘C’ hold, gently grasp your breast with your fingers in line (parallel) with your
baby’s mouth.
■■ For the ‘U’ hold, place your fingers flat on your chest wall and hold your breast from
below with your fingers and thumb.
Place your hand on your breast without covering the areola. This way, your hand does not
interfere with your baby’s latch. Don’t apply too much pressure on your breast as this could
cause a poor latch or blocked ducts.
areola: the dark area around the nipple of the breast

Common positions
Cross-cradle position
1. Sit up as straight and tall as you can.
2. Support your baby at the level of your breasts.
3. Lay your baby on their side on a pillow. Their ear,
shoulder and hip should be in a straight line.
4. Use your hand that’s on the same side that your baby is feeding on to support your
breast. Make a ‘C’ shape with your hand to support your breast, if you need to.
5. Use your other hand to support your baby’s head at the base of their skull. Place your
arm along your baby’s back and bring them close to your breast.
Cradle position
1. Sit up as straight and tall as you can.
2. Support your baby at the level of your breasts
using the arm on the same side that your baby is
feeding on.
3. Cradle your baby close to you.
4. Keep your other arm free.
If you prefer the cradle position and are having
trouble latching your baby, start with a cross-cradle
position. Then let go of your breast support (step 4 of cross-cradle) and move your arm
into the cradle position.
Football or clutch position

1. Sit up as straight and as tall as you can.
2. Use a pillow at your side to support your baby at
the level of your breast.
3. Hold your baby with your nipple pointed toward
their nose. Your baby’s head will be slightly tilted
back, with them looking up at you.
4. Support your baby using the hand that’s on the same side your baby is feeding on.
5. Use your hand to hold your baby’s head at the base of their skull, and use your arm to
hold them close to your body. When your baby opens their mouth wide, use your hand
to quickly bring them to your breast.
6. Make a ‘C’ shape with your opposite hand to support your breast, if you need to.

Side-lying position
1. Lie on your side with one pillow under your head and
another tucked behind your back. You may also like a
pillow between your knees.
2. Lay your baby beside you on the bed tummy-to-tummy,
with their nose touching your nipple.
3. Place the palm of your hand on your baby’s upper back.
When your baby opens their mouth wide, use your hand
to quickly bring them to your breast.
4. Use your hand on your baby’s back to keep them tucked in
close while breastfeeding. Reproduced with permission from
Gray, K. (2017).
Laid-back position
1. Lie back so that you’re semi-reclined in a chair or on a bed.
2. Use pillows to support your back and head, if you need to.
3. Lay your baby tummy-to-tummy on you, near your nipple.
This position helps to move your baby’s tongue and chin
forward.
4. Make sure your baby’s thighs and feet are touching
a surface that helps them ‘crawl’ towards your nipple
to latch.
Keep your baby safe

Taking your baby into bed for feeding or for comfort is risky if you fall asleep. Lying down
to feed is an effective feeding position for many moms. However, it’s easier to fall asleep
if you’re in this position, especially if you’re tired. To stay awake while feeding your baby
in your bed, try wiping your face and neck with a wet cloth or keeping the room lights,
TV or music on. If you feel sleepy, put your baby in their own crib, cradle or bassinet.
If you choose to sleep on the same surface with your baby (bed share) or feel you may
fall asleep while feeding your baby, follow the recommendations about bed sharing
and how to do it as safely as possible to reduce some of the risks (see page 221). The
safest place for your baby to sleep is on their back, in their own crib, cradle or bassinet.

“
Latch
If you’re not sure if your baby is
A correct latch is important. It helps:
latching correctly, ask a health care
■■ your baby drink milk from your breast provider to watch you feeding your
■■ you make breastmilk baby. I found this helpful at the
”
■■ you feel more comfortable during beginning. I learned what changes I
the feed needed to make early on.
Here are the steps to follow for a ~ Alexandra, mom of a baby

correct latch.
1. Once you and your baby have found a comfortable
position, hold your baby’s head at the base of their skull,
below and behind their ears—the palm of your hand will
be between your baby’s shoulder blades. Try not to touch
your baby’s cheeks. Keep your baby’s hands free—their
hands help them find their way to your breast.
2. With your baby positioned at the level of your breast,
tuck their body tightly to you so their lower lip touches
the outer part of your areola. Your nipple should come in
just under their upper lip. This helps your baby smell your
breastmilk and get ready to feed.
3. Slightly tilt your baby’s head back so that their chin
touches your breast. Your baby’s lower jaw is now under
your breast which helps them take as much of your breast
into their mouth as possible. This is a deep latch. Your
baby’s mouth opens wide, like a yawn, and their tongue
cups and stretches out over their lower gum.
You can encourage your baby to open their mouth wide
by expressing a bit of your milk and slowly touching your Photos above printed with
permission: © Crown copyright 2010.
nipple against their lips. You may need to do this a few Produced by COI for the Department
times. of Health, Great Britain.
4. Use your hand to gently press on the back of your

baby’s neck and shoulders and pull them closer to your
breast. Move your baby onto your breast with their chin
touching first.
5. Your baby’s cheeks will look full and round when feeding.
At first their suck and swallow will be fast, and then it will
slow down.

Babies can easily breathe when breastfeeding,
“ My partner would place a snack
even with their nose close to your breast. If pack next to my breastfeeding
your baby’s nose is too far into the breast and chair with apples, muffins and
they cannot breathe, they’ll naturally come off
bottled water so when I got up
your breast. Re-adjust for the next latch by:
”
to feed in the middle of the night
■■ pulling your baby’s bottom closer to you they were already there.
■■ tipping their head back a little bit
~ Chelsea, mom of a toddler
■■ bringing their chin in more deeply
When your baby latches on correctly, you’ll feel a pulling sensation, not pain. If you have
pain in your nipples, bruising, blisters or cracks, get help as soon as possible.
If you have any questions, call Health Link at 811 or talk with your health care provider.
The First Week and Beyond

The first week of your baby’s life is full of changes for all of you. In the early days, it may
seem like you’re feeding your baby all the time, as one feed blends into the next. To help
you prepare for these changes, set up a comfortable space and get ready to settle in. Keep
a basket of healthy snacks and a water bottle within arm’s reach. Also, keep a book, your
phone, or access to a TV show or movie close by.
How often does my baby need to breastfeed?

Babies should feed at least 5 times in the first 24 hours after they’re born. After that, they’ll
feed at least 8 times every 24 hours.
Your baby’s feeding cues will tell you when they are hungry and full. This information gives
you an idea of how much your baby takes in for the first few weeks:
■■ 2–10 ml (0.1–0.3 oz) at 24 hours old ■■ 30–60 ml (1–2 oz) at 4–7 days old
■■ 15–30 ml (0.5–1 oz) at 48–72 hours old ■■ 60–90 ml (2–3 oz) by 8–21 days old
You may find that your baby eats quite a bit more during growth spurts. They may also
cluster feed. This can happen anytime, but is most common during the evening.
As babies get older, they become better at sucking and will continue to get the amount
of milk they need to grow. Here’s what you may see during your baby’s first few days
and beyond:
cluster feeds: frequent, small feeds within a short time

Age Baby’s behaviour How often they feed What you can do
Birth–24 ■■ may be awake, alert ■■ will feed at least 5 times ■■ watch for their
hours old and quiet during the in the first day (24 hours) feeding cues
first few hours ■■ may have periods ■■ do skin-to-skin
■■ may not want to feed where they cluster cuddling
right away, as they feed 5–10 times over ■■ keep their hands free
recover after birth 3–5 hours then sleep so they can touch
■■ may have a long for 4–5 hours your breast
sleep, waking up once ■■ massage your baby
in a while to feed or gently to help them
cluster feed wake up to feed
■■ if you don’t notice
feeding cues or are
not sure, ask for help
24–48 ■■ will wake and show ■■ will actively feed at ■■ breastfeed your
hours old feeding cues least 8 times in a day baby whenever they
■■ feed as often as every (24 hours) want—follow their
30 minutes to 3 hours ■■ may have 1–2 long feeding cues
■■ by the 2 or 3 day,
nd rd periods of cluster ■■ listen for their quiet
they’ll be more alert feeding swallowing noises
during feedings ■■ by the 2nd or 3rd day,
■■ they’ll have a strong they’ll feed at least
sucking reflex, with 8 times in a day
their lower jaw (24 hours), with no set
moving schedule
3 days– ■■ will wake and show ■■ will feed at least 8 times ■■ breastfeed your
1 month old feeding cues in a day (24 hours) baby whenever they
■■ you’ll be able to hear ■■ feedings may not be want—follow their
their swallowing spaced evenly. Your feeding cues
during feedings baby may feed every
■■ by 4 days, their 2–3 hours mixed with
swallows are easier to 1 or 2 long periods of
hear and sound like cluster feedings.
“ka, ka, ka”
1–6 ■■ will wake and show ■■ feed about 6–8 times in ■■ breastfeed your
months old feeding cues a day (24 hours) baby whenever they
want—follow their
feeding cues
6 months ■■ will wake and show ■■ feed about 5–6 times in ■■ breastfeed your
and older feeding cues a day (24 hours) baby whenever they
■■ will drink more at a want—follow their
feeding so will feed feeding cues
less often ■■ start your baby on
solid foods

How long should I feed my baby?
There’s no set amount of time that your baby should feed. Let your baby feed as long and
as often as they want to. Your baby’s appetite may vary from day-to-day and from feeding
to feeding. Follow your baby’s cues.
You’ll see that your baby has different patterns of sucking.

At the start of the feed, they’ll have short, quick sucks until Take care of your
there’s more milk flow. Later, their suck becomes slower baby’s mouth
and deeper. Your baby will pause between these bursts of Wipe your baby’s mouth
sucking and you’ll hear and see them swallow. with a clean damp cloth
after each feed. This will
Burp your baby after they’ve finished feeding on the first help them have healthy
breast, then offer the second breast and burp them again gums and prevent
tooth decay.
if they feed on that side. For more information on how to
burp your baby, see page 204.
If you need help keeping your baby awake, change their diaper before offering the second
breast. Remember to wash your hands after the diaper change and before feeding your
baby again.
Your baby may want to feed on the second

breast for a shorter time or may not want to Hands and nails
feed at all. Follow your baby’s cues. It’s usually Keep your nails short while you’re
time to change breasts when your baby: breastfeeding. Make sure your hands
and nails are clean when handling
■■ pulls off your breast and looks for more milk and breastfeeding your baby.
■■ becomes restless at the breast
■■ is not sucking or swallowing as much
If your baby fed from both breasts, start the next feeding with the breast that your baby
fed from last. If your baby fed from only one breast, start the next feeding with your other
breast.
If your baby needs help coming off your breast, put a clean finger into the corner of their
mouth and push down lightly to break the suction. Your nipples will get sore if you pull
your baby off your breast without first breaking the suction.

Is your baby getting enough breastmilk?
You can tell if your baby is getting enough breastmilk by the number of wet and dirty
diapers they have.
Age Wet diapers in 24 hours Stools in 24 hours

Birth–24 ■■ at least 1 small, wet diaper ■■ at least 1 meconium stool
hours old ■■ small amounts of dark orange or
rusty looking urine
24–48 ■■ at least 2 small, wet diapers ■■ at least 1 meconium stool, each the
hours old ■■ small amounts of dark orange or size of the palm of your baby’s hand
rusty looking urine or larger
48–72 ■■ at least 3 wet diapers ■■ at least 3 black, green-yellow

hours old ■■ small amounts of dark orange or (transitional) stools, each the size
rusty looking urine of the palm of your baby’s hand or
larger
3–5 days ■■ at least 4 large, heavy wet diapers ■■ Day 3: at least 3 black, green-yellow
old every 24 hours stools, each the size of the palm of
■■ amount of urine will increase and your baby’s hand or larger
turn a light yellow and clear ■■ Day 4 and 5: at least 4 yellow, seedy
stools every day, each the size of the
palm of your baby’s hand or larger
6–7 days ■■ at least 6 large, heavy wet diapers ■■ at least 4 yellow seedy stools every
and older every day day, each the size of the palm of your
baby’s hand or larger
■■ after 4 weeks, your baby’s stools
continue to be soft, yellow, seedy
and easy to pass. After this, the
frequency will vary with age.
Here are other ways to tell if your baby

is getting enough milk after they’re Call Health Link at 811 or your
72 hours old: health care provider NOW if you
notice any of the following:
■■ Your breasts will feel smaller and
!
softer after feeds. ■■ your baby will feed if you wake
them, but will not wake up on their
■■ Your baby will wake on their own to
own to feed
feed at least 8 times in 24 hours.
■■ your baby is always sleepy
■■ You can hear or see your baby
swallowing and their jaw moving.
■■ your baby will not feed or is not
showing feeding cues

Call Health Link at 811 or your health care provider if your baby has any
of the following:
■■ green, watery bowel movements ■■ vomits most, or all of their feeding,
that smell bad 2 or more times in a row
! ■■
■■
white, light grey, or very light
yellowish bowel movements
blood in their stool or urine
■■
■■
does not have the recommended
number of wet or dirty diapers
is fussy during or after feeding
■■ urine that still looks dark orange ■■ wants to feed all of the time—this
or rusty after they’re 72 hours old is different than cluster feeding
■■ any other signs that concern you
Bowel movements
Here are what a breastfed baby’s bowel movements look like in the first 72 hours after
birth. Breastfed babies do not usually get constipated or need medicines like suppositories
if they’re getting enough breastmilk.
Meconium stool—birth to 48 hours old Transitional stool—48 to 72 hours old
Stool—after 72 hours old Stool—yellow, seedy stools

Expressed Breastmilk
Some women may want or need to use expressed breastmilk with their baby, while others
may not need to express breastmilk at all. There are many reasons why you may want to
express your breastmilk. Expressing your breastmilk will:
■■ help build and keep your milk supply
■■ collect breastmilk for your baby as needed If you’re a partner
Expressing and pumping can be
■■ help keep you more comfortable if your
a lot of work. Here are some ways
breasts are full or engorged you can help:
Other reasons you may need to express your ■■ Bring a warm moist cloth to your
partner for their breasts before
breastmilk:
they begin pumping.
■■ your baby is not able to latch ■■ Put music on to help them relax.
■■ your baby is sick or born preterm ■■ Take care of your baby.
■■ you’re going to be away from your baby
for longer than 2 hours
■■ you’re going back to work before your baby has weaned
You’ll find it easier to express your milk after:

■■ your baby has breastfed
■■ your baby’s first feed in the morning—this is
when you have more milk
■■ you put a warm, moist cloth on your breasts
■■ you use gentle breast massage
■■ you’ve touched or cuddled your baby
At first, you may only be able to express very small amounts of milk. One breast may make
more milk than the other. As you become more comfortable with expressing by hand or
with a breast pump, your milk will flow more easily. After a few days, your milk supply will
increase. The amounts may be different each time you pump.

Tips when you express breastmilk:
■■ Choose a comfortable place.
■■ If your baby is not with you, take reminders of them along, such as a piece of clothing
with their scent or a recording of your baby that you can listen to or watch.
■■ Use relaxation techniques before and while expressing, such as music and deep breathing.
Breast massage
Massaging your breasts before expressing milk will help start your milk flowing, may help
you express more milk and increase your milk supply. Massaging your breasts before
breastfeeding can help with your let-down, if needed. You can also do breast massage
before and while your baby is feeding.
When doing breast massage:

■■ Always handle your breasts gently so you don’t damage the delicate tissue.
■■ Put a warm cloth on your breast before massaging.
■■ Support your breast with one hand and massage with the other.
■■ Place the flat part of your fingers palm side down on your breast.
■■ Massage your breasts in small circular motions, from your chest towards your nipple and
massage your entire breast.

Expressing by hand
Expressing breastmilk by hand is a skill that takes practice. You may not get much milk at
first. Even expressing a small amount of milk will signal your body to make more. It may be
easier to practice in the bathtub or shower, or after breastfeeding your baby.
To express by hand:
1. Wash your hands with soap and warm water.
2. Put a warm cloth on your breasts, then gently
massage them before starting to express.
3. Put your thumb on top of your breast, not too
close to your nipple. Your thumb and index
(pointer) finger need to be opposite to each other
and about 2.5–4 cm (1–1½ inches) back from the
edge of your areola.
4. Lift your breast slightly with the fingers that are under your breast. Push straight back
in towards your chest and gently squeeze your thumb and fingers together, rolling
them forward towards your nipple. Keep doing this until your milk starts to flow. Do not
squeeze the base of your nipple, as it will stop the milk flow.
5. Repeat step 3 and 4 a few times in each position as you rotate your hand around your
nipple and areola like a clock. If you’re not getting any milk flow, move your fingers
back a little. Keep doing this until the milk flow slows and your breast feels soft.
6. Repeat with your other breast.
Gently push in towards Squeeze your thumb Gently roll your fingers
your chest and fingers together toward your nipple
To learn more about hand expression, visit the Videos section at


Expressing with a breast pump
Breast pumps work to express breastmilk by imitating your baby’s sucks. There are different
types of pumps you can use.
■■ Manual (hand), battery-operated or small electric
pumps are used when you pump only once in a
while and after your milk supply is established.
■■ Hospital-grade electric pumps are used when
you’re not able to breastfeed for some time, if your
baby is not regularly breastfeeding, or if you’re
having problems with breastfeeding. These pumps
are better for establishing and maintaining your Manual breast pump
milk supply than manual pumps. You can rent
these pumps.
If you’re expressing milk while in the birth centre, there

may be hospital-grade electric pumps for you to use.
Ask your nurse to show you where they are and how to
use them.
Here are some tips for pumping breastmilk:

■■ Follow the manufacturer’s instructions for using and Electric breast pump
cleaning your breast pump.

■■ Only use as much suction as needed to get your milk to flow—pumping should
not hurt.
■■ Centre your nipple in the nipple tunnel—it should not press against the sides.
■■ It could take a few minutes for your milk to
start flowing. Expressing breastmilk
■■ If you’re pumping one breast at a time, switch You may find that expressing
between your breasts several times. your milk by hand works well
for you or you can buy or rent a
■■ Pumping both breasts at the same time will breast pump.
help you pump more milk.

Storing and preparing expressed breastmilk
At the birth centre
When your baby is at the birth centre, your breastmilk needs to be handled safely. When
storing breastmilk at the birth centre:
■■ Ask your nurse for bottle labels that have your baby’s name and your birth centre
identification (ID) number on them.
■■ Put your breastmilk into the bottles you’re given.
■■ Write the time and date you expressed on the label.
■■ Ask your nurse to store the labelled breastmilk in a secure refrigerator or freezer
right away.
■■ If you express breastmilk at home while your baby is at the birth centre, follow the
guidelines below. Put your breastmilk in your refrigerator right away. Use ice or freezer
packs to take your breastmilk to the birth centre.
To make sure your baby gets your breastmilk, check that the bottle you store it in has your
birth centre ID number on it. The bottle label will be checked with your baby’s birth centre
ID bracelet at the bedside by 2 people before the breastmilk is given to them.
At home
Here are some guidelines for preparing and storing breastmilk at home:
■■ Always use clean feeding equipment ■■ Chill fresh breastmilk for 1 hour in
(see page 191). a refrigerator before adding it to a
■■ Write the date you expressed your container with already chilled or frozen
breastmilk on the container with a breastmilk.
waterproof marker. ■■ If freezing, leave a 1.5 cm (1/2 inch) space
■■ Store your breastmilk in the amounts at the top of the container, as breastmilk
your baby needs for one feeding. expands when it’s frozen.
■■ Refrigerate or freeze freshly expressed

■■ Keep your breastmilk cool or frozen
breastmilk that’s not going to be used while travelling.
right away. ■■ If you express breastmilk while you’re
■■ Do not mix warm expressed breastmilk away from home, store it in an insulated
with cooled or frozen expressed cooler bag with a frozen gel pack for no
breastmilk. more than 24 hours.

Keep the original expressed breastmilk
date on the container if you add more Check the date
breastmilk to it on a different day. Always Check the date on the container with
use the breastmilk in the container that’s expressed breastmilk. Use the one that’s
been frozen the longest first, even if you been stored the longest first. Throw out
any that is past the storage time.
have added fresh breastmilk to it.
Storing expressed breastmilk

Here are some guidelines on where and how long you can store your breastmilk.
Where it can be stored How long it can be stored

At room temperature Up to 4 hours
In an insulated cooler bag with a frozen gel pack Up to 24 hours at 4 °C (39.2 °F) or lower
In the refrigerator—not in the door Up to 3 days (72 hours)
In the freezer of a 1-door refrigerator Up to 2 weeks
In the freezer of a 2-door refrigerator or a side- Up to 4 months

by-side refrigerator
In the chest or deep freezer Up to 12 months at -18 °C (-0.4 °F) or lower
Thawing breastmilk
To thaw breastmilk quickly, put it under cool or warm running water or in a pot of warm
water. If you don’t need it right away, thaw the milk in the refrigerator. When using thawed
breastmilk:
■■ Gently shake the milk to mix it back together—the fat in breastmilk may separate
during thawing.
■■ Refrigerate breastmilk after thawing and
use it within 24 hours. Throw it out if it’s
Microwaves
not used within 24 hours or if your baby Thawing or warming breastmilk in
a microwave is not recommended.
does not finish it.
Microwaves heat liquids unevenly and
■■ Don’t re-freeze breastmilk that’s already form hot spots. This can burn your
been thawed. baby’s mouth and destroy the immune
components in breastmilk.

Warming breastmilk
Your baby may prefer warm breastmilk. If you’re using frozen breastmilk, thaw before
warming.
Here’s how to safely warm breastmilk:

■■ Put the container of breastmilk in a pan of warm water for no more than 15 minutes.
■■ Do not cover the lid or nipple with water when it’s being warmed. This can contaminate
the breastmilk.
■■ Gently shake the container to mix it.
■■ Test the breastmilk on the inside of your wrist to make sure it’s not too warm to feed
your baby. It should feel lukewarm to the touch.
■■ Do not put the bottle nipple in your mouth to check the temperature or to clean it. This
can pass germs to your baby.
Feed breastmilk using a dropper, spoon, cup or bottle. For more information on preparing
feeding equipment, see page 191 and feeding your baby by bottle, see page 190.
Taking Care of Yourself While

Breastfeeding
Eating
You may feel more hungry and thirsty
while breastfeeding your baby. Eat Track your servings
a variety of foods from Canada’s My Food Guide Servings Tracker can help you
Food Guide. You only need an extra keep track of the amount and type of food
2–3 servings, about 350–400 calories you eat while breastfeeding.
each day from any of the four food To learn more, visit the Printables section at
groups to meet your needs. Try to healthyparentshealthychildren.ca/resources
drink enough fluids to keep you from
feeling thirsty.
If you’re vegan, vegetarian, or on a restricted diet, you and your baby may need certain
extra vitamins and mineral supplements. Call Health Link at 811 or talk with your health
care provider to find out more.

Omega-3 fats are important for your baby to grow and develop. Eating fish high in
omega-3 fats will increase these fats in your breastmilk. Canada’s Food Guide recommends
eating at least 2 servings of cooked fish and shellfish per week (see page 52).
Some fish are high in mercury, which can harm the developing brain and nervous system
of infants and young children. For a list of fish that are higher in mercury as well as some
safer fish alternatives, see page 54.
Small amounts of caffeine are fine for most people when breastfeeding. Try to limit your
caffeine intake to 300 mg per day or less.
Caffeine is found in:

Energy drinks
■■ coffee—about 150 mg of caffeine per 250 ml (1 cup)
Many energy drinks
■■ green and black tea—about 30–50 mg per 250 ml (1 cup) have a lot of caffeine
■■ cola and some other carbonated beverages—about in them and are not
23–40 mg of caffeine per 250 ml (1 cup) recommended when
breastfeeding.
■■ chocolate—about 3–50 mg of caffeine in 1 chocolate bar
“
Most breastfeeding babies are not
bothered by what you eat. The only
foods you should not eat are the ones Every time you sit down to feed your
”
you or your baby are allergic to. If baby, you can eat and drink and feed
you think something you’re eating is yourself too.
bothering your baby, talk with your
health care provider. ~ Sara, mom of a toddler
Medicine, supplements and herbal products

Before taking any prescription or over-the-counter medicine, supplements or herbal
products, talk with your health care provider to ensure they’re safe for you and your baby
to take while breastfeeding. Many medicines may be safe to take when used as directed.
To learn more about medicine, supplements, herbal teas and

products, call Health Link at 811, the Medication & Herbal Advice
Line toll-free at 1-800-332-1414 or visit the Links section at

Alcohol
Drinking alcohol is not advised while breastfeeding. Alcohol passes into your breastmilk
and then to your baby. The level of alcohol in your breastmilk is the same as the level in
your blood. Alcohol in breastmilk can affect your baby’s brain development. Drinking
alcohol can also decrease the amount of milk your body makes.
If you choose to have an occasional alcoholic drink, breastfeed before you have a standard
drink. A standard drink is 148 ml (5 oz) of wine, 341 ml (12 oz) of beer or 44 ml (1.5 oz) of
liquor. After drinking, wait until the alcohol has left your breastmilk before breastfeeding
again—this usually takes around 2–3 hours for a standard drink. Express your milk
during this time if you’re uncomfortable. This expressed breastmilk should not be fed to
your baby.
You may want to plan ahead if you know that you’re going to have an alcoholic drink. Have
expressed breastmilk available in case your baby is hungry before the 2–3 hours are up.
If you choose to drink more than one occasional alcoholic drink, talk with your health care
provider about how to reduce your baby’s exposure to alcohol through your breastmilk. To
learn more, call Health Link at 811 or talk with your health care provider.
Tobacco and tobacco-like products

Nicotine from tobacco passes into your breastmilk. It can make your baby more likely to
refuse feedings, be fussy, sleep poorly and spit up. The best thing you can do for you and
your baby’s health is to cut down or quit using tobacco.
If you choose to use tobacco, it’s still important to breastfeed as breastmilk has many
benefits. Try to breastfeed your baby first before you use tobacco, so that less nicotine
passes through your breastmilk to your baby. Before you use tobacco, put on clothing,
like a jacket or sweater that acts as a barrier to smoke and vapour. Take it off after using
tobacco. After you use tobacco, remember to wash your face and hands and remove or
change your clothing before holding and cuddling your baby. This will reduce your baby’s
exposure to second- and third-hand smoke.
When your baby has periods of cluster feeding, often in the evening, do your best to try
and skip a cigarette, but never a feeding. Be ready for when this happens. Make a list of
ideas that help you cope with stress for when you plan to skip a cigarette. Put the list up
somewhere easy to see so that it’s there when you need it.

For help quitting tobacco:
Change takes time
■■ Ask for support from your partner,
Making changes in your life is a process that
family or friends. can take time. You may make changes, make
■■ Call the AlbertaQuits confidential progress, and then slip back to old habits
helpline 24/7, toll-free at again. Remember, each time you try to
1-866-710-QUIT (7848) or visit change, you learn more about what gets in
your way and what helps you succeed. This
albertaquits.ca
means you’re more likely to succeed the next
■■ Make a plan for how you’ll cope time. Keep trying. Small steps matter.
with stress.
For more information, visit the Links section at

Cannabis
There is no known safe amount of cannabis (marijuana, hashish, hash oil) to use while
breastfeeding. If a mom uses cannabis, it could affect her mood, judgment and how she
supervises and cares for her baby. It could also affect her ability to breastfeed and respond
to her baby’s feeding cues.
THC from cannabis is passed into breastmilk and is stored there. If this breastmilk is given
to the baby, the THC is passed to them. The THC is then taken into their brain and fat
cells and can stay in the baby’s body for weeks. There is limited research on the effects
of cannabis on a breastfed baby. Some research shows that THC can affect a baby’s brain
development and cause them to have slower movements and reactions. More research
is needed on the possible effects of cannabis use and breastfeeding. Until more is known
about it, using cannabis while breastfeeding is not advised.
Cannabis smoke also has many of the same harmful chemicals as tobacco smoke.
Second-hand cannabis smoke can cause babies and young children to be sick and it can
affect their level of alertness, understanding and judgment. If someone around you uses
cannabis, it’s important for them not to smoke or vape cannabis in your home, in your
vehicle, or in any closed spaces around your baby and other children.
For information about cutting down, quitting or finding a safer alternative if you
use cannabis for medical reasons, talk with your health care provider. To learn
more, you can also call the Addiction Helpline 24/7, toll-free at 1-866-332-2322,
or visit the Links section at healthyparentshealthychildren.ca/resources

Other drugs
Using other drugs such as ecstasy, methamphetamines, cocaine, heroin and fentanyl is
not recommended while breastfeeding. These drugs can be harmful, both mentally and
physically, and can affect a person’s ability to think and make decisions, which can create
an unsafe environment for children. These drugs can pass through breastmilk to babies
and could affect their health and well-being.
If you’re concerned about your own or someone else’s drug use, talk with your health
care provider. To learn more, you can also call the Addiction Helpline 24/7, toll-free at
1-866-332-2322, or visit the Links section at healthyparentshealthychildren.ca/resources
Challenges and What To Do

If you have breastfeeding challenges, you’re not alone. Challenges are common in the
first few weeks. Be gentle with yourself as you learn and build confidence. Breastfeeding
is a personal experience and there’s no ‘one size fits all’ approach to handling challenges.
Some of the common challenges that can happen while breastfeeding, and some tips you
can try are included in this section. If you have any questions, call Health Link at 811 or talk
with your health care provider.
“ I had different problems breastfeeding each of my two kids. With one, I was
really engorged once my milk came in. With the other, I had thrush. Both times,
my midwife helped problem-solve with me. I felt like I had amazing support
”
from her. She had so much experience and had seen it all. She helped me to feel
confident. I ended up breastfeeding until their first birthdays.
~ Alisha, mother of two children
Sore nipples
During the first week of breastfeeding, your nipples may
feel tender, but breastfeeding should not hurt. While some Sore nipples?
tenderness is common during the first week, pain that does Check your baby’s
not go away is not normal. Cracked, bleeding or blistered position and latch.
nipples are not normal either. The most common reason for
sore nipples is that your baby is not positioned or latched properly.

Sore nipples may also be caused by
bacteria or a yeast infection (thrush). If you Call Health Link at 811 or
or your baby have a yeast infection, both your health care provider
of you will need to be treated, even if only
one of you has symptoms. To learn more
about thrush, visit the Links section at
! if your baby has white
patches that stick to their
mouth and tongue. This
healthyparentshealthychildren.ca/resources can look like milk curds.
To help prevent sore nipples:

■■ Check your baby’s position and latch. If your baby is not getting a deep
latch, take them off your breast by sliding a clean finger between their
gums until the suction is released. Latch your baby again.
■■ Do not use creams or ointments on your nipples unless your health care provider tells
you to.
■■ Do not use soap on your nipples. This can make them too dry.
■■ Use cotton breast pads, not plastic-lined ones.
Call Health Link at 811 or your health care provider if you have any of the
following:
! ■■
■■
■■
nipples that are red, itchy, burning or cracked
sharp, shooting or burning pain in your breast during and after feeds
nipples that are not feeling better within 1 or 2 days
If you have cracked or blistered nipples:

■■ breastfeed your baby as soon as they ■■ start breastfeeding on the side that’s
wake up and before they start to cry— less sore
it’s okay to wait to change their diaper ■■ use a warm face cloth or towel on
until after they feed your nipples
■■ check your baby’s latch and try different ■■ put some of your expressed breastmilk on
feeding positions your nipples to help them heal
■■ massage your breast before and during
the feed to help your milk flow
Talk with your health care provider before taking pain medicine, using a breast pump, or
using a nipple shield.
nipple shield: breastfeeding equipment that fits over the nipple and areola

Breast fullness
It’s normal for your breasts to feel full and heavy in the first few weeks as your body makes
more breastmilk. Your breasts will become softer after each feeding.
Sometimes your breasts might become very full and make you feel uncomfortable. Your
breasts may feel firm, warm or tender, but your milk will still flow and be easy to express.
Your breasts will feel softer, less heavy and less tender after feeding.
If your breasts feel very full, here are some ways to help you feel more comfortable, help
with milk flow and make it easier for you to breastfeed.
Before breastfeeding While breastfeeding After breastfeeding

■■ Take a warm shower or bath ■■ Massage your breasts. ■■ If your breasts are tender,
just before you breastfeed. ■■ Position and latch your baby put a cool compress such
■■ Put a warm cloth or towel so that their chin and nose as a gel pack, frozen peas
on your breasts. are pointing to different or ice that’s wrapped in a
areas of the breast while dry cloth on your breasts for
■■ Express a small amount 5–10 minutes.
of milk. feeding.
Engorgement
Engorgement is more than breast fullness. It happens when milk does not flow easily from
your breasts. Signs that you’re engorged:
■■ Your breasts are hard, swollen, shiny, painful and red.
■■ Your nipples become flat.
■■ It’s hard to express your milk.
How to prevent engorgement

Feeding your baby often is the best way to prevent engorgement. Other things that
help include:
■■ good positioning and latch
■■ cue-based feedings—at least 8 feedings in 24 hours. Try not to miss any feedings.
■■ breastfeeding for as long as your baby wants
■■ expressing just enough milk by hand or by using a breast pump so you’re comfortable.
Pumping your breasts too much can make it worse as your body will make more milk.

How to manage engorgement
Here are some tips to help you feel more comfortable and make it easier for you to
breastfeed:
Before breastfeeding While breastfeeding After breastfeeding

■■ Put a cool compress such ■■ Help your milk flow by ■■ If your baby does not feed
as a moist towel, a gel gently massaging your on your second breast,
pack, frozen peas or ice breasts. express just enough milk to
that’s wrapped in a dry ■■ If your baby is having feel comfortable. Start the
cloth on your breasts for trouble latching, you can next feed on this breast.
5–10 minutes. Do this as express some breastmilk ■■ Put a cool compress such
often as you can, then by hand, or pump some as a moist towel, a gel
gently massage your breastmilk to soften your pack, frozen peas or ice
breasts. breast. that’s wrapped in a dry
■■ Talk with your health ■■ Position and latch your baby cloth on your breasts for
care provider about pain so that their chin and nose 5–10 minutes.
medicine you can take while are pointing to different ■■ If you’re feeling
breastfeeding. areas of the breast while uncomfortable between
feeding. feeds, express a little milk
■■ Feed on one breast and until you feel better—
offer your other breast if expressing or pumping
your baby is still hungry. too much milk will make
it worse as your body will
make more milk.
! Call Health Link at 811 or your health care provider NOW if these tips do
not help and your breasts are still engorged.
Blocked milk ducts

Blocked milk ducts happen when there is a build-up of milk in the breast ducts. These
areas may be tender, lumpy, red and sore.
To help prevent blocked milk ducts:

■■ Position and latch your baby correctly. ■■ Breastfeed your baby often and try
■■ Get help if your nipples are sore and are different feeding positions.
not getting better. ■■ Wear a well-fitting bra and comfortable
■■ Try not to miss feedings. clothing.
■■ Wash your hands often.

■■ Do not wear underwire bras or wear a
bra to bed.

Here are some things you can do to help you clear the blocked duct:
■■ Feed your baby at least every 2–3 hours ■■ Position and latch your baby so their chin
to keep your milk flowing. and nose are pointing to the tender area.
■■ Put a warm cloth on your breasts for ■■ Try to rest—ask your partner, family and
5–10 minutes before breastfeeding, as friends to help you at home.
this helps with let-down. ■■ Drink enough fluids and eat well.
■■ Use your fingertips to gently massage ■■ Express or pump regularly, if your baby is
your breast from behind the tender area not feeding every 2–3 hours and at least
all the way to your nipple before and once at night. This will help regularly
during breastfeeding. empty your breast if your baby is not able
■■ Have your baby breastfeed on your to breastfeed.
tender breast first, then your other breast. ■■ Talk with your health care provider about
taking pain medicine, if you need it.
Even though you may not feel

well, your milk is safe for your Point baby’s nose and chin to
baby. Continue to feed your baby different areas
to keep your milk flowing. If the Your baby gets the most milk from the area where
lumps don’t soften or decrease their chin and nose are pointing to. Changing the
with feeding, talk with your health direction that they’re pointing to will help relieve
care provider as you may need the pressure in the blocked duct and drain milk
from different areas.
additional treatment for mastitis.
Mastitis
Blocked ducts that are not drained can lead to an inflammation of the breast tissue called
mastitis. Mastitis can also be caused by an infection.
Signs that you may have mastitis:

■■ areas of your breast become inflamed and are red, painful, hard and swollen
■■ only one breast is affected
■■ you can feel a lump close to the skin
■■ your breast is tender or hurts around the lump
■■ flu-like symptoms that include a fever of 38 °C (100.4 °F) or more, chills and body aches

Here are some things you can do to help if you have mastitis:
■■ Feed your baby at least every 2–3 hours ■■ Position and latch your baby so their chin
to keep your milk flowing. and nose are pointing to the tender area.
■■ Put a cool cloth on your breasts for ■■ Try to rest—ask your partner, family and
5–10 minutes before breastfeeding, as friends to help you at home.
this helps with let-down. ■■ Drink enough fluids and eat well.
■■ Use your fingertips to gently massage ■■ Express or pump regularly, if your baby is
your breast from behind the tender area not feeding every 2–3 hours and at least
all the way to your nipple before and once at night. This will help regularly
during breastfeeding. empty your breast if your baby is not able
■■ Have your baby breastfeed on your to breastfeed.
tender breast first, then the other breast. ■■ Talk with your health care provider about
taking pain medicine, if you need it.
Mastitis can be serious and may need to be treated with antibiotics if it’s due to an
infection. It usually clears up quickly once treated.
Your baby may refuse your breast because your milk may have a different taste when you
have an infection. If this happens, your baby will need to be supplemented (see page 187).
You’ll need to express your breastmilk to maintain your milk supply during this time.
Call Health Link at 811 or your health care provider if you have any of the
following when breastfeeding:
■■ trouble with, or are unable to ■■ a fever of 38.5 °C (101.3 °F)
!
breastfeed, express or pump or higher
■■ flu-like symptoms such as ■■ red, warm spots or streaks on
headaches, aching muscles, your breasts
chills, feeling tired or other signs ■■ hard, swollen breast that your
of infection baby has trouble latching to
■■ hard, red and painful breasts

Breasts leaking milk
After the first few weeks, when your milk supply increases, milk may leak from one breast
while your baby is feeding from the other. You can either gently press a clean cloth or
towel on your nipple to stop the flow or collect your breastmilk in a clean container.
Milk may also leak from your breasts between feedings. You may want to use cotton breast
pads to protect your clothes. To help prevent infection, change your breast pads often.
Not enough milk

Women usually make enough milk for their baby. For more information on how to tell if
your baby is getting enough milk, see page 164. There are some things that can affect milk
production.
Your body may make less milk if your baby:

■■ is not positioned and latched properly
Herbal product claims
■■ is not breastfeeding often enough during
the day or night Some herbal products such as teas
claim to increase breastmilk supply.
■■ is not breastfeeding long enough at each There is not enough research around
feeding their safety. To learn more, call the
Medication & Herbal Advice Line
■■ is only offered one breast at each feeding
toll-free at 1-800-332-1414.
■■ is being supplemented and you’re not
pumping or expressing your milk
■■ is feeding with a nipple shield, but you’re not using it correctly
Your body may make less milk if you:

■■ are in pain or stressed
lost a lot of blood during or after birth
!
■■
your health care provider if
■■ have had breast surgery such as a breast your breasts don’t feel full
reduction and heavy by the time your
■■ have certain health issues such as thyroid baby is 72 hours old.
problems, diabetes or high blood pressure
■■ take certain medicines such as birth control pills, antihistamines or some herbal teas
■■ drink alcohol
■■ are pregnant

Talk with your health care provider if you think any of the above or something else may be
affecting your milk supply.
Here are some tips to help increase your milk supply:

■■ Spend more time skin-to-skin cuddling ■■ Offer both breasts at every feeding. Let
with your baby. your baby finish the first breast before
■■ Rest when your baby is sleeping. Ask for offering the other one.
help with household chores. ■■ Express milk by hand or by using a breast
■■ Feed your baby at least 8 times in pump after feedings. Using an electric
24 hours and watch for their feeding cues. pump together with expressing by hand
will increase your supply more than
■■ Put a warm face cloth or small towel on pumping on its own.
your breasts and massage them before
and during pumping, hand expressing or
■■ Use an electric breast pump if your baby
while your baby is feeding. is not breastfeeding well or you’re not
able to breastfeed. Set it at a comfortable
■■ Use breast compression when your setting and use it at least 6–8 times in
baby’s sucking slows down. 24 hours. Express at least once at night.
Call Health Link at 811 or talk with your health care provider if you have any concerns with
not having enough breastmilk.
Breast compression
Breast compression is a way to gently squeeze
your breast during feeding to increase milk
flow. Increasing milk flow can encourage your
baby to suck if they fall asleep after only a few
minutes at your breast.
To do breast compression, gently massage

and place your thumb on top of your breast
and the fingers of the same hand below it.
Apply gentle pressure behind your areola for a few seconds. Do not squeeze so hard that it
hurts. You can do this throughout the feed or at the end, when your baby gets sleepy.
To learn more about breast compression, visit the Videos section at


Too much milk
Your milk supply is usually affected by your baby’s appetite. Sometimes you may have a
larger milk supply than your baby needs (oversupply).
Signs that you may have an oversupply include:

■■ leaking a lot of milk during and between feedings
■■ feeling your breasts are really full
■■ getting blocked ducts often
There may be other reasons for having too much milk. If you have any questions, talk with
If you have too much milk, your baby may:

■■ be fussy after or between feeds
■■ spit up a lot
Donating breastmilk
If you have too much breastmilk,
■■ have explosive, watery, green stools you may be interested in
■■ want to feed often, even after taking donating it to the milk bank
large amounts of breastmilk in Alberta. To learn more,
visit the Links section at
■■ be gaining weight well, but is fussy healthyparentshealthychildren.ca/resources
and always seems hungry
Here are some tips that may help if you have too much milk:
■■ Use different feeding positions, such as laid-back.
■■ Feed your baby as many times as they want.
■■ For 3–6 hours, offer only one breast at each feed. After 3–6 hours, offer the other breast
at each feed. Let the breast you’re not feeding from leak milk and express just enough
milk for comfort. Once your symptoms are better, go back to offering both breasts at
each feed.
■■ Use a cold face cloth or small towel, for no longer than 20 minutes at a time on the
breast you’re not feeding on.
■■ Burp your baby often.

Milk flows too fast
An overactive let-down is when your breastmilk flows too fast. Overactive let-down and
oversupply are often seen together.
Signs that you may have milk that flows too fast include:
■■ pain with let-down at the start of the feed
■■ breastmilk spraying from one breast, while your baby feeds on the other breast
■■ painful nipples from your baby biting down to slow milk flow
If your milk flows too fast, your baby may:

■■ have a poor latch, suck and swallow
■■ push off the breast when your breastmilk sprays
■■ be fussy and cough, sputter or pull away during feeds
■■ come on and off the breast often
■■ refuse to breastfeed
Here are some tips to help with a fast milk flow:

■■ Use positions that put your baby above
your breast, such as laid-back. Call Health Link at 811 or your
health care provider for any of
■■ Respond to your baby’s feeding cues
the following:
early, like when they’re just waking up.
■■ concerns about your milk
■■ Express or pump a little milk before
supply
latching your baby.
your baby pulls off your breast
!
■■
■■ Burp your baby often and take breaks
often and looks like they’re
so your baby can pace themselves
having trouble breathing
during the feed.
■■ your baby chokes, coughs or
■■ Release your baby’s latch if they choke sputters while feeding
or sputter. Let your milk spray into a
■■ your baby has explosive,
cloth before your baby latches again.
green, watery stools
■■ Avoid using warm cloths or towels or
■■ your baby spits up more than
taking long, warm showers or baths
usual
before breastfeeding.

Sleepy newborn
Some newborns are sleepier than others. A baby may be sleepy because of:
■■ a hard labour and birth ■■ too much light and noise (over
■■ medicine you’re taking, if breastfeeding stimulation)
■■ long periods of crying

■■ illness such as an infection
■■ not getting enough breastmilk or

■■ jaundice or other health reasons
infant formula
Here are some ways to wake up your baby to feed:

■■ Do skin-to-skin cuddling.
■■ Unwrap or undress your baby, or change their
diaper.
■■ Hold your baby upright while supporting their neck
and head, make eye contact, and talk to them.
■■ Gently stroke or massage your baby’s body. Move
their arms and legs, stroke their cheek, rub their
back or circle their lips with your clean finger.
■■ Express breastmilk onto their lips. If feeding your
baby infant formula, put it on their lips.
■■ Burp and put them on the same breast to feed until
your breast feels empty or you hear less swallows.
■■ If your baby falls asleep after only a few minutes
at the breast, use breast compression while
breastfeeding to encourage sucking (see page 183).
You can do this throughout the feed or at the end
when your baby gets sleepy.
! Call Health Link at 811 or your health care provider NOW if

you’re having trouble waking up your baby.
jaundice: yellowing of the skin and whites of the eyes due to high bilirubin levels

Supplementing
There may be different reasons your baby needs to be supplemented. Talk
with your health care provider if you have any concerns. If you need to
supplement, you can use your own expressed breastmilk or infant formula,
along with or in place of breastmilk. Although some hospitals may have
pasteurized and screened donor human milk, there is a limited supply and
it’s used mainly for premature and very sick babies. For others, you may
be able to buy it from a milk bank. To learn more, visit the Links section at
When supplementing:
What about feeding
■■ Keep doing skin-to-skin cuddling with
breastmilk donated from
your baby during and after feeding.
friends or bought online?
■■ If possible, breastfeed first, then offer the Feeding your baby unpasteurized
supplement. Finish the feed at the breast. donor human milk from friends
This helps your baby link the feeling of or bought online is very risky. This
fullness with the breast. breastmilk can carry communicable
diseases that can make your baby very
■■ If you use a bottle, choose a nipple
sick. There is also an increased risk of
that has a slower flow rate and a single contamination with harmful organisms
hole to help your baby coordinate their such as bacteria and viruses, and the
sucking, swallowing and breathing. possibility that your baby may be
exposed to medicine, alcohol, cannabis
■■ If you’re using infant formula, talk with
or other drugs.
your health care provider about the one
that’s right for your baby. Follow the
manufacturer’s formula mixing instructions
exactly. Mixing and storing formula Call Health Link at 811 or
incorrectly could cause serious health your health care provider
problems for your baby (see page 194). NOW for any of the
following:
■■ Try to express your breastmilk to help keep
your milk supply up. If you don’t, your milk your baby is not breast-
!
■■
supply will decrease. feeding well or cannot

breastfeed
If your baby no longer needs to be ■■ your baby falls asleep
supplemented, you can start exclusive after only a few sucks
breastfeeding again. Talk with your health care
provider if you have questions or concerns.
■■ your baby will not
feed or is not showing
feeding cues

of the following:
■■trouble latching does not make noise when
■■
!
swallowing after they’re
■■is fussy during or after 72 hours old
breastfeeding
has hard stools that are difficult
■■
■■wants to feed all the time to pass

■■fewer than the recommended has any other signs that
■■
number of wet or dirty diapers concern you
Weaning off the Breast

Weaning (stopping breastfeeding) is a process, not a single event. It starts when you offer
your baby foods other than breastmilk, like formula or solid foods, and ends when your
baby stops breastfeeding. Your baby will gradually begin to eat more solids, once solid
foods are introduced around 6 months, and breastfeed less. This may take several weeks
or months, depending on you and your baby. Just as each baby has their own schedule for
feeding, they’ll also have their own schedule for weaning.
Weaning may be led mostly by your baby, mostly by you or by both of you. All of these are
okay. Listen to your own feelings and read your baby’s cues and you’ll know when it’s the
right time. When it’s time to start weaning, make a plan so you can have a gradual stop
that makes it easier for your breasts to adjust.
If you’re introducing infant formula, replace only one feeding at a time. Begin by feeding
your baby using a cup or a bottle at a time of day when they’re not as hungry. They may
refuse it at first—offer it again each day. When they’re feeding well, you can start to replace
other feedings.
If you’re weaning when your baby is

under 9 months:
Babies over 9 months
When your baby is 9–12 months old, you
■■ Use infant formula. can give them pasteurized, homogenized
■■ At 6 months old, use a cup without a whole milk (3.25% milk fat), as long as
they’re eating iron-rich foods at each
lid for small amounts of water or infant
meal (see page 296).
formula.

Breastfeeding has provided food, security and comfort for your baby. Continue to offer
skin-to-skin cuddles and hugs often during weaning to support your baby through this
change and continue to build your attachment.
If you need to wean suddenly

If you and your baby need to be separated for a long time such as during an illness,
breastfeeding may need to stop suddenly. Here are some things to help you feel more
comfortable:
■■ Wear a supportive bra.
■■ Use a gel pack, frozen peas or ice that’s wrapped in a dry cloth on your breasts for no
longer than 20 minutes at a time to relieve fullness.
■■ Express a small amount of milk for comfort if needed. Taking a warm shower may also
help your breasts leak.
■■ Your breasts may soften but will still produce milk for several weeks or months. You can
wear breast pads if your milk leaks.
If you did not plan to stop breastfeeding, you may feel a sense of loss. Ask for emotional
support from your partner, friends or family. You can also call Health Link at 811 or talk with
your health care provider for information and support.
When Breastfeeding is Not Advised

In rare cases, it may not be safe to breastfeed, but you might still be able to feed your
baby your breastmilk. This may happen if you have some types of infection such as herpes
lesions on your breasts.
There may be times when your health care provider advises you not to breastfeed or give
breastmilk to your baby. This may happen if:
■■ your baby has a rare metabolic condition such
as phenylketonuria (PKU), galactosemia or maple If you’re advised not
syrup urine disease
to breastfeed
This may be an emotional time.
■■ you’re HIV positive Whatever you’re feeling, be
■■ you’re on chemotherapy or taking other medicine gentle with yourself and ask for
that is not safe while breastfeeding help if you need it.

■■ you’re being given certain radioactive compounds
■■ you’re misusing prescription medicine or alcohol, or using cannabis or other drugs such
as ecstasy, methamphetamines, heroin or fentanyl
If you’re advised not to breastfeed your baby, feed your baby infant formula (see page 193).
If you have questions, call Health Link at 811 or talk with your health care provider.
Feeding by Bottle
Whether you’re feeding your baby expressed breastmilk or using infant formula, when you
feed your baby from a bottle:
■■ Hold your baby almost upright in your ■■ Tip the bottle so the liquid just fills
arms, using skin-to-skin cuddling. the nipple.
■■ Hold your baby’s cheek to your breast ■■ Let your baby seek the nipple. Follow
to feed. their feeding cues.
■■ Change the arm you use to hold your ■■ When they’re ready, put the nipple deep
baby at each feed—just as you would enough into their mouth until they have a
when breastfeeding. wide latch. They should not gag.
■■ Always hold your baby until they’re ■■ Babies will usually feed for 15–30 minutes
finished their feed. Never leave your baby at each feed. If they drink too fast, tip the
alone with a bottle in their mouth—they bottle down to slow their feed or remove
can choke. it. Your baby should not gasp, cough or
■■ Choose a low flow nipple with a cry while bottle feeding.
single hole. ■■ Burp your baby when they’re finished
feeding (see page 204).
Let your baby control the flow of milk and follow their feeding cues. You can tell if your
baby is swallowing too fast when:
■■ They’re not taking a breath between swallows.
Choose low flow nipples
■■ Their eyes are opened wider than usual.
Low flow nipples help your
■■ Their nostrils are flaring. baby coordinate their sucking,
■■ Their arms and legs are stiffening as they swallowing and breathing.
struggle to breathe and feed at the same time.
■■ Breastmilk is leaking from the sides of their mouth.

Follow your baby’s cues. When they’ve had enough they’ll:
■■ stop or slow down their sucking or
swallowing Leftover breastmilk or formula
■■ let go of the nipple Throw away any breastmilk or formula left
in the bottle after 2 hours. The breastmilk
■■ look relaxed or formula can grow bacteria in it from your
■■ stop showing feeding cues baby’s saliva which can make them sick.
■■ fall asleep
Feeding Equipment
You’ll need preparation and feeding equipment if you’re supplementing or formula
feeding your baby. This includes things such as cups, bottles, bottle nipples, caps, tongs
and spoons. Follow the manufacturers’ instructions for use.
Use glass or BPA-free plastic containers. BPA is

a chemical used in some plastics that Can you boil your
may not be safe for children. Baby feeding equipment?
bottles purchased in Canada after 2010 Choose equipment, bottles and
do not contain BPA. If buying plastic artificial nipples that can be boiled
baby bottles outside of Canada or any other after each use. Bottles or nipples
plastic containers, make sure they’re BPA-free. that warp, melt or become sticky
after being boiled are a choking
Check the package or call the manufacturer if
hazard and should not be used.
you’re not sure if it has BPA in it. To learn more
about BPA-free plastic, visit the Links section at
Check bottle nipples before each use for signs of damage such as tears,
cracks, discoloration, swelling or stickiness. These can be a choking hazard
for babies and should not be used.
Cleaning feeding equipment

To keep your baby safe, clean all of the feeding equipment you’ll use like tongs, measuring
cups, bottles and nipples. Young babies are at higher risk of getting sick because their
immune systems are still developing. How you clean the equipment depends on if your
baby is under or over 4 months old.

For babies under 4 months old
Clean feeding equipment before use. Feeding equipment is not fully clean until it has
been boiled or cleaned in a dishwasher with the sanitation cycle.
If you don’t use the cleaned bottles right away, wait until they are completely dry and
then fully assemble them so the inside stays clean. Store all feeding equipment in a clean,
protected area.
Clean by boiling
Wash your hands well Clean feeding equipment Put all the feeding equipment
1 with soap and water for 2 and working area with hot, 3 in a large pot. Cover the items
at least 20 seconds. soapy water. Then rinse in with water.
clean water.
2 min.
Remove feeding equipment

Put lid on the pot.
5 with tongs that have been boiled.
4 Bring to a rolling boil. Put items on a clean towel or
Boil for 2 minutes. paper towel. Let cool.
Clean by dishwasher
You can also use the sanitize cycle on a dishwasher to clean the feeding equipment if:
■■ There’s a National Sanitation Foundation (NSF) symbol on your dishwasher.
You can also check online to see if the dishwasher is NSF 184 certified.
■■ The dishwasher has a sanitize feature.

For babies 4 months and older
All feeding equipment should be cleaned before and after every use with hot, soapy
water—boiling is no longer needed. You can also use your dishwasher—the sanitize cycle
isn’t needed.
To clean the equipment:

1. Wash your hands well with soap and warm water for at least 20 seconds.
2. Use hot soapy water to clean and remove any residue on the equipment. Rinse in
clean water that’s safe to drink. If using a dishwasher, use the longest, hottest wash and
dry cycle.
3. Air dry the equipment on a clean paper towel or clean cloth.
If you don’t use the cleaned bottles right away, fully assemble them once they are
completely dry so the inside stays clean. Store all feeding equipment in a clean,
protected area.
Formula Feeding Allergies?

You may decide to feed your baby infant formula Your child may be at risk of an
allergy if either parent or one of
only or in combination with breastfeeding.
their siblings has a confirmed
Feeding your baby infant formula can provide food allergy. Call Health Link at
them with the nutrition they need. Choose an 811 or talk with your health care
infant formula that meets your baby’s needs. A provider to find out what infant
cow’s milk-based infant formula is recommended formula is right for your baby.
until your baby is 9–12 months old.
Infant formula has iron in it to help your baby grow and develop. Only use soy protein
or other specialized formulas such as lactose-free or hypo-allergenic if your health care
provider tells you to. Talk to your health care provider about the formula that’s right for
your baby.
Infant formula sold in Canada must meet Take care of baby’s mouth
Health Canada’s safety and nutrition standards.
Wipe your baby’s mouth with a
Buying infant formula over the Internet or from
clean damp cloth. This will help
stores outside of Canada is not recommended. them have healthy gums and
These formulas may not be safe or have the prevent tooth decay.
right nutrition for your baby.

Types of infant formula
Infant formula comes in three forms:
■■ ready-to-feed Do not give homemade formula
■■ liquid concentrate Homemade formula does
■■ powder not offer proper nutrition
and can make your baby
Liquid concentrate or ready-to-feed very sick. To learn more,
formulas are the safest types because visit the Links section at
they’re sterile until opened. Powdered
infant formula is not sterile but can be
used for healthy babies if it’s prepared and handled properly.
No matter what type of infant formula you use:

■■ Check the expiry date on the can before you use it.
■■ Check the formula can label carefully to make sure it’s the type of formula concentration
you want to use (e.g., ready-to-feed or liquid concentrate).
■■ Before mixing, follow the preparation and handling instructions on the can.
■■ Add the correct amount of water to liquid concentrate or powdered infant formula so
that your baby gets the right nutrition. For more information on how to prepare the
water for babies under 4 months old, see page 196.
Preparing infant formula

When preparing infant formula, always follow the manufacturer’s directions and use the
right amount of water. Not mixing infant formula properly can be dangerous and can
make your baby very sick.
For ready-to-feed infant formula, do not add water. You’ll have to add water to liquid
concentrate or powdered infant formula. It’s very important to follow the directions and
use the correct amount of water:
■■ adding too much water will dilute the formula—your baby will not get the right
nutrients
■■ adding too little water makes the formula too strong and can damage your baby’s
kidneys

For babies under 4 months old, boil the water, equipment and containers that will be
used to prepare and store formula (see page 192).
For babies 4 months and older, the feeding equipment needs to be cleaned. Water no
longer needs to be boiled (see page 193).
For more information on the preparation of feeding equipment, see page 191.
Water used to prepare infant formula

All water used to prepare infant formula for babies under 4 months old needs to be
boiled to make it safe. Water does not have to be boiled for babies over 4 months old.
Here are some tips to make sure the water you use for your baby is safe:
■■ Use cold tap water. Hot tap water may have more
metal contaminants from pipes such as copper or Water
lead and should not be used. For babies under 4 months
■■ If the tap has not been used for more than 6 hours, old, water used to make
liquid concentrate or
run the water for 2–3 minutes before using it.
powdered infant formula
■■ Boil bottled water before using it, as it may contain must be boiled. Let the
disease-causing organisms. water cool before using it to
prepare formula.
■■ Do not use mineral, vitamin, carbonated or
flavoured water to prepare infant formula.
Well water, water from a cistern or water from other

sources should be tested before you use it to prepare infant formula (see page 58).

Boiling water for babies under 4 months old
2 min.
1 2
Fill a pot with cold tap water. Remove the pot from the heat.
Bring to a rolling boil. Boil for 2 minutes. Cool the boiled water.
3 4
Pour the boiled, cooled water into a Store the boiled, cooled water in a tightly
container that has been cleaned by boiling closed container for 2–3 days in the refrigerator
or in a dishwasher using a sanitize cycle. or for 24 hours at room temperature.

Preparing and storing ready-to-feed infant formula (do not add water)
You do not need to add water to ready-to-feed infant formula. Prepare the bottle using
the steps below. If you’re leaving the prepared infant formula at room temperature, use it
within 2 hours. If not being used, put the formula in the refrigerator right away. If you store
formula in the refrigerator, make sure you use it within 48 hours, unless the formula can has
different instructions. You may want to have a bottle ready so that you can respond quickly
to your baby’s feeding cues.
Throw away any leftover formula from the feed—don’t re-heat or re-refrigerate used
formula. After 2 hours, your baby’s saliva in the leftover formula can create growth of
bacteria that can make your baby sick.
1 2 3
Wash your hands Use clean* feeding equipment. Rinse the top of
with soap and water the can with water.
for at least 20 seconds.
4 5 6
Pour the amount of

formula needed
into the bottle.
DO NOT ADD WATER.
Shake the can. Open the can with

a clean* can opener.
7 8
Use the formula right away Tightly cover the open can.
or store in the refrigerator. Refrigerate and use within
the time recommended on the can.
* For more information on cleaning feeding equipment, see page 191.

Preparing and storing liquid concentrate infant formula (add water)
You must add water to liquid concentrate infant formula. Read the directions on the can
for the correct amount of liquid concentrate and water to use. Prepare the bottle using
the steps below. Use formula within 2 hours of preparing it or put it in the refrigerator
right away. If the formula is stored in the refrigerator, make sure you use it within 48 hours,
unless the can has different instructions.
Once you have fed your baby, throw away any leftover formula from the feed after
2 hours—do not re-heat or re-refrigerate used formula. After 2 hours, your baby’s saliva
in the leftover formula can create growth of bacteria that can make your baby sick.
1 2 3
Wash your hands with soap and Use clean* feeding equipment. Rinse the top of the can with water.
water for at least 20 seconds.
5 6
4
4
Pour the correct

Read the directions on the can for the amount of liquid
correct amount of liquid concentrate concentrate into
Shake the can. and water** to use. Open the can with the bottle.
a clean* can opener.
7 9
8
Follow the directions

on the Infant Formula Store prepared formula in the
Concentrate can for Shake well to mix. refrigerator for up to 24 hours. Cover
the amount of water** Use the formula right away the open formula can and store it in
to add. or store in the refrigerator. the refrigerator. Use within the time
recommended on the can.

** For more information on water to make infant formula with, see page 194.

Preparing powdered infant formula (add water)
You must add water to powdered infant formula. Read the directions on the infant formula
can for the correct amount of powder and water to use. It’s safest to prepare powdered
infant formula and use it right away. If you’re preparing more than one bottle for use later
on, store it in the refrigerator and make sure that you use it within 24 hours.
Once you have fed your baby, throw away any leftover formula from the feed after
2 hours—do not re-heat or re-refrigerate used formula. After 2 hours, your baby’s saliva
in the leftover formula can create growth of bacteria that can make your baby sick.
1 2 3
Powdered
Infant
Formula
Read the directions on the can

Wash your hands with to find out the correct amount
Use clean* feeding equipment.
soap and water for at of powder and water** to use.
least 20 seconds.
4 5 6
Powdered
Infant
Formula
Pour cool water** Use the scoop from the can. Level Add the powder
into the bottle. with a clean* knife. Use the number to the bottle.
of scoops of powder as directed.
7 8
Powdered
Infant
Formula
Shake to mix well. Cover the can with the lid and
Serve right away. store in a cool dry place. Use
within 1 month of opening.

** For more information on water to make infant formula with, see page 194.

If you need to prepare more than one bottle of powdered infant formula, follow these
extra steps to stop any bacteria from growing:
■■ Use clean water (boiled for babies under 4 months old) that has been cooled to
refrigerator temperature, 4 °C (39.2 °F).
■■ Put prepared formula that you’re not going to use in the refrigerator right away and
store for up to 24 hours.
■■ If you don’t have access to a refrigerator, keep prepared formula cool in an insulated bag
with an ice pack and use it within 2 hours.
Storing powdered infant formula:

■■ Store the powdered infant formula can in a cool, dry place with the lid tightly closed.
Do not store the can in the refrigerator.
■■ Write the date you open the can on its lid. Throw out any unused formula 1 month after
you open the can.
■■ Do not freeze the powdered infant formula. It can change the texture and may not mix
well with water.
Warming infant formula

Your baby may prefer warm formula. Here’s
how to warm it safely: Microwaves
Do not microwave formula.
■■ Put the prepared bottle in a container of Microwaves heat liquids unevenly
warm water for no more than 15 minutes. and form hot spots. This can burn
■■ Do not cover the lid or nipple with water your baby’s mouth. Warm milk in a
when you’re warming formula. This can container of warm water instead.
contaminate the formula.
■■ Gently shake the bottle to mix the
formula. Call Health Link at 811 or your
health care provider if you’re
■■ Test the formula on the inside of your
wondering about any of the
wrist to make sure it’s not too warm for
!
following:
your baby. It should feel lukewarm to
the touch. ■■ what kind of formula to feed
your baby
■■ Do not put the bottle nipple in your
mouth to check the temperature or ■■ how to prepare the formula
to clean it. This can pass germs on to ■■ allergies
your baby.

The first week and beyond with infant formula
The first week of your baby’s life is full of changes for all of you. Your baby may not follow
the same feeding pattern every day. Feed your baby whenever they show signs of hunger
and stop feeding when they show signs of fullness, even if there’s formula left in the bottle.
In the first week or so, if your baby is sleepy, massage them gently to help them wake up
to feed. You can also do skin-to-skin cuddling. As your baby grows, you’ll get to know their
feeding patterns. If you don’t notice feeding cues, ask for help. For more information on
feeding cues, see page 149.
How much formula and how often

Expect your baby to eat often and small amounts at a time in the first week. Watch their
cues and gradually increase the amount of formula you offer. Talk with your health care
provider if you have questions.
Here’s what you may see during your baby’s first few days and beyond:
Birth–24 ■■ may be awake, alert ■■ will need to feed often ■■ follow your baby’s
hours old and quiet during the because they have a feeding cues
first few hours small stomach ■■ do skin-to-skin
■■ may not want to ■■ feed at least 5 times in cuddling
feed right away as the first day (24 hours) ■■ massage your baby
they recover after ■■ drinks small amounts of gently to help them
birth formula at a time wake up to feed
■■ may only take 10–15 ml ■■ if you don’t notice
(1/3 – 1/2 oz) per feed feeding cues or are
not sure, ask for help
24–48 ■■ will wake and show ■■ drinks small amounts of ■■ follow your baby’s
hours old feeding cues formula at a time feeding cues
■■ will need to feed ■■ feed about 6–8 times a ■■ slowly increase the
often day (24 hours), with no amount of formula
■■ by the 2nd or 3rd day, set schedule you feed your baby at
they’ll be more alert each feed
during feedings
■■ they’ll have a strong
sucking reflex, with
their lower jaw
moving

48–72 ■■ will wake and show ■■ drinks small amounts of ■■ follow your baby’s
hours old feeding cues formula at a time feeding cues
■■ will need to feed ■■ feed about 6–8 times a ■■ slowly increase the
often day (24 hours), with no amount of formula
set schedule you feed your baby at
each feed
3–7 days ■■ will wake and show ■■ drinks small amounts of ■■ follow your baby’s
old feeding cues formula at a time feeding cues
■■ will need to feed ■■ will feed about 6–8 ■■ slowly increase the
often times a day (24 hours), amount of formula
with no set schedule you feed your baby at
each feed
1–2 weeks ■■ will wake and show ■■ drinks about 60–90 ml ■■ follow your baby’s
old feeding cues (2–3 oz) at each feeding feeding cues
■■ will need to feed ■■ feed about 6–10 times a
often day (24 hours)
3–8 weeks ■■ will wake and show ■■ drinks about 90–150 ml ■■ follow your baby’s
old feeding cues (3–5 oz) at each feeding feeding cues
■■ will need to feed ■■ feed about 5–8 times a
often day (24 hours)
2–5 ■■ will wake and show ■■ drinks about 120–180 ml ■■ follow your baby’s
months feeding cues (4–6 oz) at each feeding feeding cues
old ■■ feed about 5–7 times a
day (24 hours)
6–8 ■■ will wake and show ■■ drinks about 120–240 ml ■■ follow your baby’s
months feeding cues (4–8 oz) at each feeding feeding cues
old ■■ feed about 4–5 times a
day (24 hours)
Your baby’s appetite may vary from day-to-day and from feeding to feeding. Babies who
need to feed more often may be having a growth spurt. This usually happens around
2–3 weeks, 6 weeks and 3–4 months of age. Growth spurts only last a few days. Your
baby may also cluster feed, which can happen anytime, but is most common during the
evening. When your baby starts to eat solid foods, at around 6 months, they’ll start to drink
less formula.

Is my baby getting enough?
You can tell if your baby is getting enough infant formula by the number of wet and dirty
diapers they have.
Age Wet diapers in 24 hours Stools in 24 hours
Birth–24 ■■ at least 1 small, wet diaper ■■ at least 1 meconium stool

hours old ■■ small amounts of dark orange or rusty
brown urine
24–48 ■■ at least 2 small, wet diapers ■■ at least 1 meconium stool, each

hours old ■■ small amounts of dark orange or rusty the size of the palm of your baby's
brown urine hand or larger
48–72 ■■ at least 3 wet diapers ■■ at least 1 green-brown (transitional)

hours old ■■ small amounts of dark orange or rusty stool, the size of the palm of your
brown urine baby's hand or larger
3–5 days ■■ at least 4 large, heavy, wet diapers every ■■ at least 1 yellow or pale green stool
old 24 hours every 24 hours, each the size of the
■■ amount of urine will increase and turn palm of your baby's hand or larger
light yellow and clear
6–7 days ■■ at least 6 large, heavy, wet diapers ■■ Day 6: at least 1 yellow or pale
and older every day green stool, the size the palm of
your baby's hand or larger
■■ Day 7 and onwards: an average
of 2–3 stools every day for the first
1–4 weeks. After this, the number
will change with age.
Call Health Link at 811 or your health care provider NOW for any of the
!
following:
■■ your baby will feed if you wake them, ■■ your baby is always sleepy
but will not wake up on their ■■ your baby will not feed or is not
own to feed showing feeding cues

of the following:
■■ green, watery bowel movements ■■ vomits most, or all of their feeding,
that smell bad 2 or more times in a row
! ■■
■■
white, light grey, or very light
yellowish bowel movements
blood in their stool or urine
■■
■■
does not have the recommended
number of wet or dirty diapers
■■ urine that still looks dark orange or ■■ wants to feed all of the time—this is
rusty after they’re 72 hours old different than cluster feeding
Burping Your Baby

Babies often swallow some air when they’re
feeding and burping helps them get this air out of
their stomach. There’s more than one way to burp
your baby.
Over your shoulder

■■ Hold your baby close to your body, facing
over your shoulder.
■■ Put a cloth on your shoulder in case your
baby spits up milk.
■■ Gently pat or rub their back.
Sitting on your lap

■■ Sit your baby in your lap and support their
head with one hand under their chin.
■■ With your other hand, gently pat or rub
their back.
Laying on their tummy

■■ Lay your baby on their tummy over your legs.
■■ Support their head as needed and gently pat
or rub their back.

Newborns:
Birth–2 Months

205
Newborns: Birth–2 Months
Every new baby is a miracle and with their birth, your lives will be forever
changed! In these first 2 months, you may feel many emotions all at the same
time. You and your new baby are learning a lot and getting to know each
other. Give your baby your time, love and attention.
In this chapter you’ll learn about your baby’s development and how to care for
yourself and your newborn. You’ll learn about common concerns many parents
have and how to keep your baby safe. You’ll also find information about some
of the emotional changes that you might experience after the birth of your
baby. Be patient with yourselves and take your time—you’re learning a lot.
206
Your Newborn Baby’s Development
N E W B O R N S : B I R T H –2 M O N T H S
Newborns change and grow every day and the changes are amazing! This chart gives you
information about the developmental milestones and tasks your baby is working on over
these two months. As your baby grows and changes during this period, this chapter will
help you learn what you can do to help.
Birth–2 months: The ‘being’ stage

Tasks Milestones
During this stage, your Physical

newborn is learning to: ❑❑ kicks, grasps and sucks, based on reflexes
■■ trust: knowing that good, ❑❑ has weak neck muscles and a heavy head. At first, their head
dependable and loving care turns by reflex. As your baby gets older, they’ll turn their head
is always there for them with more control and purpose.
■■ form a secure attachment: ❑❑ feeds and sleeps with no set pattern—this becomes more
a close emotional bond predictable over time
between you and your ❑❑ discovers their hands and brings them to their mouth
baby, and how you relate to ❑❑ starts to lift up their head when on their tummy
each other
❑❑ starts to make smoother leg and arm movements
Emotional
❑❑ fusses or cries to tell you they need something
❑❑ begins to quiet more often when comforted, but may still
have times when they cannot stop crying
❑❑ depends on you and others to cope with their emotions
❑❑ feels safe when their needs are met
Social
❑❑ smiles to show pleasure by 2 months
❑❑ begins to recognize familiar voices
❑❑ looks at faces and prefers familiar faces
Cognitive (thinking and communicating)

❑❑ continues the learning that began before birth
❑❑ is startled by loud noises
❑❑ begins to make pleasure sounds like ‘coos’ and ‘goos’
❑❑ prefers people to toys
❑❑ starts to turn and follow things with their eyes
❑❑ begins to try to get and keep your attention

To use an interactive tool about your baby’s development, visit the Tools section at
If you have concerns about your child’s development, call Health Link at 811 or talk with
your health care provider. You can also visit your nearest Parent Link Centre and ask
about the Ages and Stages Questionnaire (ASQ). To learn more, visit the Links section at
Newborns
A new baby means many changes for
parents, whether this is your first child or
you’ve been a parent for a while. There’s a
lot to think about. The first few weeks of
your baby’s life will bring many surprises for
you, like how fast your baby changes, how
much they cry, and the feelings you have
for them. A newborn needs gentle care and
patience. At first it may seem that your days
and nights are a continual cycle of feeding,
sleeping, diapering and cuddling. You’ll
soon learn what your baby’s cues mean,
and begin to see their personality emerge.
Over time, you’ll start to feel more confident
and comfortable in your role as a parent.
Right from the start, newborns are able to send you cues by fussing or crying to let you
know when they’re hungry, tired or need to be held. Newborns are able to hear you
and see you. By the end of the first 2 months, your baby will be smiling and cooing and
following you with their eyes. As you take care of your baby, you’ll get to know each other
“
better. Your baby needs to know that
you’re there to care for and comfort them
One thing I loved about my
when they need you. When you give your
baby love, time and attention, they start to
new baby was her smell.
recognize you, learn to trust that you’ll be Surely there’s a science to the
”
there for them, and build an attachment pheromones of it all…but I’d
with you. This is how you build a secure rush home just to smell her.
attachment with your child.
~ Khoi, dad of one child

Attachment
Attachment is the close emotional bond that forms between you and your baby, which
makes them feel safe and loved. You build a secure attachment with your baby when you:
■■ hold, hug and cuddle them
■■ use gentle care and handling A parent’s touch
Your gentle touch is one way to help your
■■ offer skin-to-skin cuddling
baby feel safe and secure. In the first few
■■ smile and talk gently weeks, skin-to-skin cuddling when you’re
awake helps your baby settle and gets
■■ sing and read
them used to being in the world.
■■ comfort them when they cry
Skin-to-skin cuddling
Cuddling skin-to-skin with your baby is good for you and them. When cuddling skin-to-
skin, your baby only needs to be wearing a diaper and have their back covered with a
blanket for warmth. With their head on your chest, your baby can hear your heartbeat and
smell you. Your partner can also do skin-to-skin cuddling.
Cuddle your baby this way as often as you want, especially in the first few weeks. For safety
reasons, stay awake when cuddling skin-to-skin with your baby and keep your baby’s head
uncovered. For more information on safe sleep, see page 218.
Skin-to-skin cuddling helps you bond with and get to

know your baby. For your baby, it can also:
■■ regulate their heart rate, breathing and blood sugar
■■ keep them warm if they’re too cool—your body
temperature can raise theirs by 2 °C
■■ cool them if they’re too warm—your body
temperature can lower their temperature by 1 °C
■■ help them be calm and cry less
■■ help lower their stress
■■ help both premature and full-term babies gain weight

For moms, skin-to-skin cuddling can:
■■ increase the hormones that make breastmilk and help milk flow
■■ promote breastfeeding and help your baby latch more easily to the breast
For both moms and dads, skin-to-skin cuddling can:

■■ help you feel relaxed and lower stress levels
How your newborn looks

You’ve been waiting a long time to meet your
baby and you may notice some differences in How big are full term
how your baby looks compared to other babies newborns?
you’ve seen. That’s because newborns look Most newborns weigh between
quite a bit different than babies who are a few 2500–4000 g (5 lbs 8 oz–8 lbs 13 oz).
weeks old.
Skin
■■ Slippery white coating
(vernix): Your baby’s skin
may be covered with
vernix that protected their
skin in your uterus. It will
be absorbed or is washed
off in the first 24–48
hours.
■■ White spots (milia):
Your baby may have milia
around their nose that
may last a few months.
These white spots will go away on their own—don’t try to remove them.
■■ Fine, downy hair (lanugo): Your baby may have lanugo on their forehead, ears and
shoulders. Lanugo usually disappears within 2 months.
■■ Dry or peeling skin: Your baby’s skin may be dry and peeling, especially on their hands
and feet. Talk with your health care provider about using any creams or lotions on your
baby’s skin if it’s still dry after a few days.

Black or blue marks (congenital dermal melanocytosis): You may see these marks
■■
on your baby’s body, usually on the lower back or bottom. They look like a bruise, but
they’re not. They usually fade in the first or second year of life.
■■ Reddish areas or stork bites (hemangiomas): You may see these areas on your baby’s
forehead, eyelids, nose or the back of their neck. These usually fade and are gone by the
time your child is 3 years old.
Head and face

■■ Soft spots (fontanelles): The anterior soft
spot is found on the top of your baby’s head Front of head
and the posterior fontanelle is at the back
of their head. The bones of your baby’s skull
Anterior
have not joined yet, allowing their brain to fontanelle
continue to grow. The soft spots will join
together as your baby gets older. Gently
touching the soft spots will not harm your
baby. The soft spot near the front closes Posterior
fontanelle
between 6–24 months. The soft spot near
the back might be very small and closes
between 8–12 weeks.
■■ Head shape: Few newborns have perfectly Back of head
shaped heads. It may take up to 6 weeks for
your baby’s head to become round.
■■ Hair: Your baby may have lots of hair or no hair at all. Babies may lose some of their hair
soon after birth. Their hair may also change colour.
■■ Eyes: Your baby’s eyes may be swollen from the birthing process. Their eyes may be
sensitive to bright lights in the first few days. This is because your baby is used to being
in the dark. It’s common for their eyes to change colour during the first year. Some
babies look cross-eyed until about 3 months of age. If this does not go away as your
baby grows, talk with your health care provider.
■■ Nose: Your baby’s nose may be flat or bruised. It will return to its normal shape and the
bruising will go away in time.
■■ Mouth: Your baby’s mouth should be pink and moist.

Body
There are other normal changes you may notice with your baby. These temporary changes
are caused by your baby being exposed to your hormones before birth.
■■ Swollen breasts: Your hormones may cause your new male or female baby to have
swollen breasts that sometimes leak a milky discharge. This may last for a couple of
weeks.
■■ Swollen genitals: Your baby (male or female) may have swollen genitals for the first
few days.
■■ Vaginal discharge: Your female baby may have white, pink or red discharge from their
vagina during the first week.
Umbilical cord
The umbilical cord joined mom and baby before birth.
When your baby is born, the cord is clamped and cut,
leaving a clamp and a small amount of cord attached to
your baby. Your baby’s umbilical cord will look bluish-white.
As the cord dries, its colour will change to a yellowish-
brown then a greenish-black. A small amount of oozing or
bleeding is normal when the cord starts to fall off.
The cord and clamp usually fall off on their own, about
1–3 weeks after birth. The cord will harden and turn
greenish-black as it dries. If the cord is still attached when
your baby is 3 weeks old, talk with your health care provider.
How to care for your baby’s umbilical cord:

■■ Keep the area around their cord dry. This ■■ You can give your baby a full bath before
will help it stay clean. the cord falls off. After the bath, fully dry
■■ Wash your hands before touching the cord with a cotton-tipped applicator
their cord. or the tip of a clean cloth before dressing
your baby.
■■ Keep their diaper folded below their cord
so that the cord remains dry.
■■ Cleaning with alcohol is not
recommended.
■■ Clean any discharge around the cord
using a cotton-tipped applicator (a cotton
■■ Do not apply coins, buttons, bandages
swab) dipped in tap water, then dry it and binders to the umbilical cord.
well with dry cotton-tipped applicators.

Feeding your newborn
During the first few months, babies can only feed small amounts at each feeding so they’ll
need to feed often. Watch for their feeding cues (see page 149), and feed your baby when
they show you they’re hungry.
You’ll know your baby is getting what they need if they:

■■ are content after most feedings
■■ are gaining weight
■■ have enough wet and dirty diapers for their age (for breastfeeding, see page 164 and for
formula feeding, see page 203)
Your baby will likely wake and need to feed during the night. In these early months, they
can only suck and swallow liquids. They’re not able to safely swallow solids and don’t need
them yet.
Your baby will not have a set schedule, but

they’ll begin to have more predictable feeding Vitamin D for newborns
patterns as they get older. They may feed Newborn babies should be given a
more often and longer during growth spurts. liquid 400 IU vitamin D supplement
In the first 2 months, growth spurts usually every day. Follow the directions on
the bottle. If you have questions,
happen at about 2–3 weeks and again at
call Health Link at 811 or talk with
6 weeks. Growth spurts usually only last a your health care provider.
couple of days. During growth spurts your
baby may:
■■ be fussier than usual
■■ cling to you when you go to put them down
■■ want to eat more often or for longer periods of time
■■ have a change in their sleep patterns

Weight gain
Children will grow at their own rate, but they tend to follow a general pattern of growth.
They grow the fastest when they’re babies.
Your baby's weight gain

Birth–14 days old ■■ Babies usually lose weight during the first few days after birth.
■■ They’re usually back to their birth weight by 2 weeks of age.
2–8 weeks old ■■ Once babies are back to their birth weight, they grow the fastest during
the first 8 weeks after birth.
■■ Steady weight gain is a good sign that your baby is getting enough
breastmilk or formula.
If you’re concerned about your baby’s weight, or you would just like to weigh your baby,
you can go to your community or public health centre during clinic hours.
If your baby is not feeding well

Feeding issues in newborns can be challenging for you and your baby. Sometimes,
these issues can become serious and your baby can become dehydrated. Some signs of
dehydration are:
■■ dark urine
■■ fewer wet diapers than recommended for your baby’s age and feeding method
■■ dry skin, mouth and tongue
For more information about how to tell if your baby’s getting enough and when to call for
help, see page 161 for a breastfed baby or see page 201 for a formula-fed baby.

Call Health Link at 811 or your health care provider NOW if you notice
your baby has any of the following:
■■ hard stools that are difficult to ■■ is always sleepy
pass ■■ will not feed or is not showing
■■ urine that’s still dark orange feeding cues
or rusty brown after they’re ■■ does not have the recommended
72 hours old number of wet or dirty diapers
! ■■
■■
dry skin, mouth or tongue
vomits most, or all of their
feeding, two or more times in a
■■
■■
any signs of choking, coughing or
sputtering while feeding
row wants to feed all of the time
■■ frequent, green, watery bowel ■■ wants to feed all of the time
movements that smell bad
■■ has any other signs that
■■ will feed if you wake them, but concern you
will not wake up on their own to
feed
Everyday Care
Taking care of your baby includes keeping
them safe and healthy. By meeting their
everyday needs, you’re also setting the
foundation for a lifetime of good habits.
Waking and sleeping

A newborn’s sleep patterns are quite
different from older children and adults.
Once you understand these patterns, it’s
easier for you to read your baby’s cues
and respond to their needs. When you
respond early to your baby’s cues, you’ll
also help them learn good sleeping habits.
As your newborn’s stomach can only hold a small amount of milk, they’ll need to wake up
to feed often. They’ll usually sleep an average of 1–3 hours at a time, day and night.

For the most part, your baby will feed and
sleep when they need to. They’ll develop How long do babies sleep?
their own feeding and sleeping patterns As babies get older, they’ll be able
that will change as they grow. As long to sleep for longer periods at a time.
as your baby is healthy, gaining enough For the first few months they’ll usually
sleep about 2 hours at a time, and
weight and growing, you do not need to
seldom more than 3–4 hours, for a total
wake them to feed. Sometimes, if they
of about 14–17 hours a day.
become excessively jaundiced or they‘re
not gaining weight as they should, your
health care provider may give you different directions. Be sure to follow those instructions
until your baby is no longer jaundiced or is gaining weight as they should.
Waking
Newborns have 3 different states of being awake:
Quiet alert state: Newborns spend very little time in this state (only about 2 ½ hours per
day). Your baby will be calm and relaxed, and their breathing will be regular. They’ll often
look at your face and may copy the movements of your face. This is a great time for you to
gently talk and sing to your baby.
Active alert state: As your baby moves into this state, they’ll wriggle, flap their arms and
kick their legs. When your baby shows these cues, they may be trying to engage with you,
or they may need a change in activity. Watch for their cues and think about what your
baby might need, like a feeding, burping or diaper change. As your baby gets older, you’ll
also see this state when they’re excited and having fun.
Crying state: Babies cry to tell you they feel upset. Your baby might be hungry, tired,
over-stimulated, uncomfortable, afraid, lonely, sad or in pain. There are different kinds of
crying for different feelings or needs. At first it may seem confusing, however, you’ll soon
learn what your baby’s different patterns of crying mean. When you respond to your
baby’s cries, they’ll learn to trust that you’ll be there to help them and meet their needs.

Sleeping
A newborn’s sleep pattern includes quiet sleep, active sleep and a transition state. Babies
go back and forth between these 3 states every 30 minutes or so while sleeping.
Quiet sleep: Your baby lies very still during quiet sleep. Their heart rate and breathing is
regular and their face is relaxed. This is the deepest level of sleep.
Active sleep: Your baby may move their arms and legs and make different faces during
active sleep. This is the lightest sleep state so your baby can wake easily in this stage. You
may think they’re waking up, but if you wait a few minutes they may go back into a quiet
sleep on their own.
Transition: This is the in-between state that happens when your baby is falling asleep,
waking up or moving between quiet and active sleep. During transition, babies respond
to voices and sounds by opening their eyes and starting to move. If you hear your baby
moving around, listen quietly for a few minutes. They may go back to a quiet sleep on their
own or they may be ready to get up. Either way they’ll let you know!
Babies will continue to wake to be fed during the night for many months. You can help
your baby start to learn that nighttime is also for sleeping. Here are some suggestions to
help your baby learn the difference between day and night:
During the day During the night
■■ keep your home light and bright ■■ keep lights dim or off
■■ don’t worry about noises such as phones, ■■ reduce noise
music and dishwashers ■■ keep feedings quiet and voices low
■■ play and talk with your baby
Having a general routine every day helps babies feel more secure. Follow your baby’s cues
for feeding and sleeping. Try to have a regular routine for your baby’s care like bathing and
play time. Aim to be predictable yet flexible when needed. Being too strict does not work
well because babies’ needs change from day-to-day.

Tips when putting your baby to sleep
■■ Put your baby to sleep when you first notice they’re sleepy. The sooner you put them
down to sleep, the better. If you wait too long, they may get overtired and have
trouble relaxing and going to sleep.
■■ You’ll know your baby is sleepy when they’re fussy, rub their eyes, pull their ear or
yawn. They may also have red rimmed eyes.
■■ It may take some time to learn your baby’s sleep cues and patterns. Until you do, for
the first 6−8 weeks, you can expect your baby to be tired and ready to sleep after
being awake for about 2 hours.
Safe sleep
Babies spend a lot of time
sleeping and need a safe
sleep environment. Research
tells us that creating a safe
sleep environment will help
reduce the risk of SIDS and
prevent other sleep-related
injuries and death in babies.
Here’s what you can do to
protect your baby in their
first year.
Put your baby on their back to sleep, for every sleep. Whether it’s nap time or
nighttime, at home or with their caregiver, the safest position for your baby to sleep is on
their back. This helps lower their risk of SIDS. Even when your older baby can roll over on
their own, research tells us it’s safest to put them on their back to sleep. If they roll over,
you don’t have to move them back.
Use a crib, cradle or bassinet that meets

Canadian safety standards. The safest place Playpens are for play
for your baby to sleep is in a crib, cradle or Playpens should not be used for
bassinet. For information on things to consider unsupervised sleep—they don’t
meet the same safety requirements
when buying cribs, cradles or bassinets, see
as cribs, cradles and bassinets.
page 222.

Keep your baby’s crib, cradle or bassinet free of clutter. A clutter-free space reduces
your baby’s risk of SIDS and helps prevent them from being trapped, strangled or
suffocated. A safe crib, cradle or bassinet has:
■■ a firm, flat mattress that’s in good
condition and fits snugly into the
frame
■■ a tight-fitting bottom sheet for the
mattress that is designed to fit the
crib, cradle or bassinet
■■ no soft items such as stuffed toys
■■ no plastic mattress cover or bumper
pads, and no loose bedding such as pillows, heavy blankets, quilts or sheepskins
■■ no positioning devices such as wedges, towels, rolls or positioning pillows
Putting a blanket over top of the crib, cradle or bassinet to block out light is not advised,
as it can cause the baby to overheat. If the blanket falls on your baby, it can also decrease
airflow and could smother them.
A note about infants sleeping in car seats

Car seats are designed to keep babies safe during travel. It’s not safe for babies to sleep
in a seated position—their head can fall forward because their muscles are under-
developed, and this can make it hard for them to breathe. When you get to where
you’re going, take your baby out of the car seat, and put them on their back to sleep on
a safe sleep surface.
Keep your baby warm, not hot. When babies get too hot (overheat), it increases their
risk of SIDS. Your baby is too hot if they’re sweating or if their chest feels too warm to
the touch.
Babies are safest when the room temperature is comfortable for an adult wearing
light clothing. If your home is cool, choose a warmer sleeper for your baby. Try not to
over-bundle or over-dress your baby. Babies don’t need blankets. If you choose to use a
blanket, make sure it’s:
■■ light-weight
■■ firmly tucked under 3 sides of their mattress
■■ only reaches up to your baby’s chest

A note about sleep sacks
Sleep sacks come in a variety of thicknesses and materials. Choose a lightweight sleep
sack to reduce the risk of overheating. If you’re using a sleep sack, you don’t need a
blanket. Make sure the sleep sack is an appropriate size for the baby’s weight and fits
properly around the neck and armholes. If the sleep sack is too large or loose, it could
strangle and suffocate your baby.
Keep spaces smoke-free. Help keep your

baby healthy by being smoke-free. Babies What about hats?
whose mothers smoked while pregnant Babies don’t usually need to wear hats
are at a much greater risk of SIDS. Babies when they’re indoors. Your health care
who are exposed to second-hand smoke, provider may have put a hat on your
baby right after birth to keep their
both before and after birth, are also at
temperature stable. When you’re at
a greater risk of SIDS. Make sure no one home however, your baby will not need
smokes around your baby—at home, a hat as it might make them too hot. For
during travel or while being cared for by more information on using hats during
others (see page 138). warm or cold weather, see page 114.
For help to cut down or quit smoking, visit

albertaquits.ca or call them toll-free at 1-866-710-QUIT (7848).
Share a room with your baby. Room-sharing means that your baby sleeps in the
same room as you or another person, but on a separate sleep surface like a crib, cradle
or bassinet. It’s recommended that you share a room with your baby for at least the first
6 months.
Room-sharing:
■■ keeps your baby close and safe
■■ supports the bond between you
and your baby
■■ makes it easier to learn and
respond to your baby’s cues
■■ makes it easier to feed your baby,
especially at night. If you bring
your baby into bed for feeding,
put them back in their own crib,
cradle or bassinet before you go
to sleep.

Do not share a bed, sofa or any other sleep surface with your baby. Bed sharing
means that a baby sleeps on the same surface, like a bed or a sofa, with another person.
This includes a parent, caregiver, child or even a pet. Bed sharing increases your baby’s risk
of SIDS and other sleep-related injuries and death.
Bed sharing also creates risks related to

falls, strangulation or suffocation if your Sleeping on the same
baby gets: surface is not safe
Sharing a bed, sofa or any other surface
■■ trapped between a mattress and
with your baby while sleeping is not
headboard or footboard recommended. This has been a factor in
■■ wedged against a wall or a person a number of deaths related to SIDS.
■■ tangled in bedding, pillows or cushions
Twins and other multiples are also safer when sleeping on their own and not sharing a
sleep surface. The risk is that one infant may entrap the other causing them to suffocate, in
the same way an adult or older child could if they were sleeping together.
If you choose to bed share:

■■ Never sleep with your baby on any soft or padded surface such as a sofa, upholstered
chair, bed with a soft mattress or bedding, or water or air-filled mattress.
■■ Keep bed covers, blankets and pillows far away from your baby.
■■ Make sure you and your partner always know when your baby is in the bed with you.
■■ Never share a bed with your baby if you or your partner:
smoke
have used alcohol, cannabis, other drugs, or any prescription, over-the-counter or
herbal medicine that makes you sleepy or less able to respond to your baby’s needs
are overtired from stress or lack of sleep
If you choose to bed share, make sure you follow all the information provided. Remember
that taking these steps may reduce some of the risk, but it does not make bed sharing safe.

Breastfeed your baby. Breastfeeding may reduce the risk of SIDS and other illnesses.
Exclusive breastfeeding for the first 6 months of life is recommended.
Taking your baby into bed for

feeding or for comfort is risky A note about soothers and SIDS
if you fall asleep. Lying down Research tells us that using soothers (pacifiers) may
to feed is an effective feeding help reduce the risk of SIDS. However, the research
position for many moms. is not clear if soothers interfere with breastfeeding.
For more information, see page 236.
However, it’s easier to fall
asleep if you’re in this position,
especially if you’re tired. To stay awake while feeding your baby in your bed, try wiping
your face and neck with a wet cloth or keeping the room lights, TV or music on. Put your
baby on their back in their own crib, cradle or bassinet if you feel sleepy. If you choose to
sleep with your baby on the same sleep surface or feel you may fall asleep while feeding
your baby, follow the recommendations on page 221 to reduce some of the risks.
To learn more about creating a safe infant sleep environment, visit the Videos section at
Cribs, cradles and bassinets

All new and used cribs, cradles and bassinets
must meet Canadian safety regulations. If
Crib safety laws
you’re borrowing or buying one, make sure it Cribs made before September
1986 do not meet current
comes with the manufacturer’s instructions or
Canadian safety regulations and
that they’re available online. The instructions
should not be used. It’s against the
should include the model, date of manufacture, law to advertise, sell or give away
assembly instructions and warnings. Always such cribs.
follow the manufacturer’s instructions when
putting it together.
Standards and recalls

To learn more about crib, cradle,
bassinet and playpen standards
and recalls, visit the Links section at

Whether new or used, make sure your baby has a safe crib, cradle or bassinet. Here are
some do’s and don’ts to think about to ensure the safety of your baby’s sleep surface.
Do use a crib, cradle or bassinet if it has: Don’t use a crib, cradle or bassinet if it:
■■ a mattress with the right thickness ■■ has any missing, loose, worn, broken or
a crib mattress that’s firm and not damaged parts
thicker than 15 cm (6 inches). Some crib ■■ is older than 10 years
mattresses have a soft side and a firm ■■ has any fabric on its sides that does not
side—make sure the firm side of the attach securely to the frame
mattress is facing up.
■■ has any decorative cut-outs
a cradle or bassinet mattress that’s firm
and not thicker than 3.8 cm (1 ½ inches)
■■ posts that are higher than 1.5 mm (1⁄16 inches)
■■ spacing between the bars that is more than
■■ posts that are not higher than
6 cm (2 3/4 inches)
1.5 mm (1⁄16 inches)
■■ a tight-fitting mattress with a gap less than
3 cm (1 3⁄16 inches) between the sides and the
mattress. Push the mattress firmly against the
sides to test this.
■■ spacing between the bars that is 6 cm
(2 3⁄8 inches) or less
As of December 2016, traditional drop-side cribs cannot be advertised, sold, imported or

manufactured in Canada, because they’re not safe. If you have a drop-side crib, consider
replacing it. If you continue to use it, make sure it has not been recalled and that it meets
current Canadian safety regulations. Ensure that both sides of the drop-side crib are in the
up and locked position when your baby is in the crib. Stop using it if it has any loose or
missing parts.
Move your baby from their cradle or bassinet to a crib when they reach the maximum
weight recommended by the manufacturer or when they start to roll over—whichever
comes first.
If being able to buy a suitable crib, cradle or bassinet for your baby is a concern for you,
call Health Link at 811 or talk with your health care provider. They can help you find local
organizations that can help.
To use an interactive tool on safe infant sleep, visit the Tools section at

Playpens
Playpens are designed for supervised play, and are not meant to be used for unsupervised
sleep. They don’t have the same safety standards as cribs, cradles or bassinets.
Here are some things to think about to keep your baby safe when choosing and using a
playpen:
■■ Choose a playpen with tightly woven mesh. Your baby’s little fingers can get caught in
mesh with large holes.
■■ Only use the mattress pad that comes with the playpen. Check that it’s firm, not worn in
any area, and fits snugly into the corners and sides.
■■ If the playpen comes with attachments like a change table or bassinet, always follow the
manufacturer’s instructions for putting it together and using it.
■■ Keep blankets, pillows, soft toys and extra mattresses out of the playpen as these can
cause your baby to suffocate.
■■ Never put a baby to sleep on the change table attachment or put them in the playpen
when the change table or bassinet is still attached. Their head can become trapped
in the gap between this accessory and the playpen, and they can suffocate or get
strangled.
Before you buy a used or new playpen, check online to see if there are any safety recalls on
it. Always follow the manufacturer’s instructions for putting the playpen together and for
using it. If you’re borrowing or buying a used playpen, make sure there are no tears in the
vinyl rail coverings, mesh panels or mattress pad. Do not use the playpen if it’s damaged or
has broken or loose parts.
Head shape
In the first 2 months, flat areas on a newborn’s head can develop very quickly. This is
because their skull bones are soft, they have weak neck muscles, and they will usually rest
their heads one way when lying on their back. These flat areas and possible neck stiffness
can be prevented and treated.
Flat areas can be on the right or left side at the back of the head (plagiocephaly) or across
both sides of the back of your baby’s head (brachycephaly), depending on how your baby
likes to rest their head. These flat areas can change the shape of your baby’s head and face,
and can be permanent if not treated early.

Normal Positional Brachycephaly
head shape plagiocephaly
Changes to head shape do not affect your baby’s brain growth or development. The
changes could make it more challenging for them to wear sports or safely helmets when
they’re older.
If your baby sleeps with their head turned consistently to one side, position them to
encourage turning their head to the other side (their non-preferred side). Each night,
place your baby in their crib with their feet in the opposite direction, as the previous night
(see photos below). As babies tend to turn their head to look for you, positioning them in
opposite directions will help them turn their non-preferred side to see you.
Continue to put your baby on their back to sleep. Do not use positioning devices during
sleep, like wedges, towels, pillows or rolls as these can smother your baby.

When your baby is awake:
■■ Give them supervised tummy time every
day, starting at birth (see page 245). Back to sleep, tummy to play
■■ Change the arm you use to carry your When your baby is awake and with
you, place them on their tummy to
baby—right one day, left the next.
play several times every day.
■■ Carry your baby close to your body, facing
over your shoulder.
■■ Offer your baby both breasts at each feeding.
■■ Alternate the arm you use during feeds if you’re feeding with a bottle.
■■ Limit the amount of time your baby spends in a car seat, bouncy seat or swing. If you
use these, position your baby’s head so it’s supported and is not always turned to
one side.
If your baby always wants to look in

one direction, use bright toys or the
sound of your voice to encourage
them to look in the other direction.
If your baby always wants to look
in one direction, they may have
tightness in their neck muscles
and may need treatment for this to
improve.
Call Health Link at 811 or your health care provider if you notice any of
the following:
!
■■ your baby only looks in one direction, or their head is tipped to one side
■■ your baby has ongoing trouble breastfeeding on one side
■■ you have trouble turning your baby’s head to one side
■■ you notice a flat area on your baby’s head

Swaddling
To swaddle a baby means to wrap them snugly in a light blanket. Swaddling is often used
to calm and soothe a baby, but babies don’t need to be swaddled for sleep. No matter
which way you choose to swaddle, doing it properly can help reduce risks.
If you choose to swaddle your baby:

■■ Always place your swaddled baby on their back—never on their tummy or side. This
helps reduce the risk of SIDS.
■■ Use a light-weight, breathable blanket to swaddle. Make sure your baby doesn’t get too
hot. If their skin feels warm or your baby is sweating, remove the swaddle. A baby who is
too hot is at a higher risk of SIDS.
■■ Leave enough room for your baby’s legs and hips to move. A swaddle that’s too tight
can cause problems with their hips, a condition called developmental dysplasia of
the hip.
■■ The swaddle must be secure enough
for the blanket not to come loose When to stop swaddling
and cause your baby to suffocate Swaddling must be stopped when your
or become strangled. It should not baby shows any of the following:
be so tight that it makes it hard for ■■ they no longer need swaddling to settle
them to breathe. Once you’re done or calm themselves
swaddling, make sure you can fit ■■ they’re able to roll over
your finger between your baby’s
■■ they’ve wiggled out of a swaddle even
chest and the blanket.
once—usually around 2–3 months of age
developmental dysplasia of the hip: a condition that causes the hips to not grow properly

How to swaddle your baby
There are different ways to swaddle your baby. One way is called the ‘hands to heart’
method. In this method, your baby’s hands are tucked in to stop their arms from moving
and startling themselves. Here’s how to swaddle using the ‘hands to heart’ method:
1. Spread a light-weight, breathable blanket around

112 cm x 112 cm (42 inch x 42 inch) into a diamond
shape. Fold the top corner in towards the centre. Place
your baby on their back on top of the blanket. Their
shoulders should be level with the folded edge so
that the blanket is kept away from your baby’s face
and their head and neck can move. Make sure the
swaddling blanket does not cover your baby’s head.
2. Move your baby’s hands onto their chest into a ‘hands

to heart’ position. Bring one side of the blanket over
the chest and arms, covering your baby’s hands, then
tuck under the baby.
3. Bring the other side of the blanket over your baby’s

chest and arms, and securely tuck it behind them. The
weight of your baby will keep the blanket in place.
4. Check to make sure you can fit your finger between

your baby’s chest and the blanket.
5. Fold the blanket at the bottom and then lay it flat

underneath your baby. This helps keep your baby flat
on their back and reduces the chance of the blanket
coming loose. Make sure there’s enough room for your
baby’s hips and legs to move.
To learn more about swaddling and the different ways to swaddle your baby, visit the
Videos section at healthyparentshealthychildren.ca/resources

Crying
All babies cry and they cry for many
reasons. Crying is a way your baby
communicates with you and tells you
that they need your help. It may mean
they need a diaper change, to be fed,
burped, held or cuddled. It may mean
that they need sleep, or perhaps they
don’t feel well. Sometimes you won’t
know what your baby is trying to tell
you. There may be times when your
baby can’t seem to stop crying, no
matter how you try to soothe them.
Try to make your baby more comfortable during this time. As a new parent, you’ll soon
learn your baby’s cues and that your baby cries differently for different reasons.
It’s more important for you to stay calm than to stop the crying. Know that even if you
cannot calm your baby, they’ll still know that you love them and that you’re trying. Ask for
help when you need it.
When your baby is crying, always take a moment to calm yourself first by using self-
regulation strategies (see page 27) before you try to calm your baby. Remember that
babies cannot calm themselves on their own. Your calm manner will help them learn, over
time, how to calm themselves. This takes many years, although the process starts when
they are tiny babies. Research has shown that when babies are consistently comforted
when they are under 6 months of age, they cry less after 6 months of age.
Babies cry from birth and the amount they cry changes
as they grow. You may notice that your baby’s crying: Cuddling does not
spoil babies!
■■ starts to increase at about 2 weeks old
Holding your baby close and
■■ peaks around 2–4 months old cuddling them helps them
feel safe and secure.
■■ starts to lessen when they’re 3–5 months old
On average, babies cry about 2 hours in total throughout the day. Some babies cry more
and some cry less. Babies can:
■■ sometimes cry for 30–40 minutes at a time
■■ cry more in the afternoon or evening
■■ sometimes look like they’re in pain when they’re crying

Plan ahead so you’re ready for the times when your baby’s crying becomes too much. Talk
to people you trust. Sometimes you need someone to talk to about how you’re feeling.
Make a plan to call them to come over right away if you’re getting frustrated. Keep their
phone numbers handy for yourself and for other caregivers.
“ Sleep—make sure you talk to your partner or a close family member if you’re
not getting enough of it. Without it, you lose your ability to think clearly, reason,
and your emotional regulation goes out the window. If you’re experiencing
”
feelings of anger, rage or violence, it’s really important to tell someone and get
the support you need. Do not let the shame take hold.
~ Maha, mom of two children
Crying Plan—Take a break, don’t shake

To soothe your baby, you can:
■■ check what they may need. Are they hungry, ■■ gently massage their tummy or back
wet, bored? ■■ snuggle them against your chest
■■ make them as comfortable as possible, ■■ gently rock them
neither too hot nor too cold
■■ sing, read or talk softly
■■ feed them slowly and burp them often
■■ put them in a baby swing
■■ try to hold them in different positions like
cuddling skin-to-skin, against your chest, in a ■■ carry them in a carrier or sling
carrier, or tummy down across your lap ■■ give them a warm bath
■■ change their diaper ■■ encourage them to suck, such as using a
■■ take them for a walk soother
■■ play soothing music ■■ reduce noise, light and movement
■■ run the vacuum ■■ check with a health care provider to see if
they’re sick or in pain
Never shake a baby for any reason.

Sometimes babies just need to cry. Keep trying. You may not be able to stop the crying,
however, your baby will feel that you care.
Other ideas to soothe your baby:

Crying Plan—Take a break, don’t shake
Asking for help…
It’s okay to ask for help.

People you can call anytime during the day or night:
You can call Health Link at 811 to get health advice

24/7 from a nurse.
To calm yourself, you can:
■■ gently put your baby where they’ll be safe, ■■ write down the 5 best things about yourself
like in a crib, and leave the room ■■ write down the 5 best things about your baby
■■ listen to music ■■ count to 100
■■ call a friend or relative to come help ■■ talk to someone about your feelings
■■ take a shower or bath ■■ do an activity or hobby like a crossword
■■ exercise puzzle or reading
■■ do housework ■■ use positive self-talk, like “I can calm myself,”
■■ close your eyes and breathe deeply and “My baby knows I’m trying.”
Remember, it’s more important to stay calm than to stop the crying.
Do not pick up your baby until you feel you have calmed down.
Other ideas to calm yourself:

Here are some tips when leaving your baby with other caregivers:
■■ Write out a list of what usually works to help soothe your baby. Share your Crying Plan
with your caregiver if you like.
■■ Leave instructions for feeding your baby.
■■ Tell caregivers that you’ll come back, if they need you.
■■ Come home when you say you will.
■■ Tell caregivers to put your baby on their back in a safe place, like their crib, cradle or
bassinet if they’re starting to feel frustrated with their crying. That’s the safest place
for your baby.
Colic
Sometimes a baby will cry for longer periods of time, no
matter what you do. This type of crying could be colic. Colic Take time for
is when a healthy baby is irritable, fussy or cries for 3 hours or yourself
more a day, more than 3 times a week, for at least 1 week. Try to take some time
for yourself and get
Colic tends to start when babies are between 3 weeks sleep when you can.
and 3 months old. It usually stops by the time your baby
is 4–6 months old.
Colic tends to follow the same pattern of typical crying. It’s at the high end of the normal
range and is often louder, more frequent, and lasts longer. Colic can be very upsetting and
exhausting for parents, so be sure to take good care of yourself. Take breaks when you can,
and seek out help from other adults that you trust. See the Crying Plan on page 230 for
things you can do for yourself and your baby.
Call Health Link at 811 or your health care provider NOW for any of
the following:
!
■■ your baby cannot stop crying and you’ve done everything you can
to soothe them
■■ your baby is crying and you feel stressed, frustrated, angry or alone
Sometimes talking with another person, especially in the middle of
the night, can help.

Coping with crying
Take a break, don’t shake
You may not be able to soothe your baby even
Frustration when dealing with a
if you’re doing all the right things. When your
crying baby is the number one
baby cannot stop crying, you may find yourself reason for shaking. Never shake
feeling frustrated or angry as your stress level your baby or child for any reason.
rises. If this happens:
Babies and young toddlers have
■■ Put your baby in a safe place, like their crib, heavy heads and weak neck
cradle or bassinet. muscles. Even a few seconds of
shaking can cause blindness,
■■ Leave the room and gently close the door. hearing loss, inability to walk,
■■ Take time to calm yourself before you try to learning problems, and in some
cases may even cause death.
soothe them again.
■■ Ask your partner, friends or family for help.
Short periods of crying while you calm yourself will not hurt your baby. Holding your baby
when you’re frustrated or angry can lead to shaking. To learn more about
your baby’s cries or to make a plan to deal with the crying, visit the Videos
Bathing
Babies do not need a full bath every day. Frequent full baths can dry out your baby’s skin,
so it’s better to limit them to a few times a week. After your baby is 1 week old, a full bath
in a sink or a baby bathtub 1−2 times a week is often enough.
In between full baths and before your baby is 1 week old, you can clean your baby using a
sponge bath. While giving your baby a sponge bath, lay them on a clean towel, cover the
areas of your baby that are not being washed to help keep them warm and dry the wet
areas as you go. Wash your baby’s face, hands, bottom and genitals with a warm, wet face
cloth at least once a day and whenever needed.
Bathtime safety
Keep your baby safe during a bath by having your hands on your baby at all times in or
around water. Never leave your baby alone around water, not even for a second. Babies
do not have good head control, which means they can drown in as little as 2.5 cm (1 inch)
of water in just a few seconds. If you’re using a baby bath seat, ensure that you’re with your
baby at all times. Bathtub rings are not safe to use as they can tip over when the suction
cups become loose and your baby will not be able to get out of the seat.
sponge bath: washing with a wet sponge or washcloth instead of in a sink, basin or baby tub filled with water

Getting ready for a bath
When getting ready to bathe your baby:
1. Make sure the room is warm.
2. Take off any jewellery that could scratch your baby.
3. Put everything you need within easy reach.
4. Lay out a blanket or towel next to the sink, basin or baby bathtub to lay your baby on.
5. Fill the sink, basin or bathtub with the least amount of warm water needed.
6. Check the temperature of the water with your wrist or elbow. The water should feel
warm to touch, not cold or hot.
Bathing your baby

When giving a bath, support your baby’s head and neck, and slowly lower them into the
water. At first, your baby may not like it as it’s a new experience, so sing or talk gently to
your baby to help calm them. Always keep one hand on your baby. Use a clean washcloth
and plain water. Babies don’t need soap as it dries out the skin. You may use a small
amount of baby shampoo once in a while if needed. Make sure to rinse it off.
Start by washing your baby’s face

and work your way down from
the cleanest to the dirtiest parts
of their body:
1. Wash your baby’s eyes and

outer ears and then the rest
of their face. Be careful no
soap gets on their face, if
you’re using soap.
2. Wash their scalp and hair.
3. Clean skin creases in their
neck and underarms.
4. Wash the rest of their body.

5. Clean your baby’s genitals and the skin creases in this area last:
■■ For baby girls, wipe gently from front to back. This will help prevent spreading germs
from their bottom to their genitals.
■■ For baby boys, wipe their penis and then their bottom. If the penis is covered with
skin (foreskin), do not pull it back.
The foreskin will loosen on its
Circumcision
own when your child is 3–5 years
Circumcision is a personal decision. It’s not
old. If your baby has had their
recommended as a routine procedure for
foreskin removed (circumcision),
all newborn males, but there
your health care provider will may be benefits for some. For
explain how to care for the area. more information, talk with
If you have any questions or your health care provider
concerns, talk with your health or visit the Links section at
care provider. healthyparentshealthychildren.ca/resources
6. Gently dry your baby’s skin,

including the skin creases, with a soft towel.
You don’t need to use lotion or baby powder after a bath as these can irritate your baby’s
skin. Baby powder can also cause choking and breathing problems for your baby.
Eyes, ears and nails

Your baby’s eyes, ears and nails need gentle cleaning and care.
Eyes
Your baby’s eyes may be swollen or have small amounts of discharge after birth.
Sometimes the discharge can last up to a year if they have blocked or narrow tear ducts.
This is normal. To care for your baby’s eyes:
1. Wash your hands.

2. Use a clean, soft, wet washcloth to wipe from the inner corner to the outer corner of
your baby’s eyes—use a different part of the cloth each time you wipe.
Call Health Link at 811 or your health care provider if you notice any of
the following:
! ■■
■■
your baby has a yellow or white build-up in the corner of the eye
your baby’s eyelids are sticking together
■■ one or both eye(s) look red and swollen

Ears
Use a clean, damp washcloth to clean only the outside of your baby’s ears. Never use a
cotton-tipped applicator inside your baby’s ears as it can poke a hole in their eardrum. It
can also push wax into their ears and cause a wax build-up or blockage, which can cause
temporary hearing loss.
Nails
Your baby’s fingernails and toenails may be quite
long when they’re born. Your baby’s skin is attached Your baby’s nails
to the underside of the nail and can be easily Never bite your baby’s nails as
damaged. The best time to care for your baby’s nails this could cause an infection.
is when they’re asleep in the quiet sleep state.
To care for your baby’s nails, use an emery board and gently file the nail. If you’re using nail
clippers, only use the ones made for babies. Push the pad of your baby’s finger away from
their nail so you don’t cut their skin.
Mouth
A healthy mouth is important to a newborn’s
overall health. Here are some tips for keeping
your baby’s mouth clean:
■■ Clean your baby’s gums with a soft, clean,
damp washcloth every morning and night.
■■ Do not put bottle nipples or soothers in your
mouth. If you share saliva with your baby, it
can pass germs to them that can cause tooth Reproduced with permission from Van Mierlo, A. (2017).
decay.
■■ Do not let breastmilk or formula stay for long periods of time in your baby’s mouth.
Avoid propping up the bottle for feeding and remove your breast or the bottle from
your baby’s mouth when feeding stops.
Soothers
Babies suck when they drink. Sucking is also a natural way for babies to comfort
themselves when they’re tired or upset. Sucking for comfort starts early in life. It usually
decreases as children get older.

Your baby may suck their thumb, fingers or fist for comfort—or you may decide to use a
soother. It’s easier to stop a soother habit than a thumb-sucking habit.
Soothers (pacifiers) are often used to help babies calm and self-soothe. Research tells us
that using a soother may help reduce the risk of SIDS. However, the research is not clear
if soothers will interfere with breastfeeding or not. Soothers can be used if your baby is
growing well and you use it once you know your baby is fed and no longer hungry. If you
use a soother, and your baby falls asleep and it falls out, there’s no need to place it back in
their mouth.
Babies don’t need a soother all the time. They need to be able to coo and babble. If you’re
using a soother:
■■ It should not replace feeding, holding, or comforting your baby.
■■ Never tie a soother around your baby’s neck as it can strangle them. You can use a clip
with a short ribbon (about 15 cm or 6 inches) to attach the soother to their clothing
instead.
■■ Do not dip your baby’s soother in sugar, honey or drinks with sugar or alcohol. This
could make your baby very sick.
To keep your baby’s soother safe and clean:

■■ Boil it in water for 2 minutes or according to the instructions on the package before
using it for the first time. Cool it completely before using.
■■ Wash it often with hot, soapy water. Rinse it after each use.
■■ Check it regularly. Throw it away if it’s cracked, has a hole or is torn.
■■ Replace soothers at least every 2 months.
Diapering
Whether you use cloth or disposable diapers, change them often to keep your baby
comfortable and to prevent diaper rash. Babies use at least 10 diapers every day. Your baby
may cry when you’re changing their diaper. Talk or sing to them to help calm them, and to
help them start understanding words and routines.
Make a separate area for diapering. If you can, set it up near a sink and away from areas
where food is prepared, stored or eaten. Clean your diaper change area often.
self-soothe: being able to get to a calm state and fall asleep

To change your baby’s diaper:
1. Wash your hands. 6. Put on an unscented barrier ointment
2. Place your baby on a safe, flat surface. or cream.
3. Take off the dirty or wet diaper. 7. Put on a clean diaper.
4. Clean your baby’s diaper area from 8. Put disposable diapers in a covered
front to back, with a warm, wet, soft diaper pail or garbage can right away,
washcloth or alcohol-free baby wipes. and empty it often. Keep dirty diapers
out of reach of children and animals.
5. Dry their diaper area with a dry cloth or
leave the diaper off until the area dries 9. Clean and sanitize the diaper
to prevent diaper rash. change area.
10. Wash your hands again.
Diaper rash?
If your baby has a diaper
rash, you can use a small
amount of a zinc-based
cream. Talk to your
pharmacist about which
cream to use.
To keep your baby safe when diapering:

■■ Always keep one hand on them—
even tiny babies can move. Call Health Link at 811 or your
health care provider if your baby
■■ Never leave your baby alone, even
has a diaper rash and you notice
for a second, on any surface where
!
they could roll off and fall. any of the following:
■■ it lasts longer than 2 days
■■ If there are safety straps, use them
when changing your baby on a table ■■ it looks like a burn or is bright red
or raised surface. ■■ it looks like red dots, bumps or
■■ Keep all pins, creams and dirty blisters
diapers out of their reach.

Here are some tips for cleaning cloth diapers:
1. Remove stool from the diaper if you can. Flush the stool down the toilet.
2. Fill the diaper pail ¾ full of water.
3. Put soiled washcloths, cloth diapers and diaper clothing in a covered diaper pail.
4. Wash these items in a washing machine in hot water, every 2−3 days, using the sanitize
cycle, if you have one.
5. Put these items in a hot dryer or hang outside in the sun.
6. Wash your hands with soap and hot water after changing your baby’s diaper, cleaning
the cloth diapers, and after cleaning the changing area.
Dressing your baby

Newborn-sized clothing fits for a very short time, so get only what you need. Always
choose sleepwear that fits your baby. Dress your baby to keep them warm, not hot—
overheating can increase the risk of SIDS.
To keep your baby safe and comfortable, choose clothing that:

■■ fits well—if it’s too big it can ride up and ■■ is easy to put on such as clothing with
could suffocate your baby a wide neck opening so it fits over your
■■ is non-flammable baby’s head
■■ does not have small buttons, drawstrings

■■ does not have a hood
or decorations that could come off
When going outside in cold weather:

Winter clothing and
■■ Put a hat on your baby and cover their hands car seats
and feet.
Bulky winter clothing could
■■ If you’re choosing a warmer, hooded sleeper affect the harness system of your
for outdoor use, make sure you choose one car seat. In the winter, use thin,
with a ‘break-away’ hood that is attached with warm layers like a fleece or a light
Velcro® or snap attachments. Fixed hoods can snowsuit with legs, not a bunting
bag style. Once your child is in the
catch on things and strangle your baby.
seat, and the straps are secure, a
■■ Dress your baby with 1 more layer of clothing blanket or cover can be placed
than you’re wearing. over them. Check that the straps
are snug each time.
■■ Do not use scarves or anything with
drawstrings, as they can strangle your baby.
■■ Do not stay outside for too long.

Washing your baby’s clothes
How you wash your baby’s clothes is important as they have very sensitive skin and can
develop skin rashes. When washing your baby’s clothes, blankets and other items that
touch their skin:
■■ Wash with a mild soap before using items for the first time.
■■ Rinse twice or add 125 ml (½ cup) of vinegar to the rinse.
■■ Do not use fabric softeners or scented soaps as these can irritate your baby’s skin.

Your baby is changing and growing daily. All areas of your baby’s development are
interconnected. Development in one area affects the development in all other areas. Your
newborn baby’s development is guided by their brain.
Physical
Emotional
Cognitive
Social

Your newborn’s developing brain

Even though babies are born with billions of brain cells, only some of them are connected
at birth. Every time your baby hears your voice, smells your scent, sees your face, feels your
touch and is cared for, brain cell connections are formed. The more often an experience
happens, the stronger the connection gets and the easier it is for signals to start passing
from one part of the brain to another. These day-to-day interactions are also building
attachment between you and your baby.

Whether you’re a mom or a dad, your brain and your baby’s brain are designed to work
together. Your baby tries to get your attention by looking at you, cooing, and flapping their
arms and legs. Parents all around the world, in every language and culture, try to connect
with their baby by getting close to their baby’s face, making their own face look happy and
gentle, and by using a gentle, higher-pitched tone of voice. This is the way you get to know
each other while your baby’s brain starts its rapid development.
Brain cell connections become stronger when you and your baby engage in serve-and-
return interactions. As this is a new experience for both of you, here are some ideas on
how to start:
1. Watch your baby and notice what they 4. Repeat what you did if they seem to like
are doing. it. After a few turns, try something new.
2. Copy your baby’s movements and then 5. Stop when your baby tells you they’ve
wait for them to take a turn. Have fun had enough (e.g., turns away, stops
and talk about what you and your baby looking at your face, starts to squirm
are doing as you take turns. or fuss).
3. Notice how your baby responds. 6. Let them have a rest, and wait for them
to try to engage you again.
Examples of serve-and-return interactions:

Birth–2 months
Your baby serves when they: You return their serve when you:
■■ look at your face ■■ look at their face and smile while you’re feeding and caring
for them
■■ start to fuss and suck on their ■■ talk to them about how they’re feeling. While you get ready
hands to feed them say “You’re hungry, aren’t you?”
■■ kick their legs and flap their ■■ push gently on the soles of their feet and let them push
arms back against your hands
■■ dangle safe objects near their hands for them to touch or
bat when you’re playing together
■■ make contented noises like ■■ copy the sounds they’re making

coos, gurgles, sighs and ■■ rub, pat and gently touch their tummy, back, arms and legs
squeals
■■ stop to see what they do. They’ll let you know to stop or to
do it again.
■■ pay attention to your voice ■■ talk to them about what you’re both doing during the day
■■ notice whether they like a gentle voice or a lively voice
For more information about how the brain develops, see page 19.

Other things you can do to help your baby’s development
How your newborn learns

Newborns learn through their senses—seeing, hearing, touching, tasting and smelling.
Your baby has an excellent sense of smell and it’s one of the main ways they get to
know you.
Babies can see from birth and can:

■■ tell the difference between light and dark
■■ see shapes
■■ see best when objects are about
20–30 cm (8 1/2–11 inches) away
■■ see your face, though at first, they may just
scan around the outside edges of it or focus on
your hairline
As they grow, they’ll:

■■ turn their head to follow faces and bright objects
■■ gaze at objects
■■ start to focus on the centre of your face and then
your eyes
Babies can hear even before they’re born and they:

■■ enjoy hearing sounds with different tones like voices
and soft music
■■ might stop moving to listen when they hear a sound
■■ will startle when they hear a sudden, loud noise
■■ are scared by angry, loud voices

Communicating with your newborn baby
Newborns communicate in
many ways. One way is by
crying (see page 229). As your
baby grows, it becomes easier
to understand what they’re
trying to tell you. Babies look
at what interests them and will
use sounds, facial expressions
and gestures to show their
awareness and excitement.
Babies grunt, gurgle, coo and
make small throaty noises.
Later, these sounds will become
words as their speech and
language develop.
Babies need you to talk with them. When you talk to your baby, they learn to recognize the
sounds and understand the words of your language.
■■ They’ll learn to talk by hearing your words, songs and stories. Sometimes adults feel
silly talking to a baby, but your baby needs to hear words many times before they’ll
understand and use them.
■■ Your baby loves voices and faces. Look into their eyes and smile. Talk or sing softly when
you’re holding, feeding and playing with them.
■■ Notice what interests them by what they’re looking at, touching, smelling, hearing and
tasting. Talk about what they’re paying attention to so they can start to attach meaning
to your words.
When you copy your baby’s

Your voice is best
sounds, they realize that they’re
able to make noises that sound Your growing baby soon turns their head to look at
you when you speak. When you comment on what
like your speech. At first you
they are interested in or looking at, you show them
copy them and soon, they’ll
that what they are trying to tell you is important.
copy you. This helps build your This is how they learn to communicate with you.
baby’s brain connections for This will set the stage for them to come to you with
speech and language. their thoughts or problems when they are older.
gestures: actions, hand movements and facial expressions used to communicate, like waving to say ‘bye’

Let’s play
Play builds healthy bodies and healthy
minds and is important for your baby’s
growth and development. Your baby plays
by using their senses to interact with you
through their everyday experiences, such
as when they follow you with their eyes,
feel your warmth, and listen to your voice.
You’re their favourite playmate.
How your baby explores and plays is

influenced by their temperament (see
page 24). They may be calmer or more
active than other babies you know. They
may have more or less fussy periods than
other babies. Some babies like to look
at you. Others prefer to look out at their
surroundings. Every baby is different.
Over time you’ll get to know what your
baby likes.
You can help your baby play by:

■■ relaxing and enjoying your new baby. They need Your baby loves to
nurturing, loving care and your smiling face. play with you
You play with your baby when
■■ having serve-and-return interactions with them—
you interact with them and
follow your baby’s lead. do things such as massaging
■■ watching and talking about the objects and them, holding and rocking
people they look at with interest. them, and carrying them in
different positions.
■■ letting them wiggle and kick. Give your baby
many chances to move freely when you’re there
to supervise.
■■ going for a walk to enjoy the fresh air. Be active and spend time together.
Your baby is also playing just by moving themselves. Babies are born with some simple
reflexes. At first they cannot control their arm and leg movements. As your baby grows,
they’ll find their fingers, toes and other body parts and enjoy playing with them. They’ll
also smell and touch you, poke at your face and grasp your hair. In time, they’ll be able to
control how they move, and will purposefully reach for and touch things.

They’ll look at you with interest
and kick their legs when you talk, Active play guidelines
play or care for them. This is how Newborns should be active every day. Make
your baby figures out how to sure your baby:
control their movements and gets ■■ gets at least 30 minutes of supervised tummy
to know you. Your baby needs time, spread throughout the day, while awake
many chances to move freely as ■■ does not sit in places such as a stroller or high
long as you’re near them to keep chair for more than 1 hour at a time
them safe.
Tummy time
Your new baby needs play time right from birth, at
least 30 minutes of supervised tummy time. One of
the best ways to do this is to provide short periods
of tummy time throughout the day and when your
baby is awake.
Tummy time helps with your baby’s development

and makes their body stronger so they’ll be able
Reproduced with permission from
to roll, sit and crawl. It also strengthens their neck Shivangi Trivedi. BscPt, MATRIX PHYSIOTHERAPY
muscles, and can help prevent flat areas on their head.
It may take time for your baby to enjoy lying on their tummies.
Here are some ideas and things to think about to help your baby get used to tummy time:
■■ Start early by combining tummy time with skin-to-skin cuddling. Lay your baby on their
tummy on top of your chest while you lean back.
■■ Try putting your baby on their tummy after every diaper change.
■■ You can put a small,
rolled-up towel under your
baby’s chest, with their arms
in front of it. This will help
them hold their head up,
so they can look in different
directions.
■■ The safest place for tummy
time is on the floor on a
clean, flat blanket.

■■ Start slowly—most babies fuss at first when put on their tummy. Try it for 1–2 minutes. If
your baby begins to fuss, turn them onto their back for the rest of the play time and try
again later. Gradually increase tummy time as your baby gets used to it. Don’t do tummy
time when your baby is hungry, tired or upset.
■■ Lie on the floor beside your baby. Use the sound of your voice or bright toys to
encourage them to look left and right and to try to lift their head up to look at you.
■■ Always stay with your baby whenever you put them on their tummy.

Babies show their emotions as soon as
they’re born. By 2 months old, your baby
smiles and coos when they like something,
and fusses or cries when they’re not happy
or tries to tell you they need your help.
As they grow, it will become easier to tell
when your baby is happy or sad.
Your baby cannot understand emotions

yet, but when you give them loving care,
they’ll feel safe and secure. This gives them
the strong base they need for life-long
good mental health.
When you respond to your baby calmly

and consistently, you help them learn to
trust while you build a secure attachment.
Your baby’s strong attachment with you
helps them form attachments with others Help your baby learn to trust
as they get older. ■■ Respond to your baby’s cues.
■■ Comfort them when they need you.
If you’re concerned that you’re not feeling
connected with your baby, or if you’re ■■ Smile, sing, talk, read, play, hug and
hold them often.
feeling sad, angry or depressed, call
Health Link at 811 or talk with your health
care provider.

Understanding and responding to your baby
Even though your baby cannot talk, their body language can often tell you what they
need. When you understand what your baby is feeling, it’s easier to know how to respond.
What your baby is saying How your baby shows it Your baby needs you to
“I like it.” ■■ looks relaxed ■■ talk

■■ is quietly alert ■■ play
■■ watches with interest ■■ read
■■ looks excited and smiles ■■ sing or hum
“I don't like it.” ■■ tenses their face and body ■■ change activities
■■ closes their eyes part way ■■ put them down to sleep
■■ wrinkles their nose or lip
■■ whimpers
■■ turns away
■■ puts their hands up
“I need you.” ■■ fusses or cries ■■ feed them

■■ looks at you or searches for ■■ hold and cuddle them
you ■■ talk calmly and gently
■■ leans or moves toward you ■■ sing or hum
■■ reaches for you ■■ rock gently
■■ check if they're sick or hurt
■■ change their diaper
■■ stay calm
“ That first and second month, when you’re getting settled with your baby,
can be quite stressful. I would call Health Link and ask my doctor and Public
Health Nurse all kinds of questions every chance I got. I felt like I learned so
”
much in such a short period of time. But I did it. He’s thriving and it’s getting
better each day.
~ Brittany, mom of one child

Your baby’s world starts with you. Their world
Check out programs
grows as they meet new people. Once you’re where you live
comfortable with the day-to-day care, try
Your community may have
taking your baby to new places. Try to plan your
programs for parents and babies.
activities around your baby’s usual feeding and Your public library and Parent Link
sleeping times—be sure to take supplies with Centre are good places to start
you as young babies are still unpredictable and looking for some in your area.
may need to feed or sleep at different times.
Try to be open to having other people

What’s in your diaper bag in your life care for and spend time with
Here are a few things you want to have in your baby. This helps your baby learn to
your diaper bag: adapt to and enjoy other people. Think
❑ Extra diapers ❑ Bottles with of it as building a network of support
❑ Barrier cream
breastmilk or for you and your baby. Others may not
formula do things exactly the same way as you,
❑ Wipes
❑ Change of clothes however, there are many ways to care for
❑ Hand sanitizer a baby. As long as they’re providing safe
❑ Light blanket
❑ Changing pad and nurturing care, your baby will be
❑ A few toys and
❑ Plastic bag fine, and will learn that there are different
books
ways to do things.

Health Checkups
You and your baby need to see your health care providers regularly during your baby’s
first 6 months. The health care providers you’ll most commonly see at this age will be your
family physician and your public health nurse. These visits will help support your baby’s
growth and development and your family’s health and adjustment to parenting.
Health care providers will:

What do the
ask how your baby is feeding
numbers mean?
■■
■■ check your baby’s general health and If your baby’s weight and height
development are plotted on the growth chart
at the 25th percentile, it means
■■ measure your baby’s weight, length and
that out of 100 babies who are the
head size
same age, 25 are smaller than your
■■ track how much your baby has grown from baby and 75 are bigger.
one visit to the next on a growth chart
Healthy growth is different for each child. Your baby will follow a growth pattern that’s
right for them. Children come in different shapes and sizes—they may be taller or shorter
or heavier or lighter than others the same age. Things that affect a child’s growth include
their eating and activity habits, the environment and their genes. The growth pattern over
time is more important than just one measurement.
For more information about keeping children healthy and safe at any age, see page 76.
Well child clinic visit

Your baby will have their first well
child clinic visit and receive their first
immunization when they’re 2 months
old. Immunizations give your baby
the best possible chance of staying
healthy. Contact your community or
public health centre if you have not
yet booked your baby’s immunizations
with the public health nurse.
To learn more about immunizations, see page 82.
genes: carry information that makes you who you are and determines what you look like. This includes your blood type,
hair and eye colour and your risk for certain diseases. Genes are passed to you from your mother and father.

During your clinic visit, your public health nurse will also check things such as your baby’s
growth and how they’re feeding. They will also ask how you’re doing, offer to screen you
for postpartum depression, answer any questions you may have, and provide you with
information about other parenting supports in your community (see page 78).
To find a community or public health centre near you, call Health Link at 811 or visit the
Links section at healthyparentshealthychildren.ca/resources
Newborn hearing screening

You’ll be offered to have your baby screened for permanent hearing loss soon after birth,
often before you have left the birth centre. As your baby grows, hearing loss can affect
speech, language and learning skills. Have your baby’s hearing checked early (before they
are 1 month old) so that support and care can be given if needed.
Screening will not hurt your baby and can be done while they’re quiet or sleeping.
During the screening test, sounds will be played into your baby’s ears and a computer will
measure how well your baby hears the sounds.
For more information about newborn hearing screening, visit the Links section at
Birth–2 2 4 6 12 18 2 3–4 5 years and
√
Check with your
doctor to find Check with your doctor to find out the
Doctor
out the checkup checkup schedule at their office
schedule at
their office
Immunization √
Regular checkups as
Dental √
Early vision √
Early vision checkups
Vision checkups with (with optometrist
with your doctor
your doctor at 3–5 years old)
Other health
As needed As needed
care providers

Common Parent Concerns
New parents are often worried about how babies look and how they act in the first few
weeks. Many of these concerns are common for babies. If you’re worried about any of
these, call Health Link at 811 or talk with your health care provider.
Newborn rash
Newborn rash is a blotchy, red, pinpoint-size rash found anywhere on your baby’s body.
You may see it within 1–2 days after birth. It usually goes away in a few days. It can also
come back in the next few weeks. The rash may not look nice, but it’s normal and doesn’t
need to be treated.
Newborn rash is not the same as diaper rash (see page 98) or other types of rashes that
include other symptoms, like a fever. For more information on these other types of rashes,
see page 97.
Cradle cap
Cradle cap is thick, waxy or flaky scales on your
baby’s scalp. It’s caused by normal changes in their
skin. It usually goes away on its own by the time
your baby is 1 year old. You can also treat it:
1. Gently massage a small amount of baby oil or

mineral oil into the scales on your baby’s scalp.
2. Leave the oil on for about 1 hour.
Baby With Cradle Cap, Starfoxy~commonswiki.
3. Wash with a mild baby shampoo and rinse well. (2005). Retrieved from https://commons.wikimedia.
org/wiki/File:Baby_With_Cradle_Cap.jpg. Creative
4. Use a soft brush to gently brush out the scales. Commons license https://creativecommons.org/
licenses/by-sa/3.0

Spitting up
Some babies spit up small amounts of milk right after a feed or between one feed and the
next. There’s no need to be concerned if it’s not forceful and if your baby is healthy and
gaining weight. To help decrease spitting up, burp your baby during and after the feed
(see page 204). You can also carry them in an upright position for 20–30 minutes after
feeding to decrease spitting up.
Spitting up is not the same as vomiting. Vomiting is forceful and may mean your baby is
sick. Vomiting can be very serious in a young baby as they can get dehydrated very quickly.
If you’re worried that your baby is sick, call Health Link at 811 or talk with your health
care provider.
Sneezing
Babies sneeze to help clear their nostrils. This is common in the first few months and it
can happen several times a day. It does not mean your baby has a cold. If your baby has a
plugged nose that seems to make it harder for them to breathe or feed:
■■ Put 1–2 drops of saline nose drops into each

of your baby’s nostrils. This makes the mucous Recipe for saline nose drops
thinner and easier to sneeze out. You can buy Saline drops can be safe to use
saline nose drops or you can make your own. if they are prepared and stored
correctly:
■■ Use a cool mist humidifier to add extra
humidity to your home. Avoid direct contact ■■ Add 2.5 ml (½ tsp) of salt to 250
ml (1 cup) of water that has been
with the humidifier’s warm mist around
boiled and cooled.
children, as they can cause burns.
■■ Store in a clean container that
If you’d like to use a bulb-shaped nasal aspirator, has a lid.
talk with your health care provider to make sure ■■ Throw it out after 24 hours.
you use it correctly as well as how often it should
be used.
If using a humidifier, clean and disinfect it regularly. Using an unclean humidifier can
lead to breathing problems, illnesses or allergies. Follow the manufacturer’s cleaning
instructions carefully. Empty the water from the humidifier reservoir when you’re not using
it and clean it before you re-fill and use it again.
Hiccups
Hiccups are very common and will not harm your baby. Sometimes they’ll stop if your
baby is cuddled, changes position or starts to suck on their fist, a soother, or when feeding.

Things to Watch for in Newborns
While most newborn babies are healthy, babies can get sick, and when they do, it can
happen quite quickly. Unfortunately, they cannot tell you when they don’t feel well, so
you’ll need to watch your baby for signs that tell you they’re sick.
Sleepy newborn
It’s normal for a newborn to be a little sleepy, and some newborns are sleepier than others.
A baby may be sleepy for many reasons. If your baby is not able to wake up enough to
feed, this creates a problem. For more information on sleepy newborns and what you can
do to wake your baby up to feed, see page 186.
Call 911 NOW for any of the following: Call Health Link at
your newborn is breathing slowly or 811 or your health
!
■■
has stopped breathing care provider NOW
!! ■■
■■
your newborn is having trouble
breathing or is wheezing
your newborn has blue or grey skin
if you’re having
trouble waking up
your baby.
■■ your newborn is limp or not moving
Jaundice
After birth, babies have more red blood cells than they
need. As these cells break down, they release a substance
called bilirubin. Your baby gets rid of bilirubin in the first
few days through their bowel movements. If bilirubin
builds up in their body, it causes jaundice. If your baby
has jaundice you’ll notice the whites of their eyes and skin
look yellowish.
There are different types of jaundice. The most common

type happens 2−3 days after birth, and sometimes it needs
to be treated. If the jaundice needs to be treated, your
baby may need to be in a hospital for a few days under

special lights (phototherapy). Putting your baby in the sun is not recommended. Sunlight
is not strong enough to help with jaundice, and your baby could get a sunburn or become
too hot.
At low levels, jaundice will not harm your baby. In rare cases, very high levels can cause
brain damage. Babies with jaundice can become sleepier and may not feed well. To help
reduce jaundice:
■■ Feed your baby often and for as long as they want to.
■■ If they are not waking on their own to feed, your health care provider may recommend
waking your baby to feed at least every 3 hours, while they are jaundiced. In the first few
weeks, babies should feed at least 8 times in 24 hours.
■■ Make sure they have a good latch when breastfeeding.
■■ Keep track of your baby’s wet and dirty diapers and their weight gain.
Your health care provider will assess your baby’s jaundice level. They may use a jaundice
meter to tell how much bilirubin is in your baby’s body. The jaundice meter is placed on
your baby’s forehead and uses a flash of light. Testing with the meter only takes a couple
of seconds and does not hurt your baby. Some babies may also need a blood test to test
their level of bilirubin.
A second type of jaundice can happen when your blood type is different from your baby’s
blood type. If this happens, your baby can become jaundiced in the first 24 hours of life.
A third and less common type of jaundice is caused by liver disease. It causes the urine to
become dark brown and the stools to become white, light grey or very light yellow.
Call Health Link at 811 or your health care provider NOW if your baby has
any of the following:
yellow skin and whites of the eyes in the first 24 hours
!
■■
■■ gets more yellow and it’s spreading to their feet and hands
■■ is not feeding well, is very sleepy or does not wake up enough to feed well
■■ fewer than the recommended number of wet and dirty diapers in 24 hours
■■ dark brown urine and white, light grey or very light yellow stool

Body temperature
Your baby needs help to keep their body temperature stable for the first couple of months.
Their body is not able to cool down if they get hot, nor warm up if they get cold.
A normal underarm body temperature is 36.5–37.5 °C (97.8–99.5 °F). For more information
on how to take your baby’s temperature, see page 92.
Take your baby’s temperature if they:

■■ feel cool to the touch ■■ are not eating well
■■ feel warm to the touch ■■ are sleeping less or more than usual
■■ look red and warm (flushed) ■■ have diarrhea or vomiting
■■ are fussier than usual ■■ look or act sick
If your baby’s temperature is normal and they seem well, but feel cool to the touch, dress
them enough to keep them warm, but not hot. You can also put a hat on your baby while
you warm them up. If they still feel cool to the touch, remove all of their clothing except
their diaper and cuddle them skin-to-skin, use a blanket to cover their back and put a hat
on their head. Skin-to-skin cuddling helps your baby regulate their body temperature.
If your baby’s temperature is normal and they seem well, but feel warm to the touch, take
off some layers of clothing or blanket. If they still feel warm, cuddle them skin-to-skin in
only a diaper and no hat, and use a light-weight blanket to cover their back.
Call Health Link at 811 or your health care provider NOW if your baby has
■■ signs of being dehydrated (e.g., ■■ is vomiting
fewer wet diapers, dry mouth) ■■ seems to be in pain (e.g., cries more
dark, cloudy, or red urine than usual, screams, rolls their head
!
■■
■■ a rash and fever or rubs their ears)
■■ many loose stools (diarrhea)

■■ is twitching or shaking
■■ a cough that’s getting worse

■■ is sick and seems to be getting
or is not going away worse
■■ red, irritated eyes that seem

■■ is very sleepy, weak or unusually
sensitive to light irritable

Go to the Emergency Call 911 NOW if your baby
!!
Department NOW if your has any of the following:
!!
baby is under 3 months ■■ blue, grey or pale skin
and has an underarm ■■ noisy breathing
temperature that is lower
than 36.5 °C (97.8 °F) or
higher than 37.5 °C (99.5 °F).
Preventing Injuries
Newborns are at risk of injuries even though they don’t move much. Injuries often happen
because parents are not aware of the risks to their baby. Wherever your baby is, there are
many ways you can help keep them safe.
For their age and stage

of development, here
are some areas that need
attention to keep your baby
safe from injuries:
■■ Falls, see page 104
■■ Safe sleep, see page 218
■■ Crying, see page 229
■■ Car seats, see page 123
For more information about

how to prevent injuries
in the early years, see
page 104.

Help your pet adjust to your newborn
Always be careful when bringing a newborn home when you have pets. Pets that have
not been around children or have had your sole attention before your baby’s birth, can
become jealous, aggressive and defensive, and will try to protect their place in the family.
As newborns don’t act, smell, or sound like the adults or children your pet is used to, this
may also confuse pets.
To help your pet adjust to your newborn, introduce them slowly, and:
■■ Give your pet a blanket or cloth with your baby’s
scent to smell before you bring your baby home. Pet safety classes
Animals have a very strong sense of smell that There may be pet safety classes
they use to get to know others. By giving your available in your community.
pet something that belongs to your baby, you’ll To learn more, contact your
help them get used to your baby’s scent before veterinarian or look online.
they meet.
■■ Have someone else take your baby into another room while you give your pet a warm
and calm welcome.
■■ Bring your pet to sit next to you and your baby, do not force them to be near your baby.
■■ Follow your pet’s regular routines like walks and feedings.
■■ Continue to give your pet some of your attention regularly.
■■ Never leave your baby alone with your pet.
Make sure you wash your hands after handling or cleaning up after your pet, and before
touching your baby. For safety, and to help reduce the risk of your pet’s fur or dander
bothering your baby’s airways, keep pets out of your baby’s sleeping area. When playing
on the floor, put your baby on a clean blanket or mat to help keep dust, carpet fibres, fur
and dander away.

The first few days and weeks after your
baby is born are often filled with many
emotions. Feelings of excitement and joy
are often mixed with feelings of worry and
tiredness. Your sense of who you are may
have changed throughout your pregnancy
and the birth of your baby.
You may find that you:

■■ have mixed feelings about no longer
being pregnant, your birth experience,
your baby and your role as a parent
■■ have a lot of energy or feel very tired
■■ have emotions that go from happy to sad and back again
■■ feel differently about how you look and the changes your body has gone through
Pay attention to your feelings and talk to your partner or a support person. You may be
surprised to find that they also have mixed feelings.
Mental health
Coming home with your new baby is an adjustment. You’re dealing with many changes
and looking after many things in the first few weeks, and this can add up to a lot of stress.
Caring for your baby as well as changes in your sleep, and emotions, can all affect how you
feel and your ability to cope. Taking care of yourself, both mentally and physically, is one of
the most important things you can do for yourself. This will help you have the energy you
need to take care of your baby and family.
“ I found that going to bed shortly after dinner was helpful in the newborn stage.
”
My partner would take care of the baby, unless she was hungry, and I could
catch up on sleep.
~ Shalza, mom of two children

Self-care
Caring for yourselves
Practicing self-care helps your mental
Remember that caring for your needs is
health by reducing stress and giving
important too. Your baby needs parents who
you the energy you need to cope take care of themselves to create a healthy
with change, solve problems and family environment to grow and thrive in.
manage your feelings and emotions.
■■ Take things one step at a time and one ■■ Practice simple relaxation techniques
day at a time. such as deep breathing and distraction
■■ Drink plenty of fluids, eat regularly, and (see page 260). Taking short relaxation
follow Canada’s Food Guide. breaks throughout the day can be really
helpful.
■■ Be active. Even going for short walks can
help boost your energy and mood.
■■ Say “No” to any household tasks that are
not urgent.
■■ Take a nap or rest when your baby sleeps.
■■ Spend time with your partner.
■■ Talk about how you’re feeling with
someone who will listen without judging
■■ Stay connected with your family and
and who can offer you support. friends.
■■ Write down your thoughts or feelings in

■■ Limit visitors if you’re tired. Decide when
a journal. visitors can come and don’t be afraid to
let them know when you’re getting tired
■■ Take time for yourself, even if it’s just for and need to rest.
short periods of time to help you feel
refreshed.
■■ Go to parenting classes and support
groups to meet others who may be going
■■ Ask for and accept help from others. through the same things as you.
Be kind to yourself—caring for a new

baby is a lot of work. No new parent How to tell if you’re stressed
has all the answers—you’ll learn When your body is stressed it may make you
as you go. Take the time to enjoy feel sad, worried, tense, nervous, or angry.
getting to know your baby. It’s your Your body may react to stress with tiredness,
headache, backache, stomach ache or a
smiles, gentle voice, facial expressions
rash. By paying attention to these signs and
and the gentle touch you provide as
learning ways to reduce and manage your
you help your baby meet their needs stress, you’ll have more energy to be the
(e.g., feeding, sleeping, changing parent you want to be. For more information,
diapers) that build the connection including ways to cope, see page 26.
needed for healthy attachment. Take
your time and enjoy the journey.

Relaxation technique
Get comfortable. Lie down or sit with your feet up. Then:
1. Take 4−5 deep, slow breaths—in through your nose, filling up your abdomen, and
out slowly through your mouth. This is like pretending you’re blowing on a candle,
and trying to flicker the flame, but not blow it out.
2. Think about sending the tension out of your body each time you breathe out.
3. Starting with your toes, relax each part of your body. Relax your way up, from your
toes to your head.
4. When you get to your head, breathe deeply 4−5 more times. Let go of all of your
tension.
5. Now, imagine a favourite place. Imagine you’re in that place and stay there a while.
Enjoy the feeling in your body and the calm in your mind.
6. When you’re ready, slowly bring yourself back to the present. Take a moment to
enjoy how you feel.
You may be surprised that your life has

changed significantly with your baby’s birth.
You’ll find it takes time to adjust to this new
normal. You may find that you’re worried
about your baby’s health and safety, your
ability to protect and care for them, or about
yourself. You may also be worried about
less income if one of you is staying home
with your baby, or having less time for other
activities and relationships. Talk about your
concerns with your partner or someone
else you trust. To learn more about what
you can do for yourself in tough times and
where to get help, visit the Links section at
Over the next few months, as you get to know

your baby better, you’ll start to feel more
confident in your abilities to take care of them
and your family. However, you may continue to have mood changes. Any parent, including
mothers, fathers and parents who adopt a baby, can have depression, anxiety or mood
changes. If you or your partner have had depression, anxiety or other mental illness before
or have these symptoms now, talk with your health care provider.

“ I knew because I had depression in pregnancy that I was high risk for
”
postpartum depression. I did all I could and used all the supports that Alberta
Health Services offered me, including support from the Public Health Nurse.
~ Maggie, mom of one child
Postpartum blues (Baby blues)

Many moms get the ‘postpartum blues’ around 3–5 days after their baby is born.
Postpartum blues are linked with hormone changes associated with pregnancy and after
childbirth. Getting support from people close to you and getting plenty of rest may help
you deal with postpartum blues if you have it.
If you have postpartum blues, you may:

■■ feel a little sad, restless, anxious or
overly sensitive Call Health Link at 811 or your
!
health care provider if you have
■■ cry for no reason
symptoms of postpartum blues
■■ be impatient and irritable that last longer than 2 weeks
■■ have trouble concentrating after your baby is born.
■■ feel overly tired or have trouble
sleeping
■■ find your mood changes often, such as going from feeling happy to feeling sad
Having postpartum blues is common and may last 1–2 weeks. If these feelings don’t go
away or if they get worse, it may be a sign of postpartum depression or anxiety. If you’re
struggling, you’re not alone.
Postpartum depression, anxiety and psychosis

Postpartum depression or anxiety can happen anytime up to one year after your baby’s
born—even if it did not happen with your other births. If you’ve had depression or anxiety
before or during your pregnancy, this
can increase the chances of you having
Supporting each other
postpartum depression. Postpartum
Partners can help by watching for signs
depression and anxiety are common
of mood changes and offering support.
after birth and often occur together. Your partner may be the first person to
Your partner may be the first one to notice your mood changes.
notice the symptoms.

When you take your baby to their first well child clinic and immunization appointment
at 2 months, a public health nurse will offer to screen you for postpartum depression.
Your mental health is as important as your physical health, and the earlier postpartum
depression or anxiety is detected and treated, the better it is for you, your baby and your
family. Untreated postpartum depression can affect your relationships with your baby,
other children, partner and family. This includes your ability to take care of yourself and
your baby. People may tell you to ‘pull yourself together’, but postpartum depression is not
something that goes away on its own. Fortunately, there is help available. Call Health Link
at 811 or talk with your health care provider about any concerns.
Symptoms of postpartum depression
Behaviours Thoughts
■■ not coping with things that you used ■■ “I’m a failure.”
to be able to handle ■■ “It’s my fault.”
■■ starting things and not finishing them ■■ “Nothing good ever happens to me.”
■■ avoiding places, people, family and ■■ “I’m worthless.”
friends
■■ “Life’s not worth living.”
■■ not doing things you used to enjoy
■■ “People would be better off without me.”
■■ having trouble concentrating or
making decisions ■■ “I wish I were dead.”
■■ using alcohol or drugs to feel better
Feelings Physical symptoms

■■ overwhelmed or hopeless ■■ tired all the time, sluggish or lethargic
■■ useless or not good enough ■■ trouble sleeping—either too much or
■■ irritable, restless or agitated too little
■■ frustrated or miserable
■■ sick, run down or no energy
■■ unhappy or sad
■■ headaches or muscle pains
■■ empty or numb
■■ upset stomach
■■ frequent mood changes

■■ changes in appetite—eating more or less

“ I knew that [my] crying all day, every day was not normal. When the public
health nurse screened me, she gave me tips and tricks about coping with
”
postpartum depression. The difference is that when you’re in it, you feel like
you’re in a fog, but when you’re out, you know you’re out.
~ Maheen, mom of one child
Symptoms of postpartum anxiety
Behaviours Thoughts
■■ having trouble sleeping ■■ feeling scattered or having trouble
■■ avoiding people, places or responsibilities concentrating
■■ starting things and not finishing them

■■ thinking about the worst
■■ pacing, fidgeting or being restless

■■ easily distracted
■■ re-checking things often such as if the

■■ having problems remembering
house is locked things
■■ using alcohol or drugs to feel better

■■ tense, stressed or uptight ■■ tight or painful chest, feeling like
■■ panicky, unsettled or irritable your heart is pounding
■■ things do not seem real or they feel

■■ dizziness, sweating or shaking
strange ■■ nausea or upset stomach
■■ feeling that something bad is going ■■ body aches or tense muscles
to happen
You may think that this is not how you’re supposed to feel or it’s not what you expected.
You may also be worried about talking to your partner or someone else about these
feelings. If you feel this way, you’re not alone and help is available so that you can
feel better.
!! Call 911 NOW if you or your partner have thoughts of hurting yourself
(e.g., suicide), hurting your baby, or hurting anyone else.

Get help when you first notice the symptoms of depression or anxiety. Asking for help
does not mean you’re weak, or that you’re not a good parent. The earlier you ask for help,
the sooner you can get the support you need, and the sooner you’ll start feeling better.
Seeking help and practicing self-care can decrease your symptoms.
To learn more about postpartum depression or anxiety, and getting help, visit the Links
and Printables section at healthyparentshealthychildren.ca/resources. A printable Family
Support Plan is available to help you cope and find resources.
“ At [the postpartum support program] I had group support. The program made
the difference. I got to talk with other moms. It wasn’t just me.
”
~ Kerri, mom of a baby
While postpartum psychosis is rare, it’s very serious and can happen quickly—usually in
the first month after your baby is born. It’s important to get help right away as this is a
medical emergency. There’s a high risk of a mother with postpartum psychosis harming
herself or her baby.
Symptoms of postpartum psychosis
Behaviours Thoughts
■■ unpredictable or unusual behaviour ■■ being very confused, forgetful and
that’s not like the mother at all having mixed up thoughts
■■ being very agitated, talking very fast ■■ beliefs that are not based in reality
and not being able to focus (delusions)
■■ seeing or hearing things that are not
there (hallucinations)

■■ feeling super strong and powerful or ■■ not being able to sleep
very depressed ■■ often pacing, even for long periods
■■ feelings range from highest of highs to of time
lowest of lows
Call 911 NOW if your partner has any of the following:
!! ■■
■■
thoughts of suicide or hurting themselves, your baby, or anyone else
symptoms of postpartum psychosis

Changes in your sexual relationship
Physical and emotional changes after the birth of a baby can affect both partners’ sexual
desire. For some people, the birth of their baby brings new joy to their sexual relationship.
For others, they are not interested in sexual activity for the first few months. You can start
sexual activity again when vaginal bleeding has stopped and you feel ready. Be sure you’re
both physically comfortable and emotionally ready.
Be gentle and patient with each other,

and talk about your feelings. Expressing
your affection is still needed, even
without any sexual activity. Sexuality can
be expressed in many ways and being
intimate can include cuddling, hugging,
kissing and showing tenderness towards
each other.
Information on resuming sexual activity

after having a baby, as well as birth
control options, can be found in the
book Healthy Parents, Healthy Children:
Pregnancy and Birth or visit healthyparentshealthychildren.ca
Birth control
A woman can get pregnant when breastfeeding and before her period returns.
Talk to your health care provider about your choices for birth control before
having sexual intercourse. To use an interactive tool about birth control,
visit the Tools section at healthyparentshealthychildren.ca/resources

“ It has been said that while babies are born, parents, in fact, are created.
No one is born knowing how to be a parent. We learn over time. Worrying
about parenthood can cause stress; learning to be a better parent can build
confidence. Over the next few months, as you, your partner and your baby get
to know each other better, you’ll start to find out what works for your family.
”
In the process, you’ll start to feel sure of yourselves and more and more, you’ll
be able to enjoy your time together.
~ Unknown

Young Babies:
2–6 Months

267
Young Babies: 2–6 Months
Your young baby is becoming more interested in the people and things
around them. As they grow during these four months, they’ll interact more,
become more active, and start to have more predictable routines. It’s a busy
time of change for both of you.
This chapter gives you information about your baby’s stage of development
and how to care for them. You’ll learn more about how to communicate with
your baby and how they love to play and interact with you.
268
Your Young Baby’s Development
YO U N G BAB I ES: 2– 6 MO NTHS

This is a time of rapid development for your young baby as they become more aware
of their surroundings. These charts give you information about the developmental
milestones and tasks your baby is working on from 2−6 months. In this chapter, you’ll learn
how you can help your baby achieve these milestones and tasks.
2–4 months: The ‘being’ stage

Tasks Milestones

baby is continuing to ❑❑ holds their head more steady and starts to turn their head
practice these tasks to with purpose
learn to:
❑❑ feeds and sleeps at more predictable times
■■ t rust: knowing that ❑❑ starts to follow moving objects with their eyes
good, dependable and
❑❑ starts to reach for and hold a toy for a few moments
loving care is always
there for them ❑❑ starts to kick and squirm
■■ form a secure ❑❑ begins pushing up on their elbows when they’re lying on
attachment: a close their stomach
emotional bond ❑❑ might start to roll from their tummy to their back
between you and your ❑❑ brings their hands to their mouth by 4 months
baby and how you
relate to each other Emotional
❑❑ cries in different ways to signal what they need
❑❑ starts to cry less at 3−4 months
❑❑ begins to learn how to self-soothe
Social
❑❑ likes you to talk, sing and play with them
❑❑ smiles, especially at other people and when you smile at them
❑❑ copies some facial expressions
❑❑ likes the sound of your voice

❑❑ lets you know if they’re sad or happy
❑❑ starts to laugh and copy some sounds they hear
❑❑ explores by looking around and looks at things that interest them
❑❑ begins to turn their head towards sounds
❑❑ starts to recognize familiar people and objects at a distance

4–6 months: The ‘being’ stage
Tasks Milestones

baby is continuing to ❑❑ starts to put things in their mouth
practice these tasks to ❑❑ may roll from tummy to back or from back to tummy
learn to:
❑❑ tongue movements change to get ready for eating solid foods and
■■ trust: knowing that making new sounds
good, dependable and ❑❑ starts to pass things from one hand to the other
loving care is always
there ❑❑ puts their hands together
❑❑ doubles their birth weight by 4–5 months
■■ form a secure
attachment: a close ❑❑ begins to sit for short periods of time with support by 6 months
emotional bond ❑❑ pushes up on their hands, lifts their chest and may start crawling
between you and your backwards by around 6 months
baby and how you
relate to each other Emotional
❑❑ has different cries for different needs
❑❑ starts to settle themselves back to sleep during the night, but still
needs you to comfort them
❑❑ shows emotions with their face, body, voice and actions
❑❑ forms an attachment to their main (primary) caregivers; begins to
know who is a stranger
Social
❑❑ looks at your face and smiles
❑❑ makes sounds, laughs and likes to be copied
❑❑ is aware of and prefers familiar faces
❑❑ starts to look at you when you call their name
❑❑ enjoys being near people
❑❑ responds to people’s voices and facial expressions
❑❑ likes to play with people by around 6 months old
❑❑ looks at themselves in the mirror

❑❑ explores by reaching, grasping and putting things in their mouth
❑❑ turns their eyes and head to look for sounds
❑❑ starts to babble, makes lots of sounds, and may start to use the
sound of letters such as ‘m’ and ‘b’; may put letters together to
make sounds such as ‘ah’ and ‘oh’
❑❑ repeats actions and sounds to get a response from you and others
❑❑ starts to make different sounds for when they’re happy or unhappy
❑❑ is more curious and tries to reach for things they want
❑❑ starts to get excited at the sight of food

To use an interactive tool about your baby’s development, visit the Tools

If you have concerns about your child’s development, call Health Link at 811 or
talk with your health care provider. You can also visit your nearest Parent Link
Centre and ask about the Ages and Stages Questionnaire (ASQ). To learn more,
“ ”
Developmental milestones cannot be forced. Parents can worry if
they compare their child too much to others.
~ Alison, mom of two children
Young Babies
Over these next few months, things will change as your baby develops and grows. Your
days and nights may be starting to become more predictable and some routines are
developing. You’ll see that your young baby is starting to communicate more with smiles,
babbles and by reaching.
They’re also beginning
to learn how to soothe
themselves. Your baby is
still fragile in many ways
and needs your gentle care,
kindness and patience.
Looking after your baby’s

physical needs and building
their trust is important
during this time. Your baby
needs to know that you’ll
care for and comfort them
when they need you. This
helps make your attachment
with your young baby stronger (see page 209).

Feeding Your Young Baby
Young babies will continue
to feed during the day, and
will probably still wake up
at night and need to be
fed. In these early months,
your baby can only suck and
swallow liquids. Breastmilk
or infant formula is all that
your baby needs during
this time.
How often will my baby feed?

Feed your baby whenever they show hunger cues and stop when they show signs of
fullness (see page 149). Your young baby may also be telling you that they’re full when they
seal their lips together, get distracted or start paying attention to their surroundings more.
If you’re breastfeeding, your baby will

continue to feed at least 8 times in 24 hours. What goes in a baby bottle?
Around 3−6 months, they may feed less Only put breastmilk or infant formula
often, about 6–8 times in 24 hours. Around in your baby’s bottle.
6 months, when your baby starts to eat solid
foods, they’ll start to drink less breastmilk
(see page 291).
If you’re formula feeding, between 2–5 months, your baby will feed about 5–7 times in
24 hours, 120–180 ml (4–6 oz) at each feeding. When they’re about 6 months old, your
baby may start to feed about 4–5 times in 24 hours, about 120–240 ml (4–8 oz) at each
feeding. Around 6 months, when your baby starts to eat solid foods, they’ll start to drink
less formula.
Over time, your baby will begin to have more predictable feeding patterns. A growth spurt
usually happens again around 3–4 months of age and only lasts a few days (see page 154).
You may find that your baby wants to feed more often for longer during a growth spurt.

Thinking about solid foods

You may be thinking about when to start solid foods. At
about 6 months old, your baby will need to start eating Vitamin D for
solid foods. Before eating solids, babies need to have young babies
good control of their head and neck and be able to sit Your young baby needs
up with little help. Before they’re 6 months old, babies 400 IU of a liquid vitamin D
may not be able to chew and swallow solids safely. Your supplement every day.
baby may not get enough breastmilk or infant formula if
solids are introduced too early.
By 6 months, babies need the added iron that solid foods can give them. For more
information about giving your baby solid foods, see page 294.
Weight gain
Your baby’s growth will have its own pattern. Babies usually double their birth weight by
the time they’re 4–5 months old. If you’d like to weigh your baby, go to your community or
public health centre during clinic hours. You don’t need an appointment. Keeping track of
your baby’s weight over time will help you know how your baby is growing.
Everyday Care
Sleeping
Follow your baby’s cues by letting them sleep and eat when they need to. They’ll soon
develop their own sleeping and feeding patterns. You do not need to wake your baby to
feed as long as they are healthy, gaining enough weight and growing. Your health care
provider will let you know if there is a reason to wake your baby to feed.
Young babies usually sleep:

Back to sleep, tummy to play
■■ 3–4 hours at a time and sometimes as
little as 2 hours at a time Always place your baby on their back to
go to sleep.
■■ a total of 14–17 hours a day for the first
Give them tummy time to play when
3 months, then after that 12–16 hours for they’re awake and you’re with them.
infants 4–12 months old

Babies’ sleep patterns stay about the same until they’re around 5–6 months old. Some
babies may start sleeping longer at night by the time they’re 3 months old. Every baby is
unique, however, some babies are not ready to sleep longer at night until they’re at least
6 months old.
By understanding and responding to your baby’s waking and sleeping cues and patterns,
you can help them learn good sleeping habits early (see page 215).
Learning to fall asleep on their own

Whenever you can, put your baby in their crib, cradle
or bassinet when they’re sleepy but still awake. If your baby uses a
Cuddle or feed your baby until they’re close to falling soother
asleep and then put them down. This will help them Check it regularly. Throw it
learn to fall asleep on their own. Babies learn from away if it’s cracked, has a hole
experiencing things over and over. When they go to or is torn. Replace the soother
sleep and wake up in the same place, they learn that at least every 2 months.
this is where they sleep. Your baby is also starting to
learn to self-soothe (see page 307).
“ It’s a good idea to have someone other than you put your baby to sleep on
occasion. This ensures that the baby doesn’t only rely on you to fall asleep.
~ Katherine, mom of two children ”

Safe sleep
Put your baby on their back to sleep in their own crib, cradle or bassinet. Move your baby
from a cradle or bassinet to a crib when they roll over or reach the maximum weight
recommended by the cradle or bassinet manufacturer, whichever comes first.
Follow all of the

recommendations for safe
sleep until your baby is 1 year
old (see page 218). This helps
reduce the risk of SIDS and
prevent other sleep-related
injuries and deaths.

If you’ve been swaddling your baby, remember to stop if your baby:

■■ no longer needs swaddling to settle or calm them
■■ is able to roll over
■■ has wiggled out of a swaddle—usually between 2–3 months old
For more information about swaddling, see page 227.
Head shape
Flat areas on the back or side of your
baby’s head can develop until they’re
more mobile. To help prevent flat areas,
keep giving your baby tummy time
every day when they’re awake and limit
the amount of time your baby spends in
a car seat, stroller or swing. Tummy time
helps with your baby’s development
and makes their body stronger so that
they can learn to roll, sit and crawl. For
more information about head shape
and tummy time, see pages 224 and 245.
If you have concerns about your baby’s head shape, talk with your health care provider.
Your health care provider may refer you for other services or recommend a special helmet
to improve your baby’s head shape.
Crying
Crying will peak when your baby is
about 2 months old and then gradually
decrease. Between 2–4 months, your
baby’s cry will change depending on
“ I had my mom, my grandparents,
brother and sister who made it
easier. If [my baby] could not stop
crying for me when she was little,
what they need.
”
they would hold her or take her
Sometimes no matter what you do, for a walk.
your baby may keep crying. Continue
~ Nikki, parent
to try and soothe your baby to help
them settle. If your baby cannot stop
crying and you need some time to calm yourself, put your baby in a safe place, and take
a short break. Have a cup of tea, take some deep breaths or walk around your home.

When you feel calmer, try again to
soothe your baby. Holding them when Take a break, don’t shake
you’re frustrated or angry can lead to Never shake your baby for any reason.
shaking them. Never shake your baby. Even a few seconds of shaking can cause
For more information on the Crying Plan, blindness, hearing loss, life-long health
problems or even death.
see page 230.
Teeth and mouth

Clean your baby’s gums, even before they get their teeth.
■■ Clean the gums with a soft, clean, damp washcloth morning and night.
■■ Once teeth appear, brush them twice a day, especially at bedtime. Use a small, soft-
bristled baby toothbrush with fluoride toothpaste the size of a grain of rice to help
prevent tooth decay. Gum cleaners are not recommended at this age.
Teething
Baby’s teeth usually start coming in at around 6 months old, although some babies may
get their first teeth earlier or later. Teething may be uncomfortable and your baby will need
lots of love and comfort from you.
To provide your baby comfort, you can:

No teething necklaces,
■■ Gently rub their gums with your clean finger. bracelets or anklets
■■ Give them a cold, clean cloth to chew on. Any kind of jewellery on babies
is a choking and strangulation
■■ Give them a solid teething ring that can be
hazard. Teething necklaces
cooled in the fridge to chew on.
can break and your baby could
choke on the small pieces.
Items that are not safe to give to your baby for
Necklaces around your baby’s
teething relief are:
neck can also catch on furniture,
■■ biscuits hooks or other objects and can
strangle your baby.
■■ rings filled with fluid
■■ raw vegetables
■■ fruit
■■ teething products such as numbing gels
For more information about how to help your baby when they’re teething, see page 311.


Your baby continues to grow and change every day. All areas of your young baby’s
development are interconnected and the development in one area affects development
in all other areas. Your baby’s development is guided by their brain.
Physical
Emotional
Cognitive
Social

Your young baby’s developing brain

Brain connections continue to be formed and become stronger with everyday
experiences. These connections become stronger when you and your baby engage in
serve-and-return interactions. Here are some examples of what this might look like with
your young baby.
Peek-a-boo
‘Peek-a-boo’ is a game where
you briefly hide your face with
your hands or a blanket, then
you remove your hands or
the blanket and say “Boo!” or
“Peek-a-boo!” It’s a fun way to
learn that you go away and
come back.

Examples of serve-and-return interactions
2–6 months
■■ look at people, things and sounds that ■■ talk about or give them the things they’re
interest them looking at or reaching for
■■ try to move while on their tummy ■■ get down on the floor and copy them
■■ coo and babble with sounds such as ‘uh’, ‘ah’, ■■ copy your baby’s sounds and actions
‘ma’ and ‘buh-buh’
■■ smile at you when you talk and sing ■■ sing, talk and look at books with your baby
■■ laugh, giggle and shout ■■ keep doing the things that they’re enjoying—
play peek-a-boo, make funny faces, or stick
out your tongue
■■ wait to see if they copy you, then do it again
For more information about how the brain develops and serve-and-return interactions, see
page 19.
Other things you can do to help your baby learn
Communicating with your young baby

Young babies communicate in many ways.
Your baby will still communicate with
you by crying. However, their cries will
become easier to understand. Between
2–6 months, your baby will also move
from cooing and gurgling to babbling.
Continue to talk and interact with your
baby as much as possible. This will help to
build the brain connections they need for
speech and language development.

Here are some things you can do:

■■ Engage: Watch, listen and respond to
your baby’s cues.
■■ Get face-to-face: Talk, sing, smile and
make faces together.
■■ Tune in: Some babies need energetic
conversations to engage with you.
Others will respond more to gentler
tones. Some babies need both. Find
what works for your baby.
■■ Play with language: Use finger games,
nursery rhymes and songs with actions
to help your baby understand words.
■■ Read: Start looking at books with your baby from birth and read with them every day.
Point to and talk about the pictures in children’s books. Choose books that are safe to
chew. If your baby wants to flip the pages or play with the book, let them. You can also
read anything that interests you out loud—even the newspaper sounds interesting
to a baby.
To learn more about ways to help with your baby’s speech

and language development, visit the Links section at
Let’s play
Play builds healthy bodies and
healthy minds. As your baby
grows and develops new skills
and abilities, the way you play
with them will change. By
copying and taking turns during
play, you’ll help your baby learn:
■■ to copy you and take turns
■■ to control their movements
■■ about the objects around
them

Your baby will start to reach for and hold toys.
They’ll also play with objects with their mouth. It’s Reduce sitting time
a good time to play when they’re smiling, cooing Try not to let your baby sit in a
and looking interested. If your baby pulls away, looks stroller or high chair for more
frustrated or cries, they may be telling you they than 1 hour at a time.
need to change activities or sleep.
By 3 months, your baby will become more interested in the people and activities around
them. They’ll start to follow moving objects by turning their head. As your baby gets used
to their surroundings and their daily routines, they’ll begin to show that they recognize you
and others by making sounds, reaching for you and becoming excited. For information on
ideas to play with your baby, see page 244.
During play time, give your baby tummy time many times every day. Put a clean, flat
blanket on the floor with some toys appropriate for your baby’s age. Give them a chance to
play on their tummy and side while awake (see page 245). Supervise your baby at all times
and join their play to make it more fun. This will help your baby’s development as they play
by reaching for and grasping toys, pushing up on their hands, and rolling.
Back to sleep,
tummy to play
Always supervise your baby
during tummy time. The
positions suggested for
tummy time are not safe for
sleeping. Turn your baby
onto their back right away
if they fall asleep during
tummy time.
Prevent choking
If your baby can pick something up, they can put it
into their mouth. If it can fit through a toilet paper
roll, it’s too small for your baby and they may
choke on it.


By 6 months of age, your baby starts to show
more emotions with their face, body, voice
and actions. It becomes easier to tell when
they’re happy or sad. They also have different
cries to express their needs. Sometimes your
baby may become overwhelmed with things
that usually make them feel good. They’ll
need your love and comfort to help them
calm themselves. This will help them feel safe
and secure to play and discover as they grow.

You can help your baby build relationships
with others by taking them to new places and
meeting new people. This will help them learn
to play and interact with others. As your baby
gets older, they’ll also learn from other people.
It may take some adjusting to accept the
way that other people interact with or care
for your baby. As long as they’re providing
safe and nurturing care, it’s okay. If you’re not
comfortable with the care being provided, talk
with them about your concerns.
Babies this age are very portable—you can take them with you when you go out. Your
baby will learn from these new experiences. It usually works best if you can plan your
activities around your baby’s usual feeding and sleeping times to keep their routine.
Your baby loves to play

with you
Play, talk and sing together. Go
outside and enjoy exploring new
things with them.

Health Checkups
Your baby will continue to see
their health care providers
regularly during their first
6 months. These visits will
continue to track and support
your baby’s growth and
development.

keeping children healthy and
safe at any age, see page 76.

Your baby will have their
routine immunizations at
their well child clinic visit.
Immunizations are scheduled
when your baby is 2, 4 and
6 months old. During your
immunization visit, your public
health nurse will also check
things such as your baby’s
growth, how they’re feeding,
and answer any questions you
have (see page 78).
If your child has not been immunized or their immunizations are not up to date, talk with
your public health nurse about how to get back on schedule. For more information about
immunizations, see page 82.
To find a community or public health centre near you, call Health Link at 811 or visit the
Links section at healthyparentshealthychildren.ca/resources


Birth–2 2 4 6 12 18 2 3–4 5 years and
Check with your doctor

Doctor √ to find out the checkup
schedule at their office
Immunization √
Regular checkups as
Dental √
Early vision √
checkups Early vision checkups Early vision checkups
Vision (with optometrist
with your with your doctor with your doctor
doctor at 3–5 years old)
Other health
As needed As needed As needed
care providers
Watch your baby closely for signs of illness

Watch your young baby more closely for signs of illness such as fever, vomiting,
diarrhea, dehydration, rash, cough and ear infection. For more information, see page 91.
Go to the Emergency Call Health Link at 811 or

Department NOW if your your health care provider
!! !
baby is under 3 months NOW if your baby is
and has an underarm between 3−6 months
temperature that is lower and has an underarm
than 36.5 °C (97.8 °F) or temperature higher than
higher than 37.5 °C (99.5 °F). 37.5 °C (99.5 °F).

Preventing Injuries
The risk of injury goes up as babies grow and develop. Babies between 2–6 months move
from kicking and squirming to rolling and sitting, and explore and play by putting things in
their mouths. There‘s a lot you can do to help keep your baby safe.
Protect your baby

from falls
Falls are the leading cause of
injury to babies and children.
Keep one hand on your baby
when they’re on any raised
surface. Being at your baby’s side
is the best way to prevent falls.
Be safe around water

Never leave your baby
unattended in or
around water.
Here are some areas that need attention to keep your baby safe from injuries for their age
and stage of development:
■■ Falls, see page 104 ■■ Choking and poisoning, see page 107
■■ Safe sleep, see page 218 ■■ Crying, see page 229
■■ Burns and scalds, see page 109 ■■ Car seats, see page 123
■■ Water safety, see page 111
For more information about how to prevent injuries in the early years, see page 104.


Eating well, being active and getting
enough sleep can help you stay
healthy and better able to manage the
day-to-day stresses of parenting. Take
time to do things you enjoy, even if it’s
only for short periods of time.
Pay attention to your feelings and talk

to your partner or someone you trust.
If you’re parenting with a partner, you
can help one another by looking for
signs of mood changes and offering
support. Your partner may be the first
person to notice your mood changes.
Postpartum depression or anxiety can happen anytime within the first year after your baby
is born and can affect both moms and dads. As a parent, your mental health is important
because it affects not only your own health, but also your baby’s health and development,
and your relationships with your partner and your family. The sooner postpartum
depression or anxiety are treated, the better you’ll feel and the more energy you’ll have to
care for yourself and your family (see page 261). If you’re concerned, talk with your health
care provider as soon as possible as they can help you feel better so you can be the parent
you want to be.
For more information about mood changes, self-care and supports available, see page 258.
Adjusting to life with a young baby

It’s easier to cope with the day-to-day stresses of parenting if you can practice self-
regulation to help you feel calm and relaxed throughout the day. This way, the stresses
don’t build-up and catch you by surprise when they get to be too much.
Over time, you’ll find what works best for you. Here are a few suggestions that may help:
■■ Breathe. Take a deep breath and slowly release it to a count of 10. Concentrate on
something you’re thankful for.
■■ Be positive. Keep the big picture in mind. It may be hard to see any change hour-
to-hour, but think about how amazing it is that your baby is growing, exploring and
changing so much from one week to the next. You might enjoy keeping a journal about
your baby’s first year.

■■ Take a break. Ask a relative, friend or
caregiver to give you a break, before Coping with your baby’s crying
you get to the point that you feel you Dealing with a crying baby can be
can no longer cope. All parents need challenging. Remember that crying is
a little help sometimes. Remember communicating; your baby is telling you
that they need something. Try to think
that it’s okay to put your crying baby
about what your baby might need right
in a safe place, like their crib, while
now, such as rocking, a diaper change, a
you leave the room for a few minutes. feeding, your calm and soothing voice,
You can try again to soothe your baby a song or some fresh air. Sometimes the
when you’re calmer. crying doesn’t stop no matter what you
do. Keep trying—your baby may not
■■ Look after yourself. Try to enjoy
be able to settle, but they can feel that
some time outside every day. Even a
you’re trying. For more information about
short walk for 5−10 minutes can be coping with crying, see page 229.
refreshing for you and your baby.
■■ Ask for help. If you’re feeling overwhelmed or that life is getting out of control, talk to
your partner or other support people. You can also call Health Link at 811 or talk with
your health care provider for support.
■■ Check out parenting programs in your community. They are a great way to connect
with other parents, make new friends and get some new ideas.

Older Babies:
6–12 Months

287
Older Babies: 6–12 Months
The time when your baby is 6–12 months old is a source of wonder. Your
older baby will likely move from rolling to sitting and pulling up on furniture,
to taking their first steps. Feeding also changes during this time, and by the
time they’re 1 year old, your baby will be eating many foods.
This chapter gives you information about your baby’s growth and
development at this age. There is information on feeding your baby solid
foods and how they explore and play. You’ll also learn about your baby’s
developing emotions and about how to keep them safe.
288
Your Older Baby’s Development
O L D E R B A B I E S : 6 –12 M O N T H S
At 6 months, your baby is more interested in and able to explore the world around them.
This chart gives you information about the developmental milestones and tasks your baby
is working on from 6−12 months. In this chapter, you’ll learn how you can help your baby
achieve these milestones and tasks.
6–12 months: The ‘doing’ stage

Tasks Milestones

baby is continuing to ❑❑ sits with support, then sits up by themselves
practice earlier tasks as
❑❑ may help with or resist feeding, dressing and undressing
well as learning to:
❑❑ teeth start to come in
■■ discover: learn about
❑❑ has more regular sleep patterns
their surroundings
through touch, reach, ❑❑ may be more able to settle themselves back to sleep during the
grasp and taste night
❑❑ usually naps twice during the day
❑❑ may roll in both directions
❑❑ may crawl
❑❑ at first picks things up with their whole hand, then with their
pointer finger and thumb
❑❑ pulls themselves up to stand and walks by holding furniture or your
hands
❑❑ gains weight more slowly and often triples their birth weight by
12 months
Emotional
❑❑ shows fear or anxiety over people and situations that didn’t bother
them before
❑❑ likes to stay close to you
❑❑ shows pleasure when you return
❑❑ looks for comfort when upset
❑❑ starts to read other people’s emotions
Social
❑❑ enjoys games such as ‘peek-a-boo’ and ‘pat-a-cake’
❑❑ enjoys being around people but may be anxious around strangers
❑❑ cries or clings to you when you start to leave
❑❑ plays purposefully with toys

6–12 months: The ‘doing’ stage

Tasks Milestones

❑❑ babbles a lot and copies sounds and actions
❑❑ makes more and different sounds
❑❑ explores by putting things in their mouth
❑❑ starts to recognize words and simple phrases; understands the
word ‘no’
❑❑ gets excited at the sight of food
❑❑ responds to their own name
❑❑ points to things they know
❑❑ starts to realize that people and things exist even when they can’t
see them
❑❑ likes having routines
❑❑ likes to stack, nest and put things in and out of containers
❑❑ says a few words but not always clearly
❑❑ searches for hidden toys
❑❑ claps
“
To use an interactive tool about your baby’s
development, visit the Tools section at It helped to check in
”
healthyparentshealthychildren.ca/resources with a developmental
checklist.
To learn more about your child’s development, visit your
nearest Parent Link Centre and ask about the Ages and ~ Grace, mom of a toddler
Stages Questionnaire (ASQ) or go to the Links section at
Call Health Link at 811 or your health care provider if you have any
concerns about your baby’s development or if you notice any of
the following:
! ■■
■■
■■
your baby does not respond to familiar voices and sounds around them
your baby does not turn their head towards sounds
your baby is not babbling and saying things such as ‘baba’ and ‘dada’
■■ your baby does not notice people and objects over 1.5 m (5 ft.) away

Older Babies
Your relationship with your
baby changes and grows as
they move more and learn
new ways to communicate.
While your baby is still fully
dependent on you, they’re also
becoming their own person
and starting to explore the
world around them. By the time
they’re 12 months old, your
baby may be walking, swaying
to music and saying a few
words such as ‘bye-bye’. This
leads to many new adventures
and discoveries.
Babies learn many things at the same time. You help your baby develop by doing things
for them. For example, when you look at and read books together, your baby does much
more than look at the pictures. They learn how the book feels, smells and tastes. They start
to understand that the pictures stand for objects. They also start to understand new words
and learn trust from snuggling with you.
Feeding Your Older Baby

Changes in feeding patterns
The nutrition your baby needs will change during their first year. Along with breastmilk or
infant formula, most babies are ready to start solid foods when they’re about 6 months old.
As your baby eats more solid food, they’ll start to drink less breastmilk or infant formula,
although these still remain an important food for them.

Breastfeeding
After 6 months, your baby will usually breastfeed about 5−6 times a day (24 hours).
Continue to breastfeed while you’re starting solid foods. The longer you breastfeed, the
more you and your baby will benefit. For more information on breastfeeding, see page 151.
If you’re breastfeeding, there is no need to give any other milk to your baby.
To watch a video on returning to work and breastfeeding, visit the Videos section at
Infant formula
Between 6−8 months, your baby will
formula-feed 4−5 times a day (24 hours), about What about follow-up
120−240 ml (4−8 oz) at each feeding. For more infant formula?
information on feeding your baby infant formula, Your baby will get all the nutrition
see page 193. they need from the solid foods
they eat starting at 6 months.
Between 9−12 months, the number of times Because of this, the extra calcium
your baby feeds will go down, but the amount and phosphorous found in follow-
up infant formula is not needed.
they drink may go up. You can also give
your baby pasteurized, homogenized whole
(3.25% milk fat) milk at this age (see page 297).
Using a cup
When your baby is about 6 months old, try
offering a small amount of breastmilk, infant
formula or water in a cup. Using an open cup
without a lid helps with the development of
your baby’s teeth, mouth and speech. Cups
with spouted lids or nipples like sippy cups or
sports bottles are not recommended.
Start with small amounts of liquid in the cup

as your baby is likely to spill. It takes time for
them to learn to use a cup—help them until
they’re able to use it on their own. Using a
cup will help your baby slowly give up their
bottle, if they use one.

Here are some things to think about when offering
drinks to your baby from a cup: Travelling with a cup
Choose a no-spill cup with a
■■ Get your baby used to the taste of water. Try straw or a lid with an opening
offering them a few sips from an open cup if that doesn’t have a spout
you think your baby is thirsty. Water should not or nipple.
replace milk.
■■ Your baby doesn’t need juice. If you decide
to give them juice, choose 100% juice and Adding water to juice
offer it in an open cup as part of a meal Adding water to juice does not make
or snack. Giving your baby more than it healthy or safe for your child’s
125 ml (½ cup) of juice per day can reduce teeth. If given throughout the day,
their appetite, increase their risk of tooth your child may get used to drinking
sweet liquids and the sugar in it will
decay and give them a lot of sugar they
increase their risk of tooth decay.
don’t need. Unpasteurized juice is not safe
for your baby.
■■ Avoid drinks that are labelled ‘beverage’, ‘punch’ or ‘cocktail’ as they have little or no real
juice in them.
■■ Drinks such as pop, fruit drinks, lemonades, vitamin or flavoured water, sports drinks,
coffee, tea or herbal tea may have added sugar or caffeine and should not be given to
your baby.
■■ When introducing milk when your baby is around 9−12 months old, use pasteurized,
homogenized whole milk (3.25% milk fat) for the first 2 years (see page 297).
Unpasteurized milk is not safe for your baby.
Weaning off the bottle

When you’re weaning your baby from a bottle:
■■ Offer them sips of water from their own cup throughout the day.
■■ Over time, decrease the number of bottles you offer during the day. Continue to offer
your baby an open cup for drinking.
■■ For many babies, a bottle is a source of comfort, especially at bedtime. Once they’ve
weaned off most of their daytime bottles, instead of giving your baby a bottle before
going to bed, try soothing them by holding or rocking them, singing, reading a story or
gently rubbing their head or tummy.
■■ For good dental health, try to have your baby off the bottle by 12−14 months of age.
If you have any concerns about weaning your baby off of the bottle, talk with your health
care provider.

Starting solid foods
Swallowing solids is different from
Feeding relationship
swallowing milk. Before they are 6 months
old, your baby’s mouth is designed to suck A healthy feeding relationship with
your child during the early years is
and swallow. Around 6 months old, your
important. It helps them develop
baby will start to develop the ability to move
healthy eating behaviours for the rest
food from the front of their mouth to the of their life. For more information,
back so they can swallow safely. Solid foods see page 49.
are introduced gradually at this time.
Here are other signs that show your baby is ready for solid foods:
■■ They can sit up with little help.
■■ They have good head and neck control Make mealtime family time
and are able to turn their head away if Mealtimes are a great time for your
they don’t want to eat. family to visit and talk. Your baby is
learning about your family’s eating
■■ They can open their mouth when food habits and traditions. Set a good
is offered. example by sitting together at the table.
With time, your baby will learn how and
If your baby is around 6 months old and what to eat by following your example.
showing all of the signs that they’re ready,
it’s time to begin introducing solids.

Timing for starting solid foods is important. Introducing solids when your baby is ready
helps them:
■■ accept new foods and flavours more quickly
Changes in bowel
have an easier time eating new textures
movements
■■
■■ get all the vitamins and minerals they need, When your baby starts to eat
such as iron solids, their bowel movements
may become softer or more solid.
It may take several tries before your baby They shouldn’t be runny.
adjusts to eating solid foods. Remember, they’re
exploring and learning how to use their mouth,
tongue and throat in a new way.
Starting solid foods can be a fun time, as well as a messy time, for you and your baby.
Babies like to touch their food and try to feed themselves—this is how they learn. The
more they can get to know about a food, the more likely your baby will be willing to try it.
Use a wide bib and keep a warm, wet washcloth close by to make clean-up easier.
Here are a few tips to get your baby off to a good start with solids:
■■ Start by offering solids once a day. Soon, your baby will be ready to eat more often.
Offer more food if your baby is still showing signs of hunger.
■■ Give your baby one new food at a time. You can introduce any healthy food as long
as it’s the right texture but wait 2 days before adding the next new food. This makes it
easier to tell if your baby is allergic to the food.
■■ Try new foods and flavours. Offer new foods when your baby is alert and relaxed—
they’ll be more likely to try them. If your baby makes a face when you feed them, it
doesn’t always mean they don’t like the taste. If they continue to reject a food, just try
again another time—don’t force them to
eat it. Let your baby explore new foods
more than once. They may need to see it,
touch it and smell it many times before
they try it (see page 54).
It’s time to get messy

Let your baby touch and explore
new foods and try to eat with their
own spoon. Eating off a spoon is an
important skill for them to learn.

■■ Be patient. Babies will make a mess as they learn to feed themselves, first with their
hands and then with a spoon. Being able to use a spoon is an important developmental
step. Eating with a spoon helps them move from sucking to chewing and biting. It helps
your baby learn the skills they need to be able to feed themselves when they’re older.
It’s also very common for babies to like a food one day and refuse it the next. Continue
to offer small amounts of the food to your baby and let them decide when they want
to try it.
Feeding cues
When you first start solids, wait for your baby’s
mouth to open and feed them with a spoon as
slowly or as quickly as your baby wants. Stop
feeding when they show signs of fullness.
You’ll know your baby is hungry when they: You’ll know your baby is full when they:
■■ lean forward ■■ turn their head away

■■ reach for food ■■ close their mouth when food is offered
■■ smack or suck their lips ■■ cover their mouth with their hand
■■ open their mouth when food is offered ■■ fuss or cry
■■ put their fist in their mouth
Healthy food choices

Babies need iron to grow and develop. Your Iron and vitamin C
baby was born with a supply of iron, but around Vitamin C found in vegetables
6 months old, it’s nearly used up. Therefore, your and fruits helps your baby use the
baby needs to get iron from their solid foods. iron from their food. Remember to
They need iron-rich foods every day, offered offer vegetables and fruits along
with iron-rich foods.
at each meal—breakfast, lunch and dinner.
For more information on what, when and how
much to offer, see page 299.
Good sources of iron include store-bought baby

Vitamin D for
cereals with iron and foods from the meat and meat
older babies
alternatives food group. As you introduce solids, Your baby needs a supplement
of 400 IU vitamin D every day
gradually increase the different types of iron-rich
to help meet their needs.
foods you offer to your baby.

Once your baby is eating a variety of foods, include items from 3–4 food groups at each
meal and 2 food groups at each snack from Canada’s Food Guide. Your baby will enjoy
many of the same healthy foods that your family is eating. Offer new foods, flavours and
textures as your baby learns to eat. Change the texture of food as your baby grows and
develops better eating skills. For more information about textures, see page 301.
Here are some suggestions for healthy foods to give to your baby:
Canada’s Food
Healthy food choices
Guide food groups
Vegetables ■■ Fresh, frozen or canned vegetables and fruit without added salt or
and Fruit sugar.
■■ Broccoli, kiwi, mango, strawberry, peppers and sweet potato are
good sources of vitamin C.
Grain Products ■■ Start with a store-bought, single-grain baby cereal with iron such as
barley, oat, rice or wheat.
■■ Add foods such as barley, couscous, rice, quinoa, roti and toast strips
when your baby is ready for these textures.
Milk and ■■ Yogurt (2.5% milk fat or higher), plain or with fruit.
Alternatives ■■ Cheese such as cheddar or cottage cheese.
■■ When your baby is 9−12 months old, you can start giving them
pasteurized, homogenized whole milk (3.25% milk fat), as long as
they’re eating iron-rich foods at each meal. Unpasteurized milk is
not safe for your baby. By the time they’re 1 year old, offer your baby
500 ml (2 cups) of milk each day. Drinking more than this amount
of milk may take the place of iron-rich foods. Breastfed babies can
continue to get all their milk needs from breastmilk.
■■ Low-fat milks such as 2%, 1% and skim don’t have enough fat and
energy and are not recommended until your child is 2 years old.
■■ Soy and other plant-based beverages such as rice, oat, almond,
potato, hemp or coconut should not replace cow’s milk in the first
2 years. These beverages don’t have enough protein,
energy and healthy fat to help your baby grow
and develop. To learn more about plant-based
beverages, visit the Printables section at
Meat and ■■ Beef, chicken, fish without bones, lamb, pork, turkey and wild game
Alternatives are good sources of iron.
■■ Fish such as Atlantic mackerel, herring, rainbow trout and salmon are
a good source of healthy fats.
■■ Meat alternatives such as black beans, chickpeas, kidney beans, lentils,
split peas, eggs and tofu also have iron.
■■ Limit processed meats such as hot dogs, salami and bologna as
they're high in salt.

Food allergies
Research shows that waiting to give your
baby certain foods does not prevent an Honey is not for babies
allergy. When your baby is around 6 months Do not give babies under 1 year old
old, you can introduce any healthy food as honey or foods with honey—even if
long as it’s the right texture. Once you start the honey is pasteurized. It can make
a new food, keep offering it. If you think your them sick with botulism (see page
baby has an allergy to the food, stop giving it. 60).
Signs of a food allergy can happen right away
or a few days after a food is introduced. Some
signs of a food allergy are:
■■ mild redness around the mouth ■■ watery or swollen eyes
■■ rash or hives ■■ stomach pain
■■ vomiting, diarrhea or a lot of gas ■■ clear, runny nose that lasts a long time
■■ crying more than usual ■■ poor growth
If your baby shows any of the signs of a food allergy, stop offering the food and call
Health Link at 811 or talk with your health care provider.
Call 911 NOW if your baby has any of the following:
!! trouble breathing
■■
■■ a swollen tongue or mouth

■■ is not able to swallow

What, when and how much food to offer
Every baby will like and eat different amounts of food from day to day. Continue to
breastfeed or feed formula as you add more solid foods.
Start by offering 5–15 ml (1–3 tsp) of smooth or pureed food. Give your baby more food
if they show you they’re hungry, and stop feeding when they show you they’re full. Some
days, your baby will eat a lot, other days not as much. Here’s a guide for what food and
when to offer it in a day:
Around 6 6–7 8–9 10–12

months old months old months old months old
Start offering Gradually Offer solid Offer 3 meals
solid foods once increase solid foods 3–5 times and 2–3 snacks
a day foods from a day a day
1–3 times a day
Continue with breastfeeding or formula feeding*
Breakfast ■■ Single-grain ■■ Baby cereal ■■ Baby cereal ■■ Baby cereal

baby cereal with with iron with iron with iron
iron or meat or ■■ Fruit ■■ Fruit
meat alternative
Morning ■■ Baby cereal ■■ Fruit

snack with iron ■■ Grain product
Lunch ■■ Baby cereal ■■ Meat or meat ■■ Meat or meat

with iron alternative alternative
■■ Fruit ■■ Vegetable ■■ Vegetable
■■ Cheese ■■ Yogurt
Afternoon ■■ Vegetable
snack ■■ Grain product
Supper ■■ Meat or meat ■■ Meat or meat ■■ Meat or meat

alternative alternative alternative
■■ Vegetable ■■ Grain product ■■ Grain product
■■ Vegetable ■■ Vegetable
Nighttime ■■ Baby cereal ■■ Baby cereal

snack with iron with iron
■■ Fruit
* When your baby is 9–12 months old, you can start giving them pasteurized, whole milk (see page 297).

As your baby gets older, slowly increase the amount of food you offer. Your baby may eat
more or less food than what you offer; they may even like one food one day and not like it
the next day. Let their feeding cues guide you. Examples are provided in the table below.
Examples of amounts of food to offer your baby

Baby cereal with iron 30–60 ml (2–4 Tbsp)
Meat 30–60 ml (2–4 Tbsp)
Meat alternatives 30–60 ml (2–4 Tbsp)
Fruit 30–60 ml (2–4 Tbsp)
Vegetables 30–60 ml (2–4 Tbsp)
Grain products 45–120 ml (3–8 Tbsp)
Milk alternatives (cheese or yogurt) 30–45 ml (2–3 Tbsp)
Should I offer foods in a particular order?

You can choose any healthy foods to offer your baby after they’ve had their iron-rich
meats or cereals. Research has shown that you don’t need to offer solid foods in a
certain order after starting the iron-rich foods.

Food textures
Babies need to try different textures to help them
develop their eating skills over time. Start with smooth or No teeth yet?
pureed food—most babies only need pureed food for a No problem!
short time before they move on to other textures. Start to Babies don’t need teeth
offer lumpy textures before they’re 9 months old. If your to start eating foods that
baby stays on pureed textures too long, they may resist are not pureed.
different textures later.
Every baby is different and will move through textures at their own rate. Introduce food
textures that match your baby’s development. Your baby might gag a bit as you offer new
textures. This is a normal reaction for a baby learning to eat a new texture. Gagging is not
the same as choking.
Here is a table to give you an idea of when to introduce new textures to your baby:
Developmental
Baby’s age Food textures
milestones
Around ■■ holds head up ■■ pureed
6 months old ■■ sits with little help ■■ smooth
■■ begins chewing motion ■■ mashed
■■ sits by themselves ■■ lumpy

■■ shows interest in feeding ■■ minced
themselves ■■ grated
■■ starts to feed themselves
with their hands
■■ diced
■■ starts to feed themselves ■■ cut-up soft foods

using their fingers ■■ cut-up cooked
■■ tries to use a spoon to foods
feed themselves
Around ■■ bites and chews
12 months old
gagging: a reflex that happens when food slips to the back of the tongue before you’re ready to swallow and is forced
back into the mouth

Baby food
You can make baby food at home or buy
it at a store. There are many things to think
about when feeding your baby solid foods,
such as making sure that it’s the right
texture and that it’s healthy for your baby.
Homemade baby food

Making baby food at home is a healthy way to feed your baby as it can be made without
added salt or sugar. You can use the same healthy foods the rest of your family is eating.
Making baby food at home can be easy. Use simple kitchen tools such as a fork, potato
masher, blender or grater to prepare food in a way that matches your baby’s eating
skills. To learn more about making homemade baby food, visit the Printables section at
Homemade baby cereal does not have

the iron your baby needs to grow and Check the food labels
develop, so use store-bought cereals Always read the ingredient list to
that are fortified with iron. make healthy food choices.
Ingredients are listed by weight
Store-bought baby food from the most to the least.
To learn more about food
If you’re buying baby food, choose labels, visit the Links section at
foods without added salt, sugar or healthyparentshealthychildren.ca/resources
trans fats (hydrogenated or partially
hydrogenated).
Keep all food and leftovers safe:

■■ Do not use the food if the safety seal is Squeezable food pouches
broken or if the safety seal button is up. These pouches encourage babies to
You should hear a pop when you open suck purees—they don’t help them
the lid on a jar. learn to accept lumpy foods or to
chew. If you choose to give your baby
■■ Throw away any baby food that is past a squeezable food pouch, squeeze
the ‘best before’ date. the food onto a spoon to encourage
development of spoon feeding skills.
■■ Feed your baby from a dish not directly
This will also ensure that any leftover
from a jar or squeezable pouch. Food food can be safely stored in the fridge
that has been in contact with your and eaten at a later time.
baby’s saliva will spoil more easily.

If you have any questions about
feeding your baby, call Health Link Food safety
at 811 or talk with your health care Compost or throw out any leftover food from
provider. your baby’s dish after they have finished eating.
Finger foods
Finger foods are foods that your baby
can pick up and put into their mouth
themselves. At first, finger food needs
to be grated or cut into small pieces
or strips. By 8 months old, most
babies can pick up foods with their
fingers and feed themselves.
To prevent choking, only give your

baby food while they’re sitting
down—not while they’re playing
or while you’re driving. For more
information on foods that can be a
choking hazard and how to make
them safe, see page 59.
Here are some foods to try as finger foods:

■■ small cooked pasta ■■ hard cheeses grated or cut into small
■■ dry toast strips, bread crusts, plain rice cubes
cakes and unsalted crackers ■■ tender cooked meat or hard-boiled eggs
■■ cooked vegetables such as carrots, cut into small pieces
broccoli and beets cut into small pieces ■■ tofu, cooked beans or other legumes
■■ soft, ripe, peeled fruit such as bananas, ■■ mashed potatoes or casserole
pears, peaches, plums and kiwis cut into
small pieces
For more information about healthy eating for your baby, see page 49.

A chart to track when you offer your baby a new food:
Your baby’s new food record

Date Age Food Comments

Everyday Care
Sleeping
From 6–12 months, babies begin to have a more predictable sleep pattern and sleep for
12−16 hours a day, including naps for healthy growth and development. Some babies will
still wake up in the night to feed. Every baby’s sleeping and waking pattern is different.
Some may nap several times a day or sleep longer at night with fewer naps during the day.
As your baby gets older, the number of hours they sleep at night will gradually increase.
Look for the average amount of sleep your baby is getting over a 24 hour period.
6-month-old babies 12-month-old babies
■■ are usually able to sleep for longer stretches ■■ usually have consistent bedtimes and
at night, about 5–8 hours wake-up times
■■ have 2 or 3 naps during the day ■■ nap for 1–2 hours, once or twice a day
Remember to put your baby on their back to sleep, for every sleep. If they roll over, you
don’t need to move them back. For more information about safe sleep for your baby’s first
year, see page 218.
Bedtime
A calming bedtime routine after your baby’s last feeding helps them settle down before
they go to sleep. When you follow a regular bedtime routine every night, your baby learns
the signs of bedtime and comes to know what to expect. Bedtime routines work the best
if they happen before your baby shows you signs that they are tired, around 7 or 8 pm.
Waiting until a baby shows you signs that they’re tired means they may be overtired before
you get them ready and into the crib. An overtired baby may have trouble settling down
for sleep and staying asleep.
Give your baby a little variety with a different book or

song, but try to follow the same overall pattern before Sing to sleep
sleep. For example, to create a calming routine: Lullabies have been used for
centuries in many cultures to
■■ Put on their pyjamas. help babies sleep.
■■ Clean their gums and teeth (see page 236).
■■ Snuggle together for a song or a story.

■■ Put your baby down to sleep in their
crib when they are drowsy but still
awake. This helps them learn that their
crib is the place to go to sleep.
■■ Say a warm ‘goodnight’ and let them
try to settle on their own.
When you’re away from home, try to

maintain bedtime routines as much
as possible. This can help to avoid big
upsets to sleep routines when you’re
back home.
Every family is different. You may need

to try a few things to find out what
works best for you and your baby.
Naptime
Babies also need naps during the day. Naps let your baby’s growing brain and body rest so
they can be healthy and keep exploring, playing and learning. Day or night, your baby will
give you cues that they’re tired and ready for sleep. They may:
■■ lose interest in people or toys
■■ fuss, yawn or rub their eyes Baby clothes
Clothes that are too big can ride up
■■ have glazed eyes
around your baby’s neck and can
■■ become more quiet or lie down choke or smother them.
If your baby does not get the opportunity to

sleep when they show these signs, they may:
“
■■ have trouble falling asleep later
■■ become overtired and fussy I needed to learn to sleep when
■■ find new energy and want to play again my baby was sleeping. It was
important to have the energy
Plan activities around your baby’s naps.
”
Taking naps around the same time each
to enjoy him. The housework
day will help your baby develop better had to wait.
sleep habits and make sure they get the
~ Medina, mom of a baby
sleep they need.

Sleep patterns
Sleeping through
Your baby’s sleep patterns will change as they the night
grow. Even after your baby starts sleeping more at
No adult or baby sleeps
night, they may have times when they have trouble through the night without
going back to sleep because: waking.
■■ they’re teething or sick Adults wake up several times
a night. They go back to sleep
■■ they’re having a growth spurt
because they’ve learned how
■■ they have separation anxiety (see page 321) to do that. With your help, your
baby can learn to do this too.
■■ they’ve learned a new skill, like rolling over or
pulling themselves up to stand
■■ there’s a change in your family’s routine such as travelling, holidays, or a new work
schedule
It may take a few days or even weeks for your baby to go back to a regular pattern. Even
though you might feel frustrated, try to be patient, comforting and consistent with your
baby. Ask others to help you with cooking, laundry or other chores so you can rest and
focus on helping your baby learn how to get back to a healthy sleep pattern.
“ Moms, don’t be afraid to wake your partner to help care for your baby in the
night. There is such pressure to let the ‘working’ partner sleep. Caring for
children all day is work too and there aren’t always chances to catch up on
”
needed sleep. Dad is a parent too and night parenting shouldn’t be solely the
mom’s responsibility.
~ Ryan, dad of two children
Self‑soothing
With time, your baby can learn to self-soothe. Self-soothing can help your baby get to
sleep or get back to sleep when they wake during the night. It can also help them soothe
themselves at other times.
You’ll see your baby start to self-soothe when they:

■■ make sucking sounds or suck on their fingers, thumb or a soother. For more information
about soothers (see page 236).
■■ rub the edge of their blanket with their fingers
separation anxiety: the anxious or upset feeling children get when separated from their parents

■■ stare at one spot or an object for a few minutes before closing their eyes
■■ grunt or fuss in bed without being completely awake
Here’s how you can help:

■■ Make soft humming sounds that your baby can copy. Then they may start to make
similar sounds as they start to settle.
■■ Gently take your baby’s hand and help them softly pat or rub their cheek, tummy or leg
when you’re cuddling with them. Once they can control their arm movements, they’ll
start to use these movements by themselves when they’re upset or tired. It may take
your older baby several weeks to learn how to self-soothe, but it’s an important skill for
them to learn, so keep trying.
■■ If they begin to fuss or make sounds while they’re sleeping, wait a few minutes to see if
they settle down on their own.
■■ Wait until your baby is fully awake to go to them.
Teaching your baby to self-soothe is not meant to replace your loving attention and care.
Your older baby will still need you to help them settle if they’re sick, upset or scared.
Learning self-soothing will help your baby get back to sleep as they move through the
sleep stages during the night (see page 217).
Going to sleep
Put your baby on their back in their crib when they’re drowsy, but not yet fully asleep. This
helps them connect going to sleep with their crib. Calmly tell them it’s time for bed.
Every baby is different when it comes to sleep. Some will go right off to sleep as soon as
you put them in their crib, while others may fuss or cry. You don’t need to rush in every
time your baby cries. Often, if you wait a
few minutes, you’ll hear their fussing start
to slow, and gradually taper off. Babies are
just learning to settle themselves, and like all
learning, it will take time.
As your baby explores and plays more,

they may be more interested in their
surroundings rather than going to sleep. Try
to be consistent and patient. It may take time
for your baby to learn when it’s time to go
to sleep.

Things to think about when helping your baby develop healthy
sleep routines
■■ Does my baby have a regular routine that tells their brain it’s time to sleep? If not,
think about setting up a routine (see page 305).
■■ Has my baby learned how to self-soothe or calm themselves? Do you do all the
calming and soothing? If you do, start teaching your baby to do it themselves,
1−2 weeks before you try to help them learn to sleep on their own in their crib. Some
babies may take even longer to learn this skill. Lots of practice and warmth and
structure from you will help.
■■ What is my baby used to at bedtime? For example, if your baby has always breastfed
to sleep every night, they’ll need time and support to learn how to go to sleep on
their own. Start with tiny steps to help them get used to sleeping in the crib. Spend
time in the daytime in the baby’s room with them in the crib as you do jobs around
them, talk, or sing to them. It’s okay to help your baby settle in their crib if they seem
upset. This can be as simple as patting them on their abdomen as they try to settle or
it may mean picking them up and rocking them. Try to avoid breastfeeding or feeding
the baby every time they go to sleep. This helps them learn that sleeping and feeding
don’t have to go together. Take your baby off the breast or bottle before it’s empty
and they’re fully asleep. Cuddle and then settle them into the crib.
■■ Do you have anyone else who can help with your baby’s bedtime routine? With
practice, other caregivers can be a big help and give you a break.
If your baby is growing and gaining

weight well, they don’t need to feed When babies cry…
at night. They may still want to feed at By 6 months, babies usually cry less than
night because that’s what they’ve always they did in their first few months. They
done. However, when your baby is going may still have times when they cry more,
such as when they’re teething or sick.
through a growth spurt, they may wake
Your baby is now starting to communicate
up to feed at night. This usually only lasts
in other ways, but crying is still one of the
for a few days. While keeping things calm ways they say “I need you.”
and quiet, feed your baby, then help
For more information about crying, see
them settle back to sleep.
page 229.

If your baby is crying and it’s getting louder and more frantic, this means that they are not
able to settle themselves yet and they need your help. When this happens, here are some
ideas you can try:
■■ Gently stroke or pat their leg, tummy or cheek with your hand when you put
them down.
■■ While keeping your hand on them, hum, sing or talk quietly to your baby.
■■ Slowly use a lighter touch with your hand.
■■ Calmly keep stroking or patting your baby, rather than picking them up, if they move
around or seem to be waking up.
■■ Some older babies will settle once you leave the room; give them a few minutes to try
to settle on their own. It won’t hurt your baby if they cry for short periods of time as they
learn how to settle to sleep on their own.
■■ If your baby cries loudly, pick them up and help them settle like you normally do.
■■ The next time they cry, try again to let them settle on their own. This may take many
tries to help them learn how to go to sleep on their own.
If you’re concerned about your baby’s sleep and not getting enough sleep yourself, you
may also be wondering about using sleep training to help your baby sleep longer. Sleep
training is a term used for a variety of methods for helping babies to fall asleep and stay
asleep. They come in many different forms. Some are universal (available to everyone and
at no cost) and some have a cost. One method of sleep training is called the ‘cry it out’
approach where a baby is left alone for long periods of time. Many parents report that they
find this upsetting and they can’t follow through with it. Other sleep training methods
might work better for some families.
Every baby can learn healthy sleep, it just takes time and the right approach for your
baby and your family. No matter what you choose, you need to feel comfortable that it’s
right for all of you. Sleep is an important contributor to the health of babies, parents, and
families. Call Health Link at 811 or talk with your health care provider about any concerns
you have and how sleep may be affecting your family’s health and well-being.

Teeth and mouth
Teething usually starts at about 6 months. It continues off and on until your child is around
3 years old, when they have all 20 of their baby teeth.
Teething is not an illness. It’s a normal and temporary process. It does not cause diarrhea,
fever or vomiting. These are signs that your baby is sick and are not related to teething. For
more information on these concerns, see page 91.
Teething may be uncomfortable for your

baby and you may find that they:
■■ are fussy and restless
■■ have more saliva and drool
■■ have swollen gums
When your baby is teething:

■■ Give them lots of love.
■■ Gently rub their gums with your clean
finger.
■■ Give them a cold, clean cloth or solid
teething ring to chew on—try the kind that Teething necklaces are
can be cooled in the fridge. not safe for babies
If you’re thinking of using medicine for teething, Teething necklaces can catch on
furniture, hooks or other objects
talk with your health care provider. Teething
and can strangle your baby.
products, such as gels, are not recommended.
Some teething gels contain the medicine
lidocaine or benzocaine, which can make your baby sick or numb their throat
making it hard for them to swallow. If you choose to use natural teething
products, choose products with a Health Canada Natural Product Number
(NPN). To learn more about teething and teething products, visit the Links
If your baby seems very uncomfortable, call Health Link at 811 or talk with
your health care provider. Something other than teething may be causing
your baby’s discomfort.

Keeping your baby’s teeth healthy
Clean your baby’s teeth every day to help keep them healthy and to prevent tooth decay.
Remember to check for tooth decay regularly (see page 63). Many foods have natural or
added sugars in them that can lead to tooth decay.
To keep your baby’s teeth healthy:

Going to the dentist
■■ Avoid snacks that stick to teeth (e.g., teething ■■ Take your baby to the dentist
biscuits and cookies). by their first birthday or within
■■ Offer water if your baby is thirsty between 6 months after their first tooth
comes in—whichever comes first.
meals and snacks.
■■ Dental problems are easier and
■■ Take your baby off of your breast or remove
less expensive to treat when
the bottle before they fall asleep. Propping they’re found early.
a bottle in your baby’s mouth is not advised.
■■ Your dentist will set up a schedule
It can cause choking due to the presence of
for dental visits that best meets
liquid in your baby’s mouth. It can also cause your family’s needs.
tooth decay.
Over time, habits such as sucking on soothers, blankets, toys, or fingers can also affect
the health of your baby’s mouth and teeth. For more information about soothers,
see page 236.
Brushing your baby’s teeth

Brush your baby’s teeth twice a day as soon as they appear—once in the morning and
again before bedtime. At first, your baby may resist you brushing their teeth, but as you
keep trying in a calm and gentle way, soon they’ll get used to it. Start to floss teeth once
they touch each other. Regular brushing and flossing is the best way to prevent tooth
decay. Replace your baby’s toothbrush when the bristles become flat.
When you brush your baby’s teeth:

1. Take off your rings and bracelets—they have germs on them and could scratch your
baby’s face.
2. Wash your hands.
3. Hold your baby securely in a position that lets you easily see and reach all of their teeth.
4. Use a soft-bristle, child-sized toothbrush and an amount of fluoride toothpaste no
bigger than the size of a grain of rice.
5. Hold the bristles against your baby’s teeth where they meet the gums.

6. Move the brush gently in small circles for about 10 seconds. Move to the next tooth.
7. Brush the outside, inside and chewing surfaces (tops) of your baby’s teeth.
If you have concerns about your baby’s teeth, talk with your dentist.
To learn more about basic dental care, visit the Links section at

As your baby grows, they’re able to do more. Throughout this stage, they’ll learn to
recognize people, play with objects, babble, sit up, crawl, stand and eventually start
walking. All areas of your baby’s development are interconnected and the development
in one area affects the development in all other areas. This development is guided by
their brain.
Physical
Emotional
Cognitive
Social

Your older baby’s developing brain

As your baby grows and experiences new things, brain cell
connections are forming and getting stronger. Everything
your baby touches, sees, hears, tastes and smells helps form
these connections in many different parts of their brain.
Brain cell connections become stronger when you and your

baby engage in serve-and-return interactions. Here are some
examples of what this might look like with your older baby.

6–9 months
■■ turn when they hear an interesting sound ■■ draw their attention to and name the
interesting sounds around you
■■ enjoy looking at objects, pictures and books ■■ talk with them about the pictures they see in
a book
■■ reach for things they want ■■ name what they're reaching for and say, for
example, “Do you want the ball?”
■■ use their voice to get your attention ■■ let them know that you hear them and that
you’re there to help. Ask them what they
need, for example, “Sounds like you want to
come down—are you all done eating?”
■■ copy what you do, such as clapping their ■■ sing nursery songs and play finger games
hands and making sounds with actions. Then wait for them to copy you.

9–12 months
■■ look at things that they’re interested in ■■ stop so your baby can look at things they
show interest in (e.g., when you’re on a walk,
name the things as you point to them)
■■ pick up, stack objects or nest containers by ■■ fill a bottom drawer in your kitchen with
putting small containers into larger ones (e.g., plastic dishes and containers for them to
nesting toys, measuring cups) play with
■■ bounce to music ■■ play music and sing songs with them
■■ watch other children ■■ take them to the park or library so they can
be with children of all ages
■■ drop things from their high chair to see where ■■ look at them, use gestures and ask, “Where
they go did it go?” As you give it back to them, say
“Here it is.”
For more information about how the brain develops, see page 19.

Other things you can do to help your
baby learn
Communicating with your older baby

Older babies communicate with their bodies, sounds and facial expressions. Your baby will
start using more sounds and putting them into longer strings, such as ‘bababa’. When your
baby babbles, they’re practicing the sounds that will soon
become words. It’s pretty exciting to hear your baby’s first
word. Some babies will likely say it before their first birthday.
Your baby needs you to talk with them so they can learn to
understand and use the sounds and words of your language.
They learn better when you say the names of people, things,
actions and places out loud. Your baby’s first words may be
hard to understand. They may need to hear a word hundreds
of times before they’ll be able to say it clearly.
How you can help your baby communicate

■■ Follow their lead. Your baby looks at and reaches for things that interest them. Use
words to describe what they’re looking at or doing.
■■ Tell them. Talk to your baby often about what you’re both doing. Use an interesting
voice and different tones so they’ll be interested in your words.
■■ Use movements. Use hand movements and other actions with your words to help
your baby understand what you say. Before they are able to use words, many babies
can learn to tell you what they want with their hands, such as when they want more or
when they’re all done.
■■ Follow routines. When getting ready for mealtime or bedtime, talk about what you’re
doing and name the things you’re using. Your baby will start to learn what the words
mean and understand what will happen next.
■■ Share books and sing songs. The rhythm and repetition of songs, stories and nursery
rhymes help build your baby’s language, literacy and learning.
literacy: the ability to read, write, understand and use information

To learn more about communicating with your baby, visit the Links section at
Let’s play
Play builds healthy bodies and healthy minds. Babies play using all of their senses and
need opportunities to play throughout the day, every day.
From 6–12 months, your baby is starting to figure out how to move from one place to
another. At this stage they’ll:
■■ move their eyes together to look at things
■■ turn to sounds they hear
■■ touch everything and have no idea what is
safe and what is not
■■ put everything in their mouth—your baby
learns by feeling and tasting things
Let them explore but stay close

Let your baby explore and play in their own way.
They learn best when you let them take the lead.
Stay close enough to help if they need you and to:
■■ make sure that what your baby can reach is safe,
including things you put in your lower cupboards
■■ keep small things out of their reach
■■ prevent big things from falling on them
Your baby will need your full attention at all times
when they are awake.
Children are naturally curious and interested in

how things work. Their drive to play is as strong
as their need to eat and sleep. Your baby will
play by touching, grabbing, shaking, dropping
and putting things in their mouth. Once they’re
mobile, they move very quickly from one thing
to the next, leaving a trail of things they’re done
playing with behind them. This is how babies
play at this age and play is how they learn.

You’ll find lots of opportunities to play with your baby in their everyday routines such as
eating, dressing, outings, bath time and getting ready for bed. Your baby loves to play and
you’re still your baby’s most important and enjoyable playmate.
Active play
Your baby is starting to be able to control their movements. At first your baby will roll over
and push up on their hands when they’re on their tummy. Soon, they’ll be able to sit on
the floor without your support.
Your baby may try to move
towards things by wiggling or
rolling. By the end of this stage,
most babies will:
■■ crawl across the floor and up
the stairs
■■ pull themselves to a standing
position
■■ walk while holding your
hand or on their own
Your baby needs to have lots of chances to move and play freely on the floor, several times
a day. This type of play encourages your baby to develop the strength and skills they’ll
need to sit, stand, crawl and walk. Stay beside them to keep them safe and put away
anything that could hurt them or break. Move furniture out of the way. If your baby is
doing something that’s harmful or unsafe, move or re-direct them.
There are many things you can get for babies, such as bouncers, jumpers and rockers but
they don’t really need these. If you use them, make sure you:
■■ Follow all manufacturer instructions and safety guidelines—fasten safety straps and
harnesses correctly.
■■ Wait until your baby has good head and neck control.
■■ Supervise your baby at all times and check that your baby is in the correct position.
■■ Place the item on the floor and not on a high surface.
■■ Use these items for short periods of time.
Continue to give your baby tummy time. Try for at least 30 minutes a day, a few minutes
at a time spread throughout the day (see page 245). Limit the amount of time your baby is
sitting in places such as a stroller or high chair to no more than 1 hour at a time.

Creative play
Your baby explores by touching or
picking things up—they play by
getting into things. Your baby will
enjoy dumping all or taking things
out of containers, holding their
own cup with both hands and
picking up finger foods. Clean toys
often as they can spread germs—
especially when your baby is sick
or if other children are also playing
with the same toys.
Toys can be fun, but your baby doesn’t always need them. There are many ways to have
fun without toys.
Here are some ideas of ways to play together:

■■ Follow your baby as they crawl
around and play with different
objects at home and outside.
■■ Sit or stand in front of your baby
and encourage them to step
towards you.
■■ Let them open the cupboards
to see what’s inside.
■■ Put laundry in and out of the
basket.
■■ Bang pots with a wooden
spoon.
■■ Stack plastic plates and bowls.
■■ Crawl in and out of boxes.
■■ Play with plastic cups.
■■ Splash in the bathtub.

Between 6–12 months of age, it becomes easier to tell when your baby is happy, sad, mad
or scared. Your baby is also beginning to know how other people are feeling.
In new or surprising situations, your baby may look at how you react to figure out how to
respond. If you smile when someone new visits, they’ll accept that person more easily. Your
baby’s temperament will also affect how they respond to new situations (see page 24).
Attachment
You are your baby’s secure base. Your baby
needs to know that it’s okay and safe for Every baby is different
them to move away from you to explore Some babies find it harder to cope with
and play. Create a safe environment for new people and changes in their lives.
them to explore and play in and let them
know you’ll be there when they come back. Pick them up when they come to you with
their arms stretched out. Your baby may want to be comforted, cuddled or reassured, or
may just want to give you a hug and be off to play again. When a baby feels worried, afraid
or unsafe, they are not able to explore and learn. You’ll help build a secure attachment with
your baby when you respond to them in a loving and welcoming way.
Help your baby feel safe and secure to explore, play and learn:
■■ Watch over them and keep their play spaces safe.
■■ Be interested in what they’re learning—it shows them you care.
■■ Help if needed without taking over. Give your baby just enough information, support
or help for them to do it by themselves.
■■ Respond to your baby’s need for comfort when they come back to you.
secure base: a dependable, caring adult a child trusts to provide comfort and support

Your older baby is becoming more predictable and content and will now begin to
recognize and enjoy the people who care for them. They’re more comfortable relating
to others when they’re with you. They like watching and being with other children and
adults. Their world gets even bigger once they start walking.
Your baby will also start to enjoy more social activities. One of the things they like to do at
this age is watch things go away and come back again. Through this game, they learn that
when you go away, you’ll also come back.
At this age, your baby will start to enjoy:

■■ being with people
■■ playing simple games
with you, such as
‘peek-a-boo’
■■ copying your actions and
having you copy them
■■ listening to the sounds of
the world around them
such as talking, birds
chirping and music
■■ looking in mirrors—they
think the reflection is
another baby
Peek-a-boo
‘Peek-a-boo’ is a game where
you briefly hide your face with
your hands or a blanket, then
you remove your hands or
the blanket and say “Boo!” or
“Peek-a-boo!” It’s a fun way to
learn that you go away and
come back.

Separation anxiety
Most babies will develop separation anxiety and it usually peaks when they’re about
8 or 9 months old. Your baby is starting to realize that they’re a separate person from you.
They are starting to know the difference between the people and things they know and
those they don’t know. Sometimes babies may have a strong attachment to one parent
who is the primary caregiver for a while—this is normal.
It helps to know that separation anxiety is a typical part of child development, and that it
shows that your baby recognizes you and has started to form a strong attachment with
you. At this stage, they are able to start forming attachments with other important people
in their lives, but it may take a little time for them to be comfortable with other people.
Your baby may fuss or cry when they are worried about being separated from you, unable
to see you, or when they are with people they don’t know very well. You’re the person
they trust and they now know that sometimes you’re not around—they understand that
you can leave, but they don’t understand that you’ll come back. Separation anxiety may
last several weeks or even months.
Some babies find it hard to adapt to change. This is part of their temperament (see
page 24), and it is neither bad nor good—it’s just the way some babies are. Separation
anxiety can last for a longer period of time for babies with this temperament.
You can help your baby cope with separations by providing warmth and structure. Here
are some examples:

■■ Know that it's normal for your baby to ■■ Play ‘peek-a-boo’.
become upset or cry when they're separated ■■ Encourage your baby to cuddle with a
from you. Over time, they'll become less favourite toy or blanket for comfort.
upset or cry less.
■■ Let them take their time. They'll watch new
■■ Give support and be patient as they learn to people carefully. They may reach out to touch
adapt. them, but hang on to you at the same time.
■■ Never threaten to leave your child—not even ■■ Introduce day care or babysitters slowly.
as a joke. This can break their trust and harm Stay for the first couple of times. Then
your relationship. try brief separations that gradually get
longer—15 minutes, 30 minutes, then 1 hour
or longer.

Saying goodbye
When you leave your baby
with someone, say a warm
“Goodbye.” Explain that you
have to go, but will be back
later, such as after naptime.
Give them a kiss and then
leave with a reassuring smile.
Leaving without saying
goodbye may cause more
separation anxiety.
Make your goodbyes short.

Coming back and forth into the house or day care can confuse your baby and make
separation anxiety worse. Talk with your child care provider or babysitter if you’re worried
about your baby’s crying when you leave. It can help you to know that they’re okay. If your
baby is not settling down, talk with your child care provider or babysitter about some
strategies to help.
Health Checkups
Regular health checkups for your baby with their health care providers will help you know
how your baby is growing and developing. Their health care providers will ask about the
foods your baby eats, check your baby’s general health and development, measure your
baby’s weight, length and head size, and track how much your baby has grown from one
visit to the next on a growth chart.
Call Health Link at 811 or your health care provider if you notice
!
■■ your baby does not turn to your voice by 9 months
■■ your baby does not babble or talk or has stopped babbling
■■ your baby does not say any single words by 12 months

Your baby is due for their next
immunizations at 6 and 12 months.
Phone your community or public
health centre ahead of time to
make appointments. If your baby’s
immunizations are not up to date,
contact your community or public
health centre and talk with your
public health nurse about how to
get your baby back on schedule.
During your visit, your public
health nurse will also check things
such as your baby’s growth, how
they’re feeding, and answer any questions you have (see page 78).
For more information about immunizations, see page 82.
Birth–2 2 4 6 12 18 2 3–4 5 years and
Check with Check with

your doctor your doctor
to find out to find out Check with your doctor to find out the
Doctor √
the checkup the checkup checkup schedule at their office
schedule at schedule at
their office their office
Immunization √
Regular checkups as recommended
Dental √
by your dentist
√ Early vision √
Early vision
checkups
Vision Early vision checkups checkups with (with optometrist
with your
with your doctor your doctor at 3–5 years old)
doctor
Other health
care providers

Preventing Injuries
Now that your baby is older, they’re stronger, and can move more easily on their own. They
can reach, pull things over, grab things that move and open cupboards. They go from
being able to roll in both directions, to crawling, to pulling themselves up, to walking. Your
baby is also improving their fine motor coordination and will continue to explore and play
by putting things in their mouth. Their risk of injury increases as they move around more
on their own and they are not yet able to learn what is dangerous and what is not.
Eyes on, hands on

Older babies need an
adult within sight and
reach at all times. They
cannot yet understand
what is dangerous and
what is not. Everything
looks new and
interesting to them, so
they’ll want to play and
explore it all.
For their age and stage of development, here are some areas that need attention to keep
your older baby safe from injuries:
■■ Falls, see page 104 ■■ Choking and poisoning, see page 107
■■ Safe sleep, see page 218 ■■ Pet and animal safety, see page 112
■■ Burns and scalds, see page 109 ■■ Car seats, see page 123
■■ Water safety, see page 111
Your baby likes to Window screens

copy you Window screens are meant to keep bugs out.
When taking medicine, do it away They are not strong enough to keep children
from your baby. They often copy in. To help prevent falls, install window
what they see their parents doing. guards on windows higher than ground level
and always supervise your child.

There’s a lot to learn in the first year of your baby’s life, especially if you’re parenting for the
first time. Be patient with yourself. You’ll learn as you go and you’ll learn something new
with each child you have. If you share parenting, you and your partner may have different
ways of doing things. This is okay
as long as you’re both giving your
baby safe and nurturing care. Over
time, your baby will benefit from
learning that there are many ways
to reach the same goal.
It helps to spend time with other

parents so you can help each other
learn new ways to have fun with
and care for your babies. Your baby
will also learn by being around and
watching other babies and children.
Practicing self-care by eating healthy, being active and getting enough sleep will give you
the energy you need to take care of yourself and your family. If you’re trying to get back to
your pre-pregnancy weight, talk with your health care provider for advice. Strict diets are
not recommended as these can affect your health and, if you’re breastfeeding, can affect
the amount of milk you produce.
Pay attention to your feelings and talk to people you trust. Postpartum depression or
anxiety that is not treated affects both you and your family (see page 261). The sooner it’s
treated, the better you’ll feel and the more energy you’ll have for yourself and your family.
Life with a busy older baby

In the early months, you were able to put your baby in one place and they were content to
stay there. As the parent of an older baby, you have likely realized those days are over. Your
older baby is now on the move! At this age, they are exploring and playing and everything
seems to go in their mouth. This is how your baby learns about all the new things they are
discovering, but it means they need to be constantly monitored. Your baby depends on
you to provide them with safe places to play.
Always being ‘on-guard’ can be stressful for parents of older babies. You can help yourself
cope by being aware of how stress affects your body and thoughts (see page 26) and what
you can do to self-regulate (see page 27) so that you can calmly respond to the demands
of parenting at this stage.

Over time, you’ll learn what works best for you and your family. Here are a few things that
can help:
■■ Make your home child-safe and child-friendly. Rearrange things so that dangerous
objects are out of reach for your curious baby. Put away breakable things for a while. You
can put them out again when they have learned not to touch those things—at around
3−4 years old. This will also help you avoid having to say “No” and re-directing them all
the time.
■■ Celebrate your baby’s learning. Your baby is becoming a budding scientist—trying
to figure out how things work. While it may be frustrating to watch them drop cereal
off of their high chair, try to remember that they’re experimenting and trying to find out
how things work, for example, “What happens when I do this?” Your baby is just starting to
learn that when things go away, they can come back again.
■■ Try not to do too much. As your baby moves into a more predictable pattern of
sleeping, it may be tempting to fill late evening hours with work or hobbies. Try to have
some time so you can get a good night’s sleep to have the energy to be the parent you
want to be.
■■ Check it out. Your community may offer a number of parenting programs. Many public
libraries also offer story time programs for children of all ages. You may find some
resources that are helpful for you as well.
“ By the time my baby had her

first birthday I felt like we’d
come so far. When I looked
back at her newborn photos,
I could see how much she
had learned and how much
she had grown. I was so
proud of her and of my
husband and I. We’d become
”
an amazing team—I guess
that’s what a family is.
~ Shivani, mom of one child

Toddlers:
1 and 2 Year Olds

327
Toddlers: 1 and 2 Year Olds
1- and 2-year-old children are called toddlers because they toddle, walk and
move with growing confidence and skill. Toddlers go through many changes
in just a couple of years. They always seem to be running, jumping and
climbing. Your toddler is a bundle of energy and emotion. They’re starting
to question everything around them. What your toddler wants to do and
what they can do are not always the same. They’ll need your patience and
guidance to learn.
In this chapter you’ll learn about your toddler’s development and how to
care for them and yourself. There is information on feeding your toddler,
toilet teaching, how they explore and play, as well as how to cope with
temper tantrums. You’ll also learn about how to keep your toddler safe as
they become more mobile and independent.
328
Your Toddler’s Development
TODDLERS: 1 AND 2 YEAR OLDS

During the toddler years, your child is becoming very busy and learning about the world
around them. They have the need and the desire to do things on their own. As younger
toddlers are very different from older toddlers, these charts have been separated for young
toddlers (12–18 months old), older toddlers (18 months–2 years old), and older toddlers
(2 years old). The charts give you information about the developmental milestones and
tasks your child is working on in the toddler years. As your toddler grows and changes
during this period, this chapter will help you learn what you can do to help.
Young toddlers (12–18 months old): The ‘doing’ stage

Tasks Milestones
During this stage, Physical

your young toddler is ❑❑ helps feed themselves and will try things such as picking up food with
continuing to practice their fingers, holding a spoon and drinking from a cup
earlier tasks, as well as
❑❑ stands up by themselves
learning to:
❑❑ walks holding your hand and then on their own
■■ explore and
❑❑ crawls up and down the stairs
discover: learning
about the world ❑❑ develops food likes and dislikes (preferences)
by trying to do ❑❑ tries to throw a ball
things, testing and ❑❑ builds towers using 2–4 blocks
experimenting
❑❑ scribbles with crayons
❑❑ takes off their clothes
Emotional
❑❑ has a favourite toy or blanket for comfort and security
❑❑ begins to need and want independence
❑❑ resists limits
❑❑ has mood swings and tantrums

Young toddlers (12–18 months old): The ‘doing’ stage

Tasks Milestones
Social
❑❑ develops a fear of strange objects and events
❑❑ feels anxious when separated from parents (separation anxiety)
❑❑ likes to watch and be with other children
❑❑ not yet able to co-operate during play with others
❑❑ copies what others do (imitates) such as clapping hands and
sweeping with a broom
❑❑ starts to show concern for others
❑❑ not yet able to share

❑❑ begins to know that things exist even if they cannot see them
❑❑ likes to look for dropped or hidden objects
❑❑ points to ask and to show interest in things
❑❑ follows simple instructions
❑❑ begins pretend play
❑❑ says more words every month—these words may not be clear
❑❑ points to familiar objects or body parts, when asked
❑❑ likes simple stories, picture books, songs and rhymes
❑❑ says “No” and “Mine” a lot
❑❑ waves ‘bye’
“ ”
When I heard my child say ‘I happy!’, that was my favourite
moment as a parent.
~ Mike, dad of two toddlers

Older toddlers (18 months–2 years old): The ‘thinking’ stage
Tasks Milestones
During this stage, Physical

your older toddler ❑❑ walks up and down the stairs with help ❑❑ opens doors
is continuing to
❑❑ kicks a ball while standing ❑❑ scribbles
practice earlier tasks
as well as learning to: ❑❑ runs ❑❑ stacks 2−3 cubes
❑❑ likes riding toys ❑❑ feeds themself with a
■■ develop
❑❑ climbs on and over furniture spoon and is messy
autonomy:
learning that
they’re a separate Emotional
person from you ❑❑ explores and plays from the secure base of the parent or caregiver
❑❑ has tantrums when frustrated or tired
❑❑ starts recognizing emotions in themselves and others
❑❑ shows affection
❑❑ has more fears and anxieties, including night terrors that
peak at 2 years old
❑❑ gets frustrated when they’re not able to do things which can lead them
to hit, slap or bite
❑❑ finds comfort in routines
Social
❑❑ feels strong ownership and keeps toys to themselves
❑❑ finds it hard to share
❑❑ plays beside, but not with, other children
❑❑ tries to comfort others
❑❑ recognizes themselves and their family in pictures

❑❑ points to pictures and body parts when they’re named
❑❑ turns the pages of a book
❑❑ can finish simple wooden puzzles
❑❑ understands more words than they can say
❑❑ begins to use 2-word phrases
❑❑ enjoys and moves to music
❑❑ likes simple games and rhymes such as ‘hide-and-seek’ and
‘Itsy Bitsy Spider’
night terrors: periods of screaming and moving about during a child’s sleep where they may appear to be awake, but
they’re not

Older toddlers (2 years old): The ‘thinking’ stage
Tasks Milestones

toddler is continuing to ❑❑ jumps off the floor with both feet
❑❑ pedals a tricycle for a short distance
❑❑ balances on one foot for short periods of time
■■ be aware of
❑❑ draws circular scribbles and lines
emotions: beginning
to learn the names of ❑❑ helps with dressing and undressing themselves
feelings ❑❑ starts to gain control of their bladder and bowels, although not
■■ begin the journey consistently—toileting accidents are common
towards being ❑❑ are aware of their body functions
independent: needing
and wanting to do Emotional
things on their own
❑❑ tests limits you set
❑❑ wants and needs to do things for themselves
❑❑ changes from wanting to be big to wanting to be little
❑❑ has poor impulse control
❑❑ finds it hard to stop doing activities they’re enjoying
❑❑ is more able to understand and manage their emotions— as their
language improves, responds less with physical actions such as
hitting or biting
Social
❑❑ dawdles or takes their time doing things
❑❑ starts to pretend play with others
❑❑ likes to please others

❑❑ asks, “What’s that?” over and over again to learn new words
❑❑ follows simple two-step instructions some of the time
❑❑ may think that toys and objects are alive
❑❑ sorts objects by colour and size
❑❑ uses 2- to 3-word sentences
❑❑ uses more words every week and likes making animal sounds
❑❑ understands ‘in’, ‘on’ and ‘under’
❑❑ is understood by you 50–75% of the time
❑❑ understands ‘one’ and ‘two’
❑❑ knows their own name
To use an interactive tool about your toddler’s development, visit the Tools section at

If you have concerns about your child’s development, call Health Link at 811

or talk with your health care provider. You can also visit your nearest Parent
Link Centre and ask about the Ages and Stages Questionnaire (ASQ). To learn
more, visit the Links section at healthyparentshealthychildren.ca/resources
Toddlers
This stage is sometimes called the
‘terrible twos’ because coping with
a toddler’s constant energy and
motion can be very demanding.
Yet, it’s also a fun time when you
can see your child’s eagerness
to learn and their excitement in
sharing their new discoveries. When
you look at them this way, you’ll see
your growing child in a new way: as
the terrific toddler that they are.
Toddlers have a strong need to

explore, play and try new things.
They will want to touch, taste and
try things out—this is how they learn. They can also have emotional outbursts at times.
However, with your help, your toddler will learn how to manage their emotions as they
grow. When you provide warmth and structure (see page 11) and use problem-solving
skills (see page 406), you’ll
help them solve today’s
challenges while teaching
them valuable skills to last a
lifetime.

Children also learn and experience the world by connecting with those around them.
When your child has strong relationships with you and the other people who care about
them, they can develop many skills including:
■■ self-confidence,
motivation to learn and
problem-solving
■■ ability to control aggression
and impulses, like biting,
hitting, and running away
from you
■■ making friends and being
a friend
These skills take time to

develop, however they start
in the toddler years.
This can be a challenging time for parents if they don’t understand their toddler’s
behaviours. At this age, toddlers have a strong need to learn to do things by themselves.
Your toddler will:
■■ be constantly exploring and trying to
figure out how things work Young toddlers and
older toddlers
■■ be very focused on themselves as they
Toddlers go through many changes in
realize they are a separate person from
just a couple of years. Younger toddlers
you are very different from older toddlers.
■■ need to learn who they are before they For this reason, we have separated
can understand others some of the information in this chapter
for young toddlers (12–18 months old),
■■ need to learn that some things belong older toddlers (18 months–2 years old),
to them (ownership) before they can and older toddlers (2 years old).
learn to share
When you see these behaviours, you’ll know that your toddler is developing well. Have
patience, keep them safe, and enjoy watching the amazing things they do.

Feeding Your Toddler

A healthy feeding relationship, and eating together as a family, help your toddler learn
healthy eating behaviours for life. You continue to be responsible for what you give
your toddler to eat as well as when and where to give meals and snacks. Your toddler’s
responsible for choosing whether to eat and how much to eat.
You may notice that your toddler’s growth

begins to slow down after they’re about
1 year old. As their growth rate slows,
they may be less hungry and eat smaller
amounts. Let your toddler listen to their
body so that they learn to stop eating when
they’re full.
Healthy food choices give your toddler

the nutrition they need for growth and
development. Offer your toddler:
■■ meals and snacks that include a variety of foods from Canada’s Food Guide (see page 51)
■■ a variety of textures—cut up, peel or grate foods, especially those that can cause
choking (see page 59)
■■ iron-rich foods such as meat and alternatives and breakfast cereal fortified with iron
Make one meal for the whole family—everyone can enjoy the same foods, just cut up or
prepare it a little differently for your toddler, if needed (see page 301). When your child
watches you eat healthy meals, they’ll be more likely to develop healthy eating habits. For
more information about feeding your child, see page 49.
Milk
If you’re breastfeeding your toddler, your breastmilk
meets all their milk needs. There is no need to Vitamin D for toddlers
give any other milk. If you’re not breastfeeding, Your child needs a supplement
offer your toddler 500 ml (2 cups) of homogenized of 400 IU vitamin D every day
whole milk (3.25% milk fat) each day. Serve milk in to help meet their needs.
an open cup with meals or snacks.

Homogenized whole milk (3.25% milk fat) has a higher fat content, is important for brain
development, and is a good source of energy. Lower-fat milk (2%, 1% or skim) can be
offered to your child once they’re 2 years old.
If your child drinks too much milk, they won’t have enough room for the other foods
they need. Milk is not a good source of iron, so you’ll need to give your toddler a variety
of iron-rich foods from meat and alternatives to meet their needs (see page 296). As
your toddler eats more solid foods, they may drink less milk. If they drink less than the
recommended amount of milk, 500 ml (2 cups) each day, you can add it to other foods,
such as hot cereal and soup, or make a smoothie with milk and fruit in a blender.
How toddlers eat

Toddlers like to eat with their hands, however they can also learn to use a spoon or a fork.
They can usually drink well from a cup, although they may have trouble putting it down
without spills. They’ll get better at
these skills with practice. Mealtimes
may still be messy.
You may have concerns about your

toddler’s eating, as it can be hard to
know what to expect from one day to
the next. It may help to know what to
do about some of the more common
eating behaviours.
Off the bottle

Toddlers need to learn how to drink from a cup. If your child is still using a bottle,
gradually replace it with a cup. Plan to replace their bottle with a cup by 12–14 months.
Using a bottle for too long may:
■■ increase your child’s risk of tooth decay, especially if using the bottle for anything
other than water
■■ affect the development of their face and mouth muscles
■■ make it more difficult for your child to give up their bottle later
For more information about weaning your child from the bottle, see page 293.

Eating behaviour Ideas that may help
Strong likes and dislikes ■■ Learn about new foods together—your child may only want to
and may not want to try try a new food when it’s their idea.
new foods ■■ Let them see, touch, smell and taste the new food without
forcing them to eat it.
■■ Offer small amounts of a new food with familiar foods.
■■ Offer the new food when your child’s most hungry (e.g., at the
start of a meal) or when they’re with other children who like to
eat that particular food.
■■ Be patient and continue to offer new foods—your child may like
a food one day and not like it the next.
■■ Your child may need to see, touch and smell a food 10−15 times
before they accept it.
Only wants to eat 1 or ■■ Be patient, as your child’s favourite foods will change from
2 kinds of food for a few day-to-day.
days or longer (food jags) ■■ Keep offering a variety of foods—remember that they need to
decide whether and how much of it to eat.
■■ Serve the same meal to the whole family.
■■ Include one or two foods your child likes with other foods.
■■ Try not to cater to and serve your child only what they want to
eat, as they need to learn to eat the same foods that the rest of
your family is eating.
Will not eat a meal or snack ■■ Listen to them when they say, “I’m full.” Your child’s appetite may
change from day-to-day.
■■ Let them know they can eat at the next meal or snack.
■■ Offer only water to drink between meals and snacks.
There will be times that toddlers may not want to eat a meal. They may not be hungry,
or may be more interested in something else they’re doing. If your toddler often refuses
meals or you’re concerned about their eating, call Health Link at 811 or talk with your
health care provider. For more information about healthy eating, see page 49.

Everyday Care
Your toddler is starting to learn simple skills and probably understands and follows some
simple directions. They’re becoming more independent and will want to do more things
on their own, yet they’ll still need your help and support to take care of their needs.
Sleeping
Most toddlers need to sleep
11–14 hours a day, including
naps. You can often tell if your
toddler is sleeping enough
by the way they act during
the day. If they’re cranky or
fall asleep in addition to their
regular naptime, they might
need more sleep at night.
A regular bedtime routine

helps you and your toddler rest
well at night. End your days
with time for quiet and calm
activities so they can shift their
active day to getting ready for sleep. Try quiet play time after supper, then a 20 minute
bedtime routine such as a bath, brushing teeth and a bedtime song or story. When your
child knows what will happen next, they’ll feel more secure and ready for bed.
When you and your partner take turns putting

your child to bed, they’ll learn that the routine is Getting ready for sleep
the same, even with different people. This also TVs and electronic devices tell
makes it much easier for a family member, friend the brain that it’s time to be
or babysitter to put them to bed when you’re awake. Everyone in the family
not there. should limit using these devices
for at least an hour before
Toddlers are often afraid of being separated from bedtime. It’s not recommended
their parents. You show confidence that your to have a TV or electronic device
in your child’s bedroom.
toddler can settle themselves when you calmly say
“Goodnight,” give them a hug, and leave the room.

Let your child know where you’ll
“ Having comfort at bedtime really

be and that you’ll see them in the helped us. It’s downtime when we can
morning. Be patient—it may take snuggle and read and catch up on
time for your toddler to learn to
the day and that’s a nice way to settle
go to sleep on their own.
”
down for the evening for all of us. It
If your toddler is having trouble really helps.
going to sleep and staying asleep
in the night, these suggestions ~ Rosie, mom of two children
may help:
■■ Get them ready for bed before they’re too tired. Move bedtime earlier by 15–20 minutes
each night until you reach a bedtime of 7–8 pm.
■■ Read and look at books or use quiet play with blocks or puzzles with them before
bedtime.
■■ Keep bedtime routine a screen-free time for you and your child. They need your time
and attention after a busy and active day—some toddlers wake up at night because
they want more time with their parents.
Talk with your child in the daytime about what bedtime will look like, especially if you’re
making any changes. Do not wait till bedtime to talk about it. Some things you can say are:
“I’m going to stay beside you until you fall asleep, then I’ll go do the dishes and you’ll be asleep
in your bed.” “If you wake up at night, I’ll help you settle back into your bed, then I’ll go back to
my bed.” “We’re going to read a book about trains tonight at bedtime, instead of watching TV.”
Encourage your toddler to use a comfort object or a small, quiet toy at bedtime such as a
toy dinosaur, teddy bear or a blanket. Tell your toddler that this object can help them settle
and be calm at bedtime and in the night when they wake up. If you have always been the
one to settle your child to sleep, it may take them a few weeks to learn that they can do it
themselves.
Your toddler doesn’t have to cry for long periods of time to learn how to sleep on their
own. They need your loving support, small changes and lots of practice to learn how. Talk
with your child about how well they’re learning how to sleep on their own. Notice and
comment on what they did to encourage little steps they’re taking instead of focusing
on what might be going wrong. For example, you could say something like, “You did such
a good job going back into your own bed last night when you woke up,” or, “You woke up last
night but then you got back into bed, and before you knew it, you were off to sleep.”
If your toddler is nursing or taking a bottle frequently at night, you can decrease the
amount of feeds to help them learn how to sleep without it. Gradually decrease the

amount such as from 250 ml (1 cup) to 200 ml (about 3/4 cup), to 150 ml (about 1/2 cup) and
so on over a week or two. If you’re breastfeeding, take them off the breast after a shorter
feeding time each night over a week or so. Cuddle and put your toddler back into their
bed or crib for the rest of the night.
If you have any concerns about your toddler’s sleep, call Health Link at 811 or talk with your
Naps
Children often stop having morning naps in the young toddler stage, but continue to have
a 1–2 hour nap in the afternoon. Toddlers will nap for however long they need, but you
may find that if your child naps for more than 2 hours at a time, or late in the afternoon,
they may have trouble falling asleep at night.
Your older toddler may stop napping in the afternoon, but end up quite fussy later in the
day. If this happens, give them quiet time in the afternoon on their own in their room
reading books or playing with toys. If they’re tired they may fall asleep and if not then the
quiet time will help them stay calm and happy the rest of the day.
When others are looking after your child, talk with them about your child’s sleep routine
and let them know if your child takes naps and for how long. Your toddler will feel safer
with a familiar and consistent routine.
Nightmares and night terrors

Some children have frightening dreams (nightmares) that they may be able to describe
afterwards. It’s normal to have nightmares once in a while. They usually happen in the
second half of the night.
A nightmare can wake your child. They might be scared and need to be cuddled and
comforted by you. They may have trouble getting back to sleep.
If your child is having many nightmares, it might be because they’re concerned about
something that has scared or hurt them or because of a big change such as:
■■ new child care
■■ new home
■■ new baby
Talk with your child about their fears in the daytime, when everyone is awake and rested.

Night terrors (sleep terrors) are different. During a night terror, children’s eyes will be open

and they’ll seem to be awake but they are not. They may also scream or move about
during their sleep. A child may not be aware of anyone around them and usually don’t
remember the night terror. For this reason, night terrors may be much more upsetting for
you than for your child.
Night terrors usually happen in the first part of the night, about 1–4 hours after falling
asleep. They often happen at the same time each night and usually last only a few
minutes. Night terrors usually peak at about 2 years and they’re more common in boys.
If your child is having a night terror, make sure they’re safe but don’t try to comfort or wake
them. If your child is having night terrors at the same time each night, try waking them
10–15 minutes before that time. Doing this for a few weeks may break the cycle. Night
terrors are more common when the child is not getting enough sleep. It may help to move
bedtime earlier by a few minutes each night to see if that helps.
If your child is having a lot of trouble sleeping or if night terrors are affecting their health or
your family life, call Health Link at 811 or talk with your health care provider.
Moving from crib to bed

Going from a crib to a bed is a big step for both toddlers and parents. Your young toddler
is safer in their crib until they start trying to climb out of it. Prevent injuries by moving your
toddler to a bed before they can climb out of their crib. Before moving your toddler, check
to make sure their room is safe and child-friendly. For more information, see page 104.
Many toddlers have trouble adjusting to being in a bed. When moving from a crib to a
bed, continue with your bedtime routines. They may change a little and you may now be
reading a book in bed instead of reading it in a rocking chair.
Help your toddler move into a bed

■■ Talk with them during the day about the move and how big they’re getting. Be positive.
■■ Get books from the library and read together about moving to a bed.
■■ Practice laying in the bed for naps or bedtime before expecting them to sleep in it.
■■ Use a side rail or put their mattress on the floor to keep them from falling.
■■ Offer them a favourite toy or blanket for comfort and security.
■■ Be clear about where they need to sleep now (in the bed) and where you’ll be. Use
words to help them know what you expect from them during bedtime.
■■ Play soft music or use a nightlight to help them settle down before falling asleep. For
more information about nightlight safety, see page 110.

Older toddlers and bedtime routines
Your older toddler may need to talk, sing, look at books, or play quietly to help them relax
before they fall asleep. They’ll drift off to sleep when they’re ready. They may find extra
comfort and security from special objects like a blanket or a soft, stuffed toy. If your toddler
is in a crib, keep it free of clutter so they cannot climb over the crib rails. Nearly half of all
crib-related injuries every year are due to falls.
Most toddlers will try to come out of their room after they’ve been put to bed. They may
want to come out for all kinds of reasons, such as they’re more independent and want
more control of their life or because they’re anxious about being away from you.
Being in a bed, with more freedom, may be both exciting and scary for children and
they may:
■■ beg to stay up or ask over and over for one more drink, story or cuddle
■■ refuse to lie down or get up many times
■■ react with strong emotions like screaming or yelling
Stay calm, especially if your child is not. Your older toddler can learn that they need to stay
in bed so they can go to sleep. You can promote peaceful bedtimes by providing warmth
and structure. Here are some examples:

■■ Realize that many children find moving to a ■■ Keep a regular bedtime routine.
bed both exciting and scary. ■■ Keep bedtime calm and quiet.
■■ Be matter-of-fact and speak with a calm and ■■ If your child doesn’t like the door closed, try
friendly voice. talking to them about why the door needs
■■ Be calm by practicing self-regulation (see to be closed. Practice being in the room with
page 27). Your calm presence will help calm the door closed in the daytime and help
your child. them learn that it’s okay. Never lock your
■■ Focus on your child during the time it takes child’s bedroom door.
to get them ready for bed. Turn off cell ■■ If they come out of their bedroom after
phones and enjoy this time with things such you’ve put them to bed, take their hand, walk
as a song, story, talking about their day or them back to their room, remind them that
plans for tomorrow. Share one good thing it’s bedtime and tuck them in.
about each of your days. If there are any ■■ Avoid arguing. Simply say, “It’s time for bed.”
problems to discuss, talk about them earlier You may have to do this many times and for
in the day—not at bedtime. several nights before they accept it.
■■ Reassure your child that you’ll be nearby and ■■ Be kind and firm. By being kind, you let them
will keep them safe. know you understand they would rather stay
■■ Give them a kiss, a hug and say goodnight awake. By being firm, you let them know that
before you leave their bedroom. it really is bedtime.

Toilet teaching

Most children are at least 2 ½ or
even 3 years old before they’re
ready to learn how to use the
toilet. Some boys are not ready
until they’re 3 ½ or 4 years old.
You cannot rush toilet teaching.
Wait until your child wants
to learn and is physically
ready—when the muscles that
control their bowel and bladder
are strong enough.
Toilet teaching will take less time,

be easier, and less frustrating if
you wait until your child is ready
and don’t rush the process.
Your child may be ready to use a toilet when they:

■■ are able to stay dry for several hours or ■■ don’t like to be in a wet or dirty diaper
through the night ■■ can pull down loose-fitting pants and
■■ have bowel movements at fairly follow simple directions
predictable times and are getting better ■■ show interest in using the potty chair
at controlling them (see page 345) or in other people using
■■ know they’re urinating or having a bowel the toilet
movement. They may even tell you ■■ can tell you they need to use the toilet
when they need a clean diaper.
Learning to use a toilet

There are many things you can do
to help your toddler learn to use It takes time to learn to use the toilet
the toilet. Your child may not be able to make it to the
toilet on time when they’re learning.
■■ Help your toddler recognize
This may upset them. Reassure your child that
when they’re urinating or having
it’s part of learning. A calm, matter-of-fact
a bowel movement by talking
approach will help them feel better about
about it—use words that are what happened.
familiar to your family.

“
Read stories about using a toilet or potty.
Every child is so different...
■■
Tell them that you and other people use
”
don’t get too stressed about it.
the toilet too.
Have patience.
■■ Let them see you empty the contents
of their dirty diapers into the toilet and ~ Kelly, parent of a toddler
flush. This will help them see where bowel
movements go.
■■ If you use disposable diapers, your toddler may not feel wet. They may learn to use the
toilet faster if you switch to cloth diapers, as they’ll be able to notice when they have a
wet or soiled diaper.
■■ Show your child the potty chair or adapted toilet-seat. Tell them how it’s used and that
you’ll help them.
■■ Ask them to tell you when they need to go to the toilet. They won’t be able to wait more
than a few moments after telling you.
■■ Watch for signs they’re about to go such as stopping what they’re doing, looking down
or off in the distance or saying, “Uh-oh.”
“
They may also fidget or hold their hand
between their legs. If you ask your toddler I switched to cloth diapers
if they have to go, they’ll likely say “No.” You when my daughter was toilet
may get a better response if you say, “Looks training. Then she knew when
like you have to go to the bathroom,” or “Let’s
”
she was wet and didn’t like it.
get you to the bathroom.”
It really helped!
■■ Stay with them or give them books to read
while they’re on the toilet or potty chair. ~ Rebecca, mom of three children
■■ Little boys may want to urinate standing
up, like other boys or their dad. It might be easier Hand washing
for them to learn in a sitting position. Get your toddler into the
■■ Help your child with wiping after a bowel habit of washing their hands,
movement. Your child may need help with this whenever they use the toilet.
until they’re about 4−5 years old. Teach girls to
wipe from front to back to help prevent infections
caused by getting stool near their urethra or vagina.
Support your toddler’s efforts even if they’re not successful at using the toilet. If your child
is not making progress after a couple of weeks, they’re likely not yet ready to learn. Try
again in a few weeks or when they seem more interested.
urethra: the tube attached to your bladder that urine passes through when you urinate

More tips for toilet teaching
■■ Be consistent. If your child has other caregivers, talk to them about what you’re doing
to help your child use the toilet.
■■ Be patient, positive and relaxed. Children learn in their own way and on their own
time. Don’t set deadlines or get into power struggles. Expect setbacks if routines
change, like starting child care or the arrival of a new baby.
■■ Take your toddler to the toilet or potty chair when they wake up in the morning, after
naps, after meals, before going out and before a bath.
■■ Put the potty chair in a bathroom close to where your toddler spends most of the day.
Keep a few books there to help them sit longer.
■■ Dress your toddler in clothes that are easy to pull up and down.
■■ Run the water. The sound may help your child feel the urge to urinate.
Potty chair
If you use a potty chair, make sure it’s sturdy and doesn’t tip easily. Your child’s feet should
be on the floor. A potty chair may help your child feel safer, especially if they’re afraid of
falling into the toilet. They’ll be able to get on and off without your help and will see the
results of their effort—their own urine or bowel movement. Follow the manufacturer’s
instructions for cleaning or sanitizing the potty chair.
Toilet-seat adapter
If you use a toilet-seat adapter:
■■ Make sure it fits securely on the toilet. If not, it may pinch your child’s leg or they may be
afraid of falling when it wiggles.
■■ Use a step stool to help your child get on and off the toilet more easily. They may feel
safer if their feet touch the step stool when they’re seated.
Many children are afraid of being flushed down the toilet. Your child may be scared if the
toilet is flushed while they’re sitting on it. Remind them that they’re too big for this to
happen. Respect their fear by letting your child flush the toilet after they’re off.
“ Toileting feels challenging for everyone. Just knowing that children are on
their own schedule can help. Your child doesn’t have to be potty trained
”
first, and they might even be last! Watch for their interest and keep the
conversations going.
~ Grace, mom of a preschooler

Dressing and undressing
Older toddlers get better at dressing
and undressing themselves. They
may not be able to get in and out
of their clothes quickly, however
they need a chance to learn what
they can do on their own. Let them
help with the steps they can do,
then gradually let them do it all by
themselves.
Your toddler may find it easier to

dress and undress if they wear:
■■ clothes with elastic waists
■■ shoes and boots that slip on or do up with Velcro®. Most children cannot tie their own
shoes until they’re 5–6 years old.
Toddlers like to make their own choices. You may find your toddler picks the same clothes
day after day. If you divide their clothes into special occasion and play clothes, you can let
them choose from the clothes that are best for what they’re going to do.
Teeth and mouth

Toddlers continue to get new teeth.
Some back teeth (first primary molars)
may come in by the time your toddler is
18 months. The second primary molars
usually come in sometime between
2–3 years old. Molars have pits and
grooves on the chewing surfaces that
can trap food and germs. Tooth decay
can start if your toddler’s teeth are not
kept well-cleaned.
Most toddlers have all 20 baby teeth by

the time they’re 3 years old.

Help keep your toddler’s teeth and

mouth healthy: Help your child care for their teeth
■■ Brush their teeth twice a day with their
■■ Have planned meals and snacks. own toothbrush and fluoride toothpaste.
Eating and drinking all day can put Use an amount of toothpaste the size of a
your toddler at risk of developing grain of rice. It might help to sing a song
tooth decay. or set a timer for about 2 minutes to help
your child learn how long it takes to do a
■■ If you’re serving sweet foods, serve
good job. It may take a while to work up
them with a meal. The extra saliva to 2 minutes—the key is sticking to the
produced at mealtime will help routine every day. Teach them to spit out
protect your toddler’s teeth. and not swallow any toothpaste.
■■ Brush their teeth twice a day—once ■■ Brush their tongue gently from back
in the morning and once before bed. to front.
■■ Floss teeth that touch each other.
Keep toothpaste out of reach and in
a safe place. Your toddler may want
■■ Check for tooth decay once a month (see
page 63).
to brush their own teeth except
they’re still too young to do a good ■■ Encourage your child by noticing when
job. Let them start, then help them they take good care of their teeth. Tell
them that they’re helping their teeth and
finish. When your toddler is able to
gums grow strong and healthy.
write their name, they’ll have the
coordination to brush and floss their
■■ Set a good example by letting them
see you brushing and flossing your
own teeth properly.
own teeth.
Using dental floss

Flossing gets rid of food and plaque build-up between your child’s teeth. Begin flossing
every day once their teeth touch one another.
1. Cut a piece of floss as long as your
child’s arm. Wrap it around your middle
fingers, leaving about 5 cm (2 inches)
of it between your hands. Using your
index (pointer) fingers, guide the floss
between your child’s teeth.
2. Wrap the floss in a ‘C’ shape around
the base of the tooth, where the tooth
meets the gums.
3. Starting at the gum line, wipe the full edge of the tooth with the floss, 2–3 times. Floss
both sides of each tooth and the back of all molars. Change to a new section of floss as
you move to each tooth.

Planning your child’s dental visit
Children who go to the dentist regularly
have less tooth decay. These visits also
help your child learn about and get
comfortable with dental care. To have a
successful visit:
■■ Plan their visit for a time when your
child will be alert and not tired or
hungry.
■■ Play a dentist game with them before
you go. Have them lie down. Shine a
light into their mouth and count their
teeth. Switch roles so they can be the
dentist too.
■■ Use positive, encouraging words
to congratulate your child on their
co-operation when they’re done.
■■ Bring along your child’s favourite toy or
stuffed animal, if they have one.
Fluoride applications
Some community or public health centres offer fluoride applications for children aged
12–35 months to protect their teeth from tooth decay. Fluoride is applied 4 times, once
every 6 months. To find out if your child qualifies, contact your community or public
health centre or visit the Links section at healthyparentshealthychildren.ca/resources


Your toddler is changing every day. They’re learning how their body works and beginning
to move in different ways. They need lots of time to explore and play. Your toddler is
busy trying to understand their world and learning to think. All areas of your toddler’s
development are interconnected. Development in one area affects all other areas. All
development is guided by your toddler’s brain.
Physical
Emotional
Cognitive
Social

Your toddler’s developing brain

Brain cell connections are forming very quickly and this will continue for many years. Your
child’s experiences help these connections form. The more often an experience happens,
the stronger the brain connections become. For more information on brain development,
see page 19.
Although you cannot see these changes in

your toddler’s brain, you’ll know their brain is
developing by how:
■■ their body grows and moves with more skill
■■ they play and explore their world
■■ their language skills are growing
■■ they learn about their emotions
■■ they learn to get along with others

“ Show lots of love, be patient and you have to build their trust early.
”
~ Amal, parent of three children
Brain cell connections become stronger when you and your toddler engage in serve-and-
return interactions. Here are some examples of what this might look like with your toddler:

12–18 months
Your young toddler serves when they: You return their serve when you:
■■ build and knock down towers of 2–4 blocks ■■ take turns putting blocks on a tower— say
“My turn,” when you put your block on, and
“Your turn,” when they put theirs on
■■ point to things that interest them ■■ notice what they’re pointing to and talk about
it or show them how it works
■■ start pretending to feed dolls or stuffed ■■ enjoy having a ‘tea party’ with them and their
animals stuffed animals—pretend to pour, stir and
drink ‘tea’
■■ try to do things on their own ■■ take time as often as you can to let them try
to dress and feed themselves
■■ grab things from others ■■ Say something like: “I see you want that toy.
Sarah was playing with that car. It’s her turn
right now. You can have a turn later.”
“ I went to ‘Tots Time’ at our

community hall every Monday
morning. Most of the people
were from the neighbourhood,
so it was a good way to meet
”
other parents who lived close by,
and my daughter loved it.
~ Leah, mom of a toddler

18 months–2 years
Your older toddler serves when they: You return their serve when you:
■■ like simple games and rhymes ■■ spend time saying rhymes and playing games
they enjoy
■■ put pieces in simple puzzles ■■ take turns putting pieces in a puzzle
■■ listen to simple stories ■■ let them hold the book and turn the pages.
Pause to let them say some of the words in a
story they know well.
■■ point to pictures, body parts, objects and ■■ read ‘lift-the-flap’ books and let them find the
people that you name pictures you name
■■ kick a ball while standing ■■ roll a ball gently for them to kick, and take
turns kicking it back and forth
■■ like to imitate the things you do ■■ give them tools they can use to help

2 year olds
Your older toddler serves when they: You return their serve when you:
■■ jump with both feet off the floor, pedal ■■ spend time playing outside together and take
a tricycle or balance on one foot for a turns copying each other
short time ■■ jump, run, sit, bend over and laugh together
■■ draw lines and circular scribbles ■■ scribble and draw with your child and talk
about what they’ve drawn
■■ talk in simple, 2–3 word sentences that have ■■ repeat back what you think your child said
lots of grammatical errors. “Poon fall down. in a more correct way. “Your spoon fell on the
Daddy gots it.” floor. Daddy’s got it.”
■■ want to keep playing when it’s time to eat, ■■ give them a 5-minute warning before any
sleep or change activities change in activity
■■ pretend play with others ■■ get together with other families with young
children so they can play together

Other things you can do to help your
toddler learn
Communicating with your toddler

Your toddler is starting to use more and more words. At first they’ll learn new words slowly.
Once your toddler is about 2 years old, they’ll learn new words at a faster rate until they
have a word for almost everything—it’s like an explosion of language. You’ll be surprised at
the words they can say and all of the things they can talk about. By the time your toddler
is 3 years old, their words will also be easier to understand. They’ll be able to tell you what
they did during their day and talk about things that interest them.
Young toddlers will:

■■ use words to greet people, ask for
what they want and comment on
what they like
■■ tell you when they don’t like
something by shaking their head
and saying “No” or “Not.”
■■ use one word for a whole thought
such as “Shoe,” to mean, “Those are
my shoes,” or “I need my shoes,” or “I
don’t want to wear my shoes.”
■■ follow simple directions, like “Bring
mommy your shoes.”
■■ answer simple questions such as, “Do you want a drink of water?” or “Where’s your blanket?”
Once your toddler knows about 50 words, it will be easier for you to understand what
they say. Then, they’ll start to use them in 2-word sentences, such as “More cracker,” or
“Mommy, go.”

Your toddler needs you to listen and talk with them so they can learn to understand and

use new words in short sentences. Here are some things you can do to encourage their
language and communication:
■■ Add to what your child has said and they’ll

start talking in longer phrases. If they say
“Daddy,” use it in a short sentence like “Daddy’s
home now.”
■■ Repeat what your child says correctly—
without telling them they said it wrong. You
can also stress the word a bit in your sentence.
For example, if they say “Dama,” say “Yes, that’s
grandma. You love grandma.”
■■ Wait after asking a question or
Talk by 2 years old
making a comment. Your toddler
needs time to put their thoughts Your toddler should talk by 2 years and be
understood by 3 years.
and ideas into words.
To learn more about speech and language
■■ Ask questions that keep
development and when to get help to support
the conversation going. your child:
Open-ended questions such
■■ Visit your local Parent Link Centre to pick up
as “What happened?” or “What
a copy of the Ages and Stages Questionnaire
could we do now?” let children (ASQ) for your child’s age.
answer with more words. Try to
■■ Check out the Talk Box in the Links section at
use them more often. Closed-
ended questions like, “Did you
■■ Call Health Link at 811 or talk
do that?” or “Do you want this?”
with your health care provider to
will be answered with one word
find information about speech
like “Yes” or “No.” These don’t and language services in your
encourage conversation—try to area or if you have any questions.
use them less often.
If you’re concerned about your
■■ Join in and play with your child’s speech and language
toddler. Talk about what you’re development, it’s important to
playing with while you play. act early.
■■ Read books and sing songs.

Read your toddler’s favourite book many times as they will learn new things every time
they read it. Talk about how books relate to their experiences. If you read a book about a
farm, you could say, “Do you remember when we saw the kittens at uncle and auntie’s farm?”

Support learning through strong attachment
Your toddler’s days are a constant cycle of moving away from you to explore and play, and
coming back to you to connect and feel safe. This cycle happens many times every day.
When your toddler feels a

secure connection, they: Your toddler may:
■■ will be confident to move ■■ poke or pick up objects and try

away from you to play to figure out how they work
■■ know that you'll protect ■■ walk or run without worrying
them about where you are
■■ be curious about the world
around them
■■ not want your help and say “No”
and run away from you
When your toddler needs

to feel connected and
secure, they: Your toddler may:
■■ come back to you ■■ reach to be picked up

■■ may need your comfort ■■ ask for a hug or want to
to feel more confident to cuddle
explore and play ■■ need to touch or cling to you
■■ follow you or look for you
■■ want to tell you about their
discoveries
Your toddler’s learning and attachment get stronger when you provide warmth and
structure. Here are some examples:

■■ Be excited about their ■■ Be clear about what they can and cannot do. Use simple
discoveries. Let them show you words to explain why, for example, “We have to hold hands
how their toy works or tell you in the parking lot so a car doesn’t hit you,” or “You can run and
the story in a book. jump when we get to the park.”
■■ Welcome them back when ■■ Distract and redirect:
they need to connect with Shift their attention to another activity (distract). For
you—they may return to you example, if they start to get upset, say “Let’s go read a book.”
often, so be patient.
Move your toddler or their activity to a more suitable
■■ Remember they do not know
place (redirect). Say things like, "We don't colour on the
what's safe or dangerous yet.
walls. Here's some paper. What would you like to draw?"
■■ Give them time to do what
■■ Change your expectations and limits to match your child's
they can—offer help only if
development as they grow.
they need it or ask for it.

Let’s play

Play builds healthy bodies and minds and is important for your toddler’s growth and
development. Your toddler learns by playing. They’ll still want to play with you, however,
they’ll also need time to play on their own and with others. Toddlers are starting to use
their hands and minds to build and create. They learn different things from different
objects and activities. Their skill and coordination will improve, especially if they have the
chance to learn simple games and practice their skills in large spaces.
Encourage your toddler’s natural curiosity:

■■ Observe what they’re doing—watch to see what they’re interested in and what
they’re trying to do.
■■ Play together—with a similar toy and follow your child’s lead. Wait for them to engage
you when they’re ready.
■■ Extend their play—ask a few simple, open-ended questions such as, “What do you think
the puppy will do now?” or “I wonder
how you could make that tower taller?”
Make sure their play environment is safe.

Start talking about safety by using simple
words and phrases like “Hot!” or “That
will hurt,” so they’ll start to learn about
danger. Supervise your toddler at all
times and remind them about dangers
often. Your toddler is still a few years
away from knowing how to stay safe
from danger.

You can provide a safe
environment for your toddler
and help them feel like they
belong. Here are some ideas:
■■ Create a special place for
books and toys.
■■ Put things they use a lot
within their reach.
“
■■ Make some changes to
your home such as lowering the coat hook
I do miss the baby stages in
on the wall so they can reach and hang their
coat and keeping a sturdy, non-slip step some ways, but I love the
stool in the bathroom so they can reach the learning and intellectual
sink. growth that comes later, too!
”
■■ Put away anything that’s valuable or It’s all about building a strong
breakable. foundation together!
■■ Remove and lock up anything that could ~ Cara, mom of a toddler
harm your toddler.
Have fun with your toddler

and encourage them to play
■■ Be active. Go on a nature walk.
Make a sandcastle or snowman.
Dance freely to music and copy
their moves.
■■ Play with objects. Bring out the
paper, glue, crayons, blocks and
yarn and let your child create
whatever they want. Get them to
tell you about it.
■■ Pretend. Put together a box of old
jackets, purses, shirts and hats and
enjoy the fun of putting them on.
Pretend you’re different animals.
Pour water into dirt and make
mud pies.
■■ Tell stories. Read books and
tell stories about their favourite
activities.

Active play

Your toddler is getting more coordinated and wants to try new movements. Young
toddlers may still need to hold onto furniture or your hand to walk. Once your toddler is
walking steadily, they’ll start to run. They’ll also try to climb on the furniture and into open
cupboards. You can expect a few bumps and stumbles as they learn to watch out for
things in their own way.
As toddlers get older, they can:

■■ walk backwards or sideways
when pulling a toy
■■ jump with both feet
■■ walk up stairs
■■ squat when they play
■■ play with ride-on toys
Being active is an important part

of everyday life for the whole
family. You can play inside or
outdoors. Being outdoors helps
build your child’s connection
to nature and their community. Be sure to actively supervise your toddler when they’re
climbing or exploring.
You promote healthy behaviours for your whole family when you:
■■ go for regular walks around your neighbourhood
■■ play in your backyard or a playground
■■ push the furniture to the edge of a room and use the open floor space for activities
■■ are a role model by being physically active
Toddlers need to be active for at least 180 minutes (3 hours) spread throughout the day.
Limit sitting in places such as a high chair or a stroller to no longer than 1 hour at a time.
Your toddler will be more interested in playing and being active if you limit the time they
spend being inactive, like watching TV or playing on a tablet.
Your toddler needs time and space for active play. For more information on active play, see
page 68.

Creative play
Your toddler’s hands are also getting more coordinated. Your young toddler will clap their
hands, use a spoon, and put things into containers and dump them back out. Your older
toddler will draw with crayons and put 2–10 pieces of simple puzzles together.
Your toddler may also:

■■ roll a ball and make towers
with blocks
■■ scribble with crayons and copy
circles and lines
■■ move a zipper up and down and
put on their shoes—they’ll still
need your help doing them up
The act of creating is more important than what your child creates. It’s the act of creating
that is beneficial for your child, not what they create. Let them tell you about what they
have made.
Start with easier board puzzles and

try harder ones as your toddler’s skill
improves. Join the fun by taking turns
putting the pieces into the puzzle.
Drawing on a chalkboard on the wall or
painting on an easel helps develop their
arm strength and skill to hold and use
a pencil or crayon. The more your child
plays, the more they learn and develop.
Here are examples of activities and the skills they help your child develop:
Type of activity Helps your child

Building with blocks build their hand-eye coordination and imaginary thinking
Doing puzzles develop problem-solving skills
Creating art learn to express themselves in creative ways
Modelling clay, dough, paint making things they experience in their world and learn
and paper to create

Pretend play

Toddlers learn about life and develop
their imaginations by pretending. They
may pretend to take a nap, feed their
stuffed animals or give their doll a bath.
At first, they’ll use objects that look
like the real thing, such as using a toy
shovel as a shovel. Before long, their
pretend play becomes more advanced
and objects can be anything they can
imagine them to be.
You may notice your toddler talking

to themselves as they play. Talking
out loud:
■■ helps your toddler start to organize
their thinking
■■ helps them learn to solve problems
and cope with emotions
■■ develops self-talk (inner speech)—
something adults use to organize
their thoughts
As their talking skills improve, toddlers start to include other children and adults in their
pretend play.
Encourage pretend play

■■ Follow what your toddler does. It lets them know their ideas are important.
■■ Let everyday activities be play. Take turns and pretend with them. Take turns putting
socks in the washer when you’re doing laundry. Pretend to be restaurant servers
when you’re setting the table.
■■ Show and play by using objects in different ways. Try using a banana as a phone and
a wooden spoon as a microphone and watch their imagination grow.
■■ Use active listening. Listen when playing. Make comments to keep the conversation
going, like “Hmm,” “I see,” or “And then what happened?”

Telling stories
Toddlers are starting to share stories. You encourage learning through stories when you:
■■ Share books, stories
and songs.
■■ Talk about what you did
during the day and what
will happen tomorrow or
in the future.
■■ Share family pictures
and stories about special
occasions.
■■ Encourage your toddler
to act out or tell a
family member their
favourite story.
■■ Act out a story about a new experience such as the first day of preschool or a visit to the
dentist, so they know what to expect.
Screen time
Screen time is not recommended for Role model screen time use
children under 2 years of age. Limit screen
Your child will learn screen time use
time to 1 hour or less each day for children
and habits from you. Develop a family
2 years of age and older. plan for screen time.
If your toddler watches something, be sure

it’s something that is suitable for their age. Take time to talk about what they’re watching
to help them understand how it relates to the real world.
As one of the main ways children learn is by watching others, your screen time use and
habits really matter. Your child will learn these habits from you so be sure to model what
you want them to learn. Pay attention to your own screen time and think about what
messages you’re sending your child. It may help to create a plan for your family to show
that limiting screen time is important for everyone. For more information about sedentary
behaviour, play and screen time, see page 72.


As toddlers develop, the way they understand and show their feelings changes. Toddlers
have strong emotions. With your help, they can learn to better understand and talk about
their emotions.
Young toddlers:
■■ feel anxiety and frustration in addition to
earlier emotions
■■ begin to recognize they have their own feelings
■■ don’t yet have the words to express how they
feel, so they often show their emotions with
their bodies
■■ have little ability to manage their feelings or
control their impulses such as biting and hitting
■■ can be afraid of strange people, objects, animals
or events—they can become anxious when
separated from their parents (see page 321)
■■ begin to recognize that other people have
emotions too
■■ don’t yet understand other people’s feelings or
views
Older toddlers:
■■ feel emotions very strongly and express them
with their bodies, whether they’re happy, mad
or sad
■■ can be overwhelmed by their feelings
■■ can get upset when they’re asked to do
something they don’t want to do
■■ are easily frustrated when they can’t do what
they’re trying to do
■■ are starting to learn how emotions make them
feel inside
■■ need help learning how to talk about the way
they feel

Help your toddler understand and cope with their feelings
■■ Describe and show empathy—give them a name for their feelings. Help them see
that you understand by using a kind voice to say things like, “I see you’re mad. You
really wanted that toy.”
■■ Distract. Use another interesting toy, game or song to distract them.
■■ Redirect. Change the activity or move it to a more suitable place.
Your older toddler’s ability to think is developing. When you name their emotion and show
that you understand, you’re building connections between the emotional and thinking
parts of their brain. The next step is to help your toddler learn to show their emotions in
ways that will not hurt them or others. This process will take many years to develop. Your
child will need lots of help and practice.
Learning to regulate emotions

Older toddlers show their emotions with
physical reactions because they don’t have Learning to solve problems
the words to use yet. When they’re excited, Children can solve problems and
your toddler may jump, skip and laugh loudly. deal with conflict better once they
When they’re upset, they may yell, throw can regulate their emotions. They’ll
need your help to build these skills
things, hit or bite. You may be surprised
over the next few years.
by the level of your toddler’s aggressive
behaviour, but know that it may be the only
way they know how to express themselves
right now. Your toddler needs your help to
learn other ways to show their frustration.
“ ”
Parenting is as easy as being the person you are, and as difficult
as being the person you want to be.
~ Sanjeev, dad of three children

Let your child know that you accept their feelings, even if their behaviour is not okay. You

can help your toddler begin to manage their emotions by providing warmth and structure.
Here are some examples:

■■ Be patient—remember ■■ First, name the feeling and show them you understand. Limit
they’re just learning. behaviour that could hurt them or other people and say things
■■ Accept your toddler’s such as, “I see you’re angry. It’s okay to be angry. It’s not okay to bite.”
feelings and let them know ■■ Explain your reasons in words your toddler can understand,
you understand. such as “Biting hurts people.”
■■ Don’t make fun of or laugh ■■ Give them one or two ideas for what they can do instead. This
at them when they’re upset could include making a mad face, sitting with you to calm
or afraid. down, taking a deep breath, using their words to tell you how
■■ Stay calm and help your they’re feeling, walking away or hugging their stuffed toy.
child learn to be calm. ■■ As they get older, ask them what they think they could do,
rather than telling them what to do. With lots of practice, they’ll
be able to think of these ideas when they’re on their own.
For more information about self-regulation, see page 26.
Temper tantrums
When your toddler is upset, they
may cry uncontrollably, yell and
thrash about. This is a temper
tantrum. A temper tantrum is simply
an emotional outburst. This is a
normal part of child development.
Most children have tantrums.
A tantrum may be the only way

your toddler’s body knows how to
show their strong emotions. When
your toddler is having a temper
tantrum, they’re feeling overwhelmed. They may When they want
be feeling frustrated, tired, hungry or rushed. something they can’t have
They’ll need your help to learn a different way to
Be kind and firm. Explain why
manage their emotions. they cannot have it. Reassure
them that you understand their
Tantrums usually start around 18 months and
feelings. Stick with your decision
peak by 3 years. They should gradually happen if you’ve said “No.”
less often after that and will become less intense.

Preventing tantrums
You cannot prevent every tantrum, however here are some ideas that may help:
■■ Plan regular meals, snacks and sleeping ■■ Learn what frustrates or overwhelms
times as toddlers become overwhelmed your toddler, such as too much noise or
quickly when they’re tired or hungry. too many choices.
■■ Learn how toddlers usually develop to ■■ Find a balance. Know when to set limits
help you know what to expect. and when to offer choices, when to be
■■ Watch for early warning signs. If you see flexible and when to be firm.
your toddler getting frustrated, it may ■■ Make sure your toddler has a chance for
help to distract them, end a shopping active play every day.
trip, change the activity or take a break. ■■ Try not to plan too many activities in the
same day.
“ I think that patience comes before everything else. Taking a step back
to re-assess helps to keep your perspective on what is happening.
”
~ Dave, dad of two children
Learn from previous tantrums. As adults, we do not always react the way we hope to. After
a tantrum, and once you’re feeling calm, think about how you responded and what you
may want to do next time. Remind yourself of your new plan often so that it comes more
easily next time.
Punishing or making fun of your toddler will not help them learn about their emotions and
will make the tantrum worse. Help your toddler understand their feelings and learn how to
show them in healthier ways by guiding and reassuring them. For more information about
positive discipline, see page 29.
It’s normal for toddlers to have a tantrum once in a while. If these outbursts happen often,
are violent or you’re concerned about them, call Health Link at 811 or talk with your health
care provider.
If you find yourself getting frustrated with your child, take some slow, deep breaths.
Remind yourself about what you’re trying to help them learn. Your calm and nurturing
response helps your child reach their goals while building attachment. Children learn
much better when they have a strong emotional connection with you. For more
information, see page 25.

Calming your child during a tantrum
Here are some ideas to help calm your toddler:
■■ Give them space and make sure they’re safe. Some children like to be held when they
feel out of control. Others may want a hug only after they’ve calmed down.
■■ Stay calm and be with them. Stay quietly with them until they calm down. It might
help to take them somewhere quiet.
■■ Once they’ve calmed down:
Help them name or describe their feelings.
Show them you understand.
Tell them what behaviour needs to change and why—based on their stage of
development.
Help them think of other ways to show their feelings.
Let them re-join the activity they were doing or move on to something else.
■■ Do not make a toddler apologize. They don’t understand why they acted the way
they did.
■■ Remind yourself that your toddler is learning. They’ll use the skills you teach them
now throughout their life.
Your emotional
response to tantrums
Self-regulation is one of the most
important skills we can teach
ourselves and our children. Calming
yourself before responding helps
people of all ages re-connect the
emotional and thinking parts of
their brain so they can make better
decisions (see page 27).
“ Love your kids unconditionally, it makes life easier.
~ Seham, mom of three children ”

Playing with others
Toddlers start to notice other
children of all ages more and
want to be around them.
However, your toddler might
not get along with others
right away. Some children
learn social skills quickly and
others will need more practice
to learn how to get along with
others. Your toddler will learn
this with time, practice and
help from you and others—especially when they spend time with people who model and
encourage sharing, taking turns and communicating in a positive way.
As toddlers develop, the way they play changes. There are also differences between how
young and older toddlers play.
How young toddlers play How older toddlers play
■■ play by themselves, with you and with ■■ begin to play on their own for short periods, yet
other adults they know still need to have you close by
■■ like to watch other children and copy ■■ like to be with other children
what they see ■■ play beside one another, but usually not together
■■ cannot follow rules yet ■■ are more aware of themselves as separate people
■■ need constant attention with you or an ■■ like to copy you and help with simple chores
adult close by (active supervision)
■■ need you to set fair and consistent limits to keep
them safe
Sharing and taking turns

It takes time for toddlers to learn to
Young toddlers are
share. They’re just figuring out who they
learning to take turns
are and what belongs to them. They’ll
It’s better if each child has their own toy to
often say things like, “Mine,” or “My nose,”
play with so they don’t have to share yet.
or “My toys.” It may seem like your young
Offer some toys like balls to encourage
toddler thinks everything belongs to young toddlers to interact and take turns.
them. Your toddler is not being selfish.

They need to learn about ownership

before they can learn how to share. Older toddlers are
Activities that involve taking turns will learning to share
help. Most children are not able to share Give older toddlers lots of practice
well until they’re over 3 years old. taking turns doing things like rolling a
ball back and forth. This skill will help
You can help your toddler learn to share. them learn to share.
■■ Give them lots of practice taking

turns every day with things such as
sliding down the slide and turning
pages in a book.
■■ Use the language of sharing in a
positive way. When rolling a ball back
and forth, say “My turn,” as you roll it
to your toddler. As they roll it back say,
“Your turn.”
■■ Give them lots of chances to be with
other children.
■■ Sit close to toddlers when they’re
playing together so you can step in
quickly when needed. Toddler property laws
■■ Notice and comment when your If I like it, it’s mine.
toddler does something you want to If it’s in my hand, it’s mine.
encourage, such as, “Sophie is very happy
If I can take it away from you, it’s mine.
that you gave her a turn to play with
If I had it a little while ago, it’s mine.
your car.”
If it’s mine, it must never appear to be
■■ Have two sets of similar toys, if
yours in any way.
possible, such as two shovels and two
If we are building something together,
pails in the sandbox. Put your toddler’s
all of the pieces are mine.
special belongings away when friends
come to visit. They may not be ready to If it looks just like mine, it’s mine.
share these yet. If I think it’s mine, it’s mine.
If I give it to you and change my mind
later, it’s mine.
If it’s broken, it’s yours!
~ Author Unknown

Building healthy relationships
You communicate with your toddler
through your words and actions. When
you talk with your toddler, get their
attention first. Stop what you’re doing
and call their name. Wait for them to
look at you before talking. How you
communicate with your toddler will
help them learn this important skill to
help them build their own relationships
with others in the future.
Use communication to build your

relationship with your toddler:
■■ Show pleasure. Tell your child how pleased you are when they learn new things
and act in ways that are okay. Make sure your voice and face match your emotion. For
example, if your child zips up their coat and says, “Yes!”, match their excitement and say
“You did it!”
■■ Use the sound of your voice. If you’re concerned, sound concerned. If you want your
child to stop throwing their food, tell them to stop, firmly without yelling. Then tell them
what you want them to do instead, for example, “Leave your food on your plate, please.”
■■ Getting down to their level. When your child talks to you, squat down so your eyes are
level with theirs, if possible. Even when you’re busy, turn and look at them.
■■ Really listen. Listen and respond to what your child says and to their thoughts and
feelings.
■■ Keep it simple. Children need simple rules and limits suited to their age. Keep
information short and use words your child understands. For example, use short
rules that tell them what you want them to do such as, “You need to walk,” instead of
“Don’t run.”
Planning for child care

Your toddler is developing a strong sense of attachment with you and prefers to be with
you. They’re better able to understand that when you go away, you’ll come back again,
but they have no sense of time. To them, 5 minutes may seem like 5 hours—or the other
way around, depending on what they’re doing and who they’re with. If there’s a new
caregiver, a new baby in the home, or something else that has changed, you may also see
an increase in separation anxiety (see page 321) at this stage.

If you find your child is having a

hard time separating from you,
here are some things you can do
to help them when they’re going
to spend time away from you,
such as at child care.
Plan ahead:
■■ If you’ve been home with
your child since birth, start
with short separations. Make
sure they’re in a safe place,
then leave the room for a few minutes or go to the bathroom on your own. Notice and
comment when you return, for example, “Here I am, back again.” This helps them know
that when you go away, you’ll come back.
■■ Try to take them to the new child care just to play. Over the next several weeks, gradually
leave for longer periods of time until they’re confident that when you go, you’ll come
back again.
■■ Talk to their caregiver about what your child is like and to find out about the daily
routine. Let your child know that their routine is changing and what the new routine
will be.
■■ If they have a favourite toy or blanket, it may give them comfort to take it with them.
When the day comes:

■■ Stay calm and comfort them.
■■ Develop a goodbye routine. Maybe it’s four quick kisses and a high five or a hug and
a kiss and a wave goodbye. This can give some structure so they know what happens
when you leave. Make your goodbyes short and try not to return after saying goodbye,
unless you absolutely have to. Never leave without saying goodbye—not saying
goodbye can make separation anxiety much worse.
■■ When you return to pick them up say something like, “Here I am, back again, just like I
said.” This helps them know that they can trust what you say.
■■ Reassure them. If they seem sad, say something like, “I know you feel sad when I leave. I
feel sad too. I’ll miss you during the day, but I’ll be back soon.” You can also encourage and
comfort your child by talking about new friends and toys they’ll have the chance to play
with. Say something like, “Today you get to play with those colourful blocks we saw and play
with your friends.”

When you’re back together, show your child
how glad you are to see them and ask them Keep their trust
about their day. Let them tell you stories Never threaten to leave your child,
about what they did. Use the caregiver’s and not even as a joke. This can break
other children’s names in your conversation. their trust and harm your relationship.
Help your child build new relationships by
getting to know the people in their life.
Separations are harder if your child is hungry, tired or sick. If your child continues to cry
when you leave, talk with their caregiver. It can be reassuring to know that the crying
stops shortly after you go. If that’s not the case, work with your caregiver to think of some
strategies that will help.
Typical toddler behaviours

Saying “No”
It can be confusing and frustrating when your
toddler, at around 18 months old, starts saying
“ What I have learned is how a
toddler thinks, ‘I want what I
want, when I want’ and once
“No.” A toddler’s language is limited and this is I was able to appreciate their
”
their way of telling you: point of view, it helped me to
■■ they don’t like something help them.
■■ they’re frustrated ~ Sue, mom of three children
■■ they want to do something on their own
It’s important for your child to be able to say “No.” It gives them some control of their
world. They’re not saying it to upset you.
Sometimes when you say “No” less often, your child will say it less too. Here are some
examples of how you can say “No” less often:
When your toddler wants… Try saying... Instead of saying…
To go outside to play "Yes, as soon as we're done lunch.” "No, not now.”
To touch something breakable "That one can break. Let's put it away. "No. Don't touch!"
You can have this one instead.”
More juice "You can have water if you're thirsty." “No, you've had
enough."

Doing things by themselves

Toddlers need and want to do things by
themselves. They may get frustrated when they
don’t have the skills to do what they want.
At this age, your toddler:

■■ needs to touch and play with everything
around them—for example, they may just
want to know what’s in the cereal box when
they happily dump the contents on the floor
■■ figures out how things work by taking them apart
■■ has no idea about danger and safety
■■ starts to learn the difference between what they can and cannot do
■■ realizes that sometimes you think differently than they do
They’ll need your help and support while they learn these things.
Teaching positive behaviour

All children need and want
their parents’ attention. If your Praise or encouragement?
toddler only gets your attention Many parents use praise when they’re happy with
when they’re behaving in ways the way their children are behaving (e.g., “Good job!”
that are not okay, they may or “You’re so smart.”). The challenge is that praise
continue these behaviours loses its meaning for children when used too much.
because they need you to Encouragement is more descriptive and helps
notice them. Busy parents can your child be more aware that their actions are
sometimes forget to notice appreciated (e.g., “Thank you for picking up your
the times when their children toys and putting them away. That is a big help.”).
behave in ways that are more Encouragement helps your child feel good about
themselves and builds their confidence and
positive. When you focus on
self-esteem.
your child’s positive behaviour,
you’re likely to see more of it. Give your child encouragement more
often than praise to help them feel
Encourage them with things
good about themselves and build their
such as smiles, hugs, saying ability to rely on themselves. To learn
“Thank you,” and commenting more, visit the Printables section at
about what they’re doing. This healthyparentshealthychildren.ca/resources
kind of encouragement helps
your toddler learn.

Here are some other ways to help your toddler learn positive behaviour:
■■ Set up your home so you can say “No” as little as possible. Remove or lock up
dangerous items and objects. Put things your toddler can use at their level. Use plastic
cups, toy baskets, low, secure bookshelves and coat hooks so they can learn to do some
things on their own.
■■ Treat your child with respect. Think about what they’re trying to do, listen to their
point of view and help them learn what to do next time. This is how they learn to treat
you and others with respect.
■■ Notice and comment on what they’ve done when they behave in a way that you want
to encourage. Be specific such as saying something like, “Thank you for putting away
your toys. Now no one will trip or hurt themselves.” This will have more effect than a simple
“Good job!”
■■ Explain and be consistent. When your child does something that is not okay, tell them
what they did, why it’s not okay and what they can do next time instead. Be consistent
whenever this happens, so they know which behaviours are not okay.
■■ Toddlers need
repetition. Know that
your toddlers won’t
remember things you’ve
told them before. A
toddler’s brain is still
forming connections
in the thinking part of
the brain. You may have
to repeat what you say
many, many times for
those connections to
get strong enough for
them to remember.
■■ Model problem-solving. Talk through the steps as you deal with a problem. If your
toddler spills their mashed peas on the floor, calmly say, “Uh oh, we have a problem.
What do we need to do?” Wait to see if they have an idea and then help them clean up.
This gives them the words they’ll need to problem-solve. For more information, see
page 406.

Teaching cooperation

When your child learns to
work with others to get
things done (cooperation)
at home, they’ll have more
success cooperating with
other children and later
at school.
You can help your child

learn to cooperate by
providing warmth and
structure.

■■ Have reasonable expectations. Know what ■■ Prepare for what comes next. Give your
toddlers can and cannot do. toddler a 5-minute warning before they
■■ Have fun. Toddlers like to be with you and need to change activities. For example, say
please you. something like, “We’ll need to go in 5 minutes.”
You could set a timer so they can learn what
■■ Be positive. Use positive requests instead of 5 minutes feels like.
negative commands. “Please use your spoon,”
will likely work better than “Don’t eat with
■■ Give choices between two things when you
your fingers.” can, as long as both choices are available and
acceptable. Offer choices like, “Would you like
the blue or green pyjamas?”
■■ Do not give a choice if there isn’t one. This
could include times such as when your child
needs to brush their teeth or go to bed.
■■ Keep it interesting by rotating toys and books
every week or so. You can borrow books from
the library or toys from a toy-lending library, if
there's one in your area.
■■ Build routines. When things are done the
same way each time your child learns what’s
expected. For example, make clean-up fun
with a special song and they'll learn that
cleaning up is part of play.

Health Checkups
See your child’s health care
providers as scheduled and
based on your family’s needs.
This will help keep your toddler
as healthy as possible. Public
health nurses and other health
care providers can help if you
have questions or concerns
about your toddler’s health,
growth and development or
other family issues.

keeping children healthy and
safe at any age, see page 76.

Your toddler is due for immunizations at 12 and 18 months. Call your community or public
health centre about one month ahead of time to make an appointment. If your child’s
immunizations are not up to date, talk to your public health nurse about how to get back
on schedule. For more information about immunizations, see page 82.
During your visit, your public health nurse will also check things such as your child’s
growth, ask about their health, as well as about how you’re doing and answer any
questions you may have (see page 78).
Oral health
If you haven’t already, set up regular visits to the dentist for your toddler. Take your child
to see a dentist by the time they’re 12 months old or within 6 months of their first tooth
coming in, whichever comes first. If your family has limited income and needs support for
dental care, you may qualify for the Alberta Child Health Benefit (see page 79).

Vision

Your child should have their vision checked by an optometrist by the time they’re
3–5 years old. Children who have a family history of childhood eye problems or who are
having problems with their vision should see an optometrist sooner. Your child may be
having problems with their vision if they:
■■ cover one eye or tilt their
head to look at things Call Health Link at 811 or your health
■■ hold things very close care provider if your child has any of the
following:
■■ don’t recognize you from a
distance ■■ does not understand someone unless
they’re facing them or in the same room
!
■■ have a cloudy film on any part
of their eye
■■ speaks loudly
■■ wants the volume of music or the TV
Vision and hearing tests are turned up very loud
offered in Alberta at no cost for
■■ does not respond when called
children 17 years and younger.
For more information, call ■■ needs things to be repeated
Health Link at 811 or talk with ■■ has any other signs that concern you
Birth–2 2 4 6 12 18 2 3–4 years 5 years and
months months months months months months years beyond
Check with your

Check with your doctor Check with your doctor
doctor to find out the
Doctor √ to find out the checkup to find out the checkup
checkup schedule at
schedule at their office schedule at their office
their office
Immunization √
Regular
Regular checkups as
checkups as
Dental √ recommended by
recommended
your dentist
by your dentist
√ √
Early vision checkups
Vision Early vision checkups with (with optometrist
with your doctor
your doctor at 3–5 years old)
Other health
care providers

Preventing Injuries
Toddlers are very curious and active
explorers. Your toddler can now climb,
slide, swing, open doors and move
quickly. They’re still too young to
know what’s safe and to remember
all of the safety rules. It will take them
time to learn these rules. Because of
this, your toddler is more likely to get
into dangerous situations and be at
risk of injuries. Watch them closely
whenever they’re awake.
Be safe
around water
Toddlers are
attracted to water,
however they don’t
understand the
danger. Even when
your child knows how
to swim, supervise
them at all times.
For their age and stage of development, here are some areas that need attention to
keep your toddler safe from injuries.
■■ Falls, see page 104 ■■ Pet and animal safety, see page 112
■■ Burns and scalds, see page 109 ■■ Playing outdoors, see page 114
■■ Water safety, see page 111 ■■ Trampolines, see page 122
■■ Choking and poisoning, see page 107 ■■ Car seats, see page 123


Parenting is full of everyday stresses. Parents of
toddlers can find life challenging because their
children are always on the go and need to be so
closely monitored. You can find other situations
create stress too—at home, at work or other
family demands. How you manage this stress
is important for your emotional and physical
health. It’s also important for what you’re
teaching your children.
When you self-regulate, you recognize that your

stress response has been set off and you know
what to do to calm yourself. You’re able to:
■■ recognize that you’re feeling stressed
■■ name your emotions
■■ calm your body’s response to stress
■■ shift your thinking to cope with the situation
■■ calmly solve the problem or take care of yourself
Here is an example. You and your toddler are trying to get out of the house in the
morning. You go to buckle your child into their car seat and they yell “No!”, throw out their
arms and legs, and turn their body as stiff as a board.
How does your body feel? Are your muscles tense? Is your breathing and heart rate faster?
Are you feeling furious that this is going to make you late for work? If you are, your stress
response has been triggered.
There are two ways that you might react:

■■ Get mad, force your child into their car seat, drive your screaming child to day care, then
feel terrible for the rest of your day.
■■ Take a moment to self-regulate. In this moment, you recognize that your stress response
has been set off by the way your body feels. These signs are like a yellow traffic light
that warns you to stop and take steps to slow down. You tell yourself, “I’m feeling really
frustrated because this is going to take too long and I’m going to be late,” and you calm your
body’s response.

Calming yourself will help activate the ‘thinking part’ of your brain. Now you can think,
“What does my child need right now?” and remember that toddlers like to do things by
themselves. You say to your child, “I wonder if you could snap the buckle in today?” Your
toddler hops on to their seat, puts on the straps, tries to buckle up and asks you to help.
You have worked together to solve the problem, and your toddler has avoided a tantrum.
When you hear that satisfying click, you celebrate together. And best of all, you’ll both
have a much better day.
Self-regulation is an important life skill for you and your child. Role modelling and
supporting your toddler to learn this skill will help them throughout their life (see page 27).
When tantrums happen in public

Many parents find it stressful and may even feel embarrassed
when their child has a tantrum in public. Although this is normal,
there are ways you can make it easier. Here are some things to
think about:
■■ Try to remember that most toddlers have tantrums and this is
part of typical development. Chances are there is another parent
nearby who understands.
■■ Keep your focus on your child and stay calm.
■■ Keep your family safe. If you sense a tantrum coming that you
might not be able to stop, move your family to a safe spot, away
from traffic or other hazards.
■■ If you have older children, tell them to stay close by so you don’t
have to worry about where they are. It may help to let your
children know what your expectations are before going out.
“ Cherish the good and the bad. All phases pass and will be missed.
”
~ Xiu, mom of a preschooler

Life with a busy toddler

Every stage of your child’s life will bring With kids it’s easy to have
”
new joys and challenges. You’re always higher highs and lower lows,
learning new skills as a parent. You may find but it’s worth the ride.
it challenging to keep up with your busy
toddler. At times, you may get upset and find ~ Marco, dad of two children
it hard to stay calm. Pay attention to how your
body feels when you’re stressed. Once you
know the signs, you can start to respond to them. Let these signs of stress be your signal,
like a yellow traffic light, that warns you to stop and take steps to calm down. Your toddler
will be calmer when you stay calm.
Here are a few suggestions that may help:

■■ Breathe. Take a deep breath and slowly release it to a count of 10. Concentrate on what
you really want for your child or on something you’re thankful for.
■■ Be positive. Think about how your toddler is growing, learning and discovering.
■■ Understand. Toddlers don’t know their limits yet. They’re still learning what they can
and cannot do. In their minds, grandma’s new lipstick is just another crayon. Remember,
your child is learning from you. If you punish or hit them when they act out or get upset,
they’ll learn to do this to others when they have a problem. Understanding toddlers’
typical growth and development will help you better support them at each stage.
■■ Take a break. All parents need a little help sometimes. Before you get to a point that
you can no longer cope, ask a relative, friend or caregiver to give you a break. If you’re
alone with your child, put them in a safe place like their crib and leave the room for a
few minutes to calm down.
■■ Look after yourself. Parents of toddlers are often stressed because their children are
always on the go and need to be closely monitored all the time. Try the relaxation
activity on page 260.
■■ Ask for help. If you’re feeling overwhelmed, talk to your partner or other support
people. You can also call Health Link at 811 or talk with your health care provider
for support.

“ Toddlers are so much fun. I find it so satisfying to see them learn to run and
talk and sing. I don’t miss the baby stage at all. I love seeing them explore
everything around them. My favourite memory is of my daughter walking in
”
the leaves and laughing at the crunching sound it made. Those little moments
are so amazing and are really the reason why we decided to have kids.
~ Justin, dad of one child

Preschoolers:
3 and 4 Year Olds

381
Preschoolers: 3 and 4 Year Olds
Your preschooler lives life to the fullest and is becoming more independent
every day. They are starting to develop their own identity. Your preschooler
is getting better at thinking about what might happen when they do things.
They still need your help to learn what is and is not okay for them to do and
to keep them safe as they move about and explore the world around them.
In this chapter, you’ll learn about your child’s development and how to help
them deal with new experiences, getting along with others and starting
preschool. There is information on how you can help develop their reading
skills as well as their skills for all types of play. You’ll also learn what you can
do to support your preschooler to develop a healthy self-esteem.
382
Your Preschooler’s Development
PRESCHOOLERS: 3 AND 4 YEAR OLDS

As your child enters their preschool years, you’ll see remarkable changes. Preschoolers
are now learning to play with and get along with others and becoming much more
coordinated in their movements. By the time they’re 4 years old, they’ll have many
interesting stories and adventures to share with you. This chart gives you information
about the developmental milestones and tasks your child is working on in the preschool
years. In this chapter, you’ll learn what you can do to help your child as they grow
and develop.
3 and 4 years: The ‘thinking’ stage

Tasks Milestones
During this time your Physical

preschooler is continuing ❑❑ eats with a spoon and fork
to practice earlier tasks
❑❑ dresses and undresses themselves
and learning to:
❑❑ balances and hops on one foot
■■ manage emotions:
❑❑ throws a ball, underhand and overhand
starting to cope with
their feelings and ❑❑ walks in a straight line, forwards, backwards, and up and
emotions down the stairs
■■ develop empathy: ❑❑ climbs on things like furniture and playground equipment
understanding and ❑❑ kicks a ball
caring about other ❑❑ uses paints, scissors, pencils and crayons to create shapes
people’s feelings and faces
■■ take initiative: planning ❑❑ develops bladder and bowel control both day and night
and acting on their own
❑❑ does simple chores with some help and direction
thoughts and ideas
■■ feel capable: Emotional
developing skills to
do more and more on ❑❑ gets better at being able to identify and name their own feelings
their own ❑❑ uses words more often to express their feelings
❑❑ fears real and imaginary things such as the dark, thunderstorms
and monsters
❑❑ exaggerates the truth
❑❑ likes to talk about body functions
❑❑ develops a sense of humour

3 and 4 years: The ‘thinking’ stage

Tasks Milestones
Social
❑❑ begins to share and take turns
❑❑ hits less, name-calls more
❑❑ likes playing with other children
❑❑ uses imagination and themes in pretend play
❑❑ may have an imaginary friend
❑❑ likes to talk
❑❑ enjoys group activities and games

❑❑ asks “Why?”
❑❑ uses longer sentences for more detailed stories
❑❑ talks about the past and future
❑❑ shows improvement in grammar and their words become clearer
❑❑ starts to understand the difference between real and
imaginary things
❑❑ listens to and understands short stories
❑❑ sings simple songs and recites rhymes from memory
❑❑ has a very active imagination and tells short stories
❑❑ by 3 years old, they can be understood by you 75–100% of
the time
❑❑ by 4 years old, they can be understood by you all of the time
To use an interactive tool about

your preschooler’s development,
visit the Tools section at
If you have concerns about your child’s

development, call Health Link at 811 or talk
with your health care provider. You can also
go to a Parent Link Centre and ask about
the Ages and Stages Questionnaire (ASQ).
To learn more, visit the Links section at

Preschoolers
As children enter their
preschool years, they
know what they like and
dislike. Their emotions
tend to be more stable
and predictable. As they
understand their emotions
better, they may start
telling you their feelings
and opinions.
Your preschooler may be

taller or shorter, bigger
or smaller than other
children their age. They’ll each have their own pattern of growth. Talk with your health care
provider if you have questions or concerns about your child’s growth.
Preschoolers want to play with other children. Over time, they’ll learn how to share and
play with others. They’ll also:
■■ become more skilled and coordinated in their movements
■■ love to imitate, sing, recite rhymes and have fun with words
■■ have great imaginations and sometimes have trouble understanding the difference
between what’s real and what’s pretend
During this stage, your child will start

wanting to make their own plans
and acting on their own thoughts
and ideas. They feel happy with
themselves when they can do things
on their own. It will take time and
practice for them to feel confident
about what they can do. When you
give your preschooler lots of chances
to develop their skills, they’ll learn
that they’re capable. This will help to
develop their self-esteem.

Feeding Your Preschooler
A healthy feeding relationship and eating together as a family continues to set healthy
eating habits for life. You’re still responsible for what, when and where food is offered. Your
preschooler is responsible for choosing whether to eat and how much to eat (see page 49).
Preschoolers are busy all day long so they need to eat often. Yet, they have smaller
appetites and stomachs than adults and find it hard to sit still for very long. Preschoolers
do best when they eat 3 meals and 2−3 snacks spaced evenly throughout the day,
whether they’re at home or away.
To help keep your preschooler healthy,

make sure to offer: Vitamin D for your preschooler
Give your preschooler a supplement
■■ regular meals and snacks throughout of 400 IU vitamin D, every day. Most
the day children do not need multivitamins. If you
■■ a variety of foods from Canada’s Food have questions, check with your health
Guide (see page 51) care provider.
■■ water throughout the day
Preschoolers love to come up with and act on their own ideas and plans, in everything
they do. In terms of eating, they may want to start helping to prepare or serve food.
Cooking with your child teaches them many skills, they’ll love spending time with you (see
page 404) and it may help them be more interested in trying new foods.
It’s normal for your preschooler to want to eat only certain foods, or to enjoy something
one day and dislike it the next. You may worry that your child is fussy about what they’ll
eat. They may just be making their own choices (see page 336).
A few simple table manners can make meals more enjoyable at home and when eating
out. Decide which table manners are important for your family. When you use these
manners all the time, your preschooler will learn to use them too. For more information
about eating out, see page 55.

Everyday Care

Your preschooler is learning how to help care for
themselves by doing things like feeding, dressing
and brushing their teeth. They’re starting to take
more initiative and feel proud of themselves and
their new abilities.
Sleeping
When children get the sleep they need, they’re
happier and healthier. Preschoolers need about
10–13 hours of sleep, including naps. Many
children continue to nap for about 1 hour a day
until they’re over 4 years old, but some children
may stop napping before that.
Your preschooler is probably not getting enough

sleep if they:
■■ regularly fall asleep during the day such as in
the car, watching TV or while looking at books
■■ need you to wake them up every morning
■■ seem cranky during the day
■■ nap more than once a day
A regular sleep routine will help your child shift from their active, busy day to getting ready
for sleep. For more information about sleep routines and helping your child stay in bed,
see page 342. If you’re concerned about your child’s sleep patterns, call Health Link at 811
or talk with your health care provider.

Toilet teaching
Your preschooler may just be starting to learn how to use the toilet or they may already be
comfortable using it. Girls tend to be ready for toilet teaching before boys. Some boys are
not ready until they’re 3 ½ or 4 years old. Here are some things to think about when you’re
toilet teaching your preschooler:
■■ Have them wear clothing that’s easy to pull up or down will make toilet time easier.
■■ You may need to help your child with wiping after they have a bowel movement.
■■ Be patient, toileting accidents are common when your child is learning to use the toilet.
For more information on toilet teaching, see page 343.
“ Don’t push toileting. If your child can’t get on the toilet, doesn’t have the
”
words or doesn’t show interest, then they’re not ready. Watch for readiness, be
patient, and remind yourself that they’re just learning.
~ Anna, mom of three children
Bedwetting
Urinating during sleep (bedwetting) is common in preschoolers—they don’t do it on
purpose. Your child may be a deep sleeper and unable to recognize the signal that tells
them their bladder is full. It may also be that they are just not yet developmentally ready to
be able to hold it in all night long. It’s very common for bedwetting to run in families and
often times a mom or dad may have had this problem as a child as well. Bedwetting can
be upsetting and your child may feel bad or embarrassed. They need your understanding,
love and support.
Try taking your child to the bathroom right before they go to bed. You can also try taking
them a second time before you’re ready for bed. Use a waterproof cover to protect your
child’s mattress and be calm and reassuring if you have to clean up in the morning. Show
your child that you have confidence that they’ll soon be able to stay dry all night.
While most children outgrow bedwetting by the time they’re 5 or 6 years old, some may
take longer. If you have questions or concerns, call Health Link at 811 or with your health
care provider.

Teeth and mouth

By now your preschooler may feel that
they’re big enough to brush their own
teeth. Encourage this by letting them
brush at the start, then help them finish
brushing and flossing their teeth (see
page 347). Talk about what you’re doing
as you’re doing it and let them see you
doing the same with your own teeth. Your child will continue to need your help until
they have the coordination to brush and floss their own teeth, about the time when
they’re able to write their name. Regular dental care will give your child the best chance of
having healthy teeth for life. Take them to see your dentist for regular checkups. For more
information on dental health, see page 61 and for financial supports available, see page 79.
Many preschoolers are able to spit. Once your child is able to spit, increase the amount of
fluoride toothpaste to a pea-sized amount on their toothbrush. Remind them to spit it all
out after brushing.
During this age, preschoolers usually have:

■■ all 20 of their baby (primary) teeth
Help your child stop sucking
■■ spaces between their teeth to give the their thumb, finger or soother
larger adult teeth room to grow in over ■■ Limit sucking to certain times or
the next few years places.
■■ Look for triggers and distract your
Sucking thumb, finger or soother child or offer a substitute. If they
It’s a natural reflex for young children to suck their thumb while doing one
suck their thumbs, their fingers or a soother. activity, switch to another activity.
They may suck their thumb when
They suck for pleasure, comfort and security.
they feel stressed or afraid. Reassure
Sucking can affect how your child’s teeth
them or give them a hug or their
bite together, as well as how the jaw and favourite toy to cuddle.
bones that support the teeth grow. The
■■ Offer gentle reminders. Speak
earlier your child stops sucking their thumbs,
calmly about how sucking may
their fingers or a soother, the less likely that affect their teeth. Do not punish or
the sucking will affect their teeth. Most make fun of them.
children stop on their own by the time ■■ Encourage and be patient. Try not
they’re 3 years old. After that, your child may to draw attention to it.
need help from you and their dentist.
If you have questions or concerns, call Health Link at 811 or talk with your dentist or health
care provider.

Your preschooler will go through many changes in just a few years. They are becoming
their own person and their learning and playing are preparing them for school and
classroom learning. All areas of your preschooler’s development are interconnected.
Development in one area affects development in all other areas. Your preschooler’s
development is guided by their brain.
Physical
Emotional
Cognitive
Social

Your preschooler’s developing brain

Your preschooler’s brain is developing
rapidly. In fact, a 3-year-old’s brain is
twice as active as an adult’s brain. Brain
cell connections are getting stronger
and connections that are not often used
are pruned away so the brain can work
more efficiently. Your child’s brain is now
forming strong brain pathways that
will help them develop the skills they
need for life. This skill set includes all of
the things that you’ve been supporting
your child with since their birth, such
as self-regulation, thinking, reasoning,
remembering, taking turns, sharing and

focusing their attention. All these skills will help your child be ready for a more advanced

type of learning once they reach school.
Your preschooler is now likely asking you lots of interesting questions. They are trying to
figure out how things work, so you may need to be patient as you answer. They’re getting
better at being able to understand the information you share with them.
Brain cell connections become stronger when you and your preschooler engage in
serve-and-return interactions. Here are some examples of what this might look like with
your preschooler:

3 and 4 year olds
Your preschooler serves when they: You return their serve when you:
■■ ask "Why?" ■■ talk to them about how things work and ask
them what they think
■■ recognize and read signs such as store names ■■ play a game as you go for a walk or ride in the
car together, such as looking for store names,
signs and other things to read
■■ enjoy rhymes and start to make their own, ■■ have fun making rhymes together—say a
such as ‘hat-cat’ word and see if they can find one that rhymes
■■ name some of their feelings and notice how ■■ talk about how the characters in a story or
other people are feeling how the people in your child's life are feeling
For more information, about how the brain develops, see page 19.
Other things you can do to help

your preschooler learn

Communicating with your preschooler
Preschoolers show amazing changes in their language. They quickly learn many words that
name and describe people, places, things, actions and experiences in their world. They
move from short sentences that leave out
some words like “Big dog coming now,” to
simple complete sentences such as “The big Language development
dog is coming to my house.” By 3 years old, your preschooler will
be able to:
Most people will understand your ■■ say short sentences like, “I’m going
preschooler’s speech and will be able to now.”
have conversations with them in person, on ■■ ask questions like, “Where you go?”
a tablet and on the phone. There may be and “What’s soap for?”
a few sounds your preschooler still cannot
■■ follow more complex directions
say correctly.
such as, “Please go to your room and
During this stage, you’ll see lots of bring me your teddy bear,” or “Pick
up your coat, go to the door and get
changes in your preschooler’s speech and
your shoes, please.”
language skills:
■■ Their vocabulary is growing rapidly.

As they learn new words, your preschooler may often ask, “What’s this?” They may
need to hear words many times before they use them. You may be surprised at the
words your preschooler learns.
They’ll have a word
for almost everything
they’re interested in.
This includes words to
describe things like “big”,
“round”, “red”, “pretty”
and “fast”.
They’ll start to tell stories
that may include a
lot of short sentences
connected by “And then.”
They may enjoy telling
jokes, even if they don’t
make sense.
vocabulary: the number and range of words a person knows

Preschoolers are very curious. They

■■
may ask many ‘who’, ‘where’, ‘why’ and

‘when’ questions to learn more about
their world.
They ask “Why?” because they want
to know how things work. They need
you to patiently show and tell them.
They ask “When?” because they’re
learning about time. Soon they’ll
understand that supper is ‘later’
and that you’re going to the library
‘tomorrow’.
■■ They’re learning how things are the same and different such as two apples are both
round and one is red and the other is green.
During play, your preschooler may line up or sort things into groups such as cars or
animals. They may talk about how the items in the group are the same or different.
They may have a favourite colour and will learn to name it. They may like to find other
things that are the same colour.
■■ They’ll start to choose books about things that interest them.
They may enjoy silly stories and rhymes by the time they’re 4 years old.
They may also start to add their own rhyming words during games and songs.
■■ They’ll be able to follow longer instructions, such as “Please put your toys away, take this
cup to the kitchen and then get a book for us to read.” They may be able to find an object
when you tell them it’s ‘in’, ‘on’, ‘under’, ‘behind’ or ‘in front’ of something.
Encourage your preschooler’s speech and language development

■■ Take time every day to talk with your preschooler. They’ll learn how to have longer
conversations and take turns listening.
■■ Start conversations. Take turns telling each other about your day, such as “What was
the best thing that happened today?” or “What did you learn?”
■■ Give them time to answer and try not to rush them.
■■ Comment on what they say and then wait for them to tell you more.
■■ Try not to ask too many questions that get a one-word answer, such as “Yes” or “No.”
Instead, ask questions that start with ‘who,’ ‘where,’ ‘why’ or ‘when.’

Early reading and writing
Ever since your child was born,
they’ve been building skills that will
help them to read and write. They
learn these skills when they scribble,
draw, talk about pictures and listen to
or tell stories.
Promote your preschooler’s reading

and writing skills:
■■ Go to libraries regularly. Let your
child pick out their own books.
■■ Read every day and often. Keep books handy so they can look at them and you can
read together anytime and anywhere, even for a few minutes.
Read books with pictures, rhymes and repetition. Your child will love to hear their
favourite stories over and over.
Try to find new ways to make familiar stories interesting for both of you. Start a
sentence and let your child fill in the words like “Jack and Jill went up the…” Act out the
story with their toys.
Run your finger along the words on the page so your child begins to connect the
sounds you’re saying to the printed words. This also shows them the direction of
reading in your language.
■■ Talk about signs and printed words in everyday life. Point out the words on cereal
boxes and signs.
■■ Draw and write indoors
and outdoors. Use chalk
on a sidewalk or a stick in
the dirt or snow.
■■ Let your child see you
read. Children who see
others reading are more
likely to want to read.

Understand by 3 years old
You should be able to understand what your child is saying most of the time by
3 years old.
To learn more about speech and language development and when to get help to
support your child:
■■ Visit your local Parent Link Centre to pick up a copy of the
Ages and Stages Questionnaire (ASQ) for your child’s age.
■■ Check out the Talk Box in the Links section at
■■ Call Health Link at 811 or talk with your health care provider to find information about
speech and language services in your area or if you have any questions.
If you’re concerned about your child’s speech and language development, it’s
important to act early. Your child can receive speech and language services at any age
at no cost.
Let’s play
Play builds healthy bodies
and minds and is important
for your preschooler’s growth
and development. Everyday
experiences and play are still the
main ways that your preschooler
learns. When they’re interested in
an activity, they’ll want to learn
and try new things.
At this age, your preschooler

needs many opportunities to play.
When they take the lead, they’ll
show more imagination and find
new ways to play. A couch cushion may become a river raft or a doormat may become a
magic carpet. When you join in the play, you can explore new ideas together.
It becomes even more interesting when children start to play together and do things such
as building a fort with boxes. Your preschooler may enjoy a music or an active play group
in your community—ask friends, other parents, your local library or recreation centre to
find out what is available in your area.

Active play
Preschoolers are becoming
more adventurous. Your
preschooler is using many of the
skills they’ve been building since
they were a toddler. They’re
now running, jumping and
hopping with confidence. Your
preschooler needs time and
space to play to burn off energy
and develop their muscles and
coordination. Playgrounds give
them the chance to swing, slide,
climb and jump.
Your preschooler needs you to supervise them while they play, even on equipment that
fits their age and stage of development. Preschool-aged children need different types of
equipment than older children.
The more they move, whether

they’re dancing to music or
playing a game of tag, the better
their coordination gets. They are
getting better at keeping their
balance while running and kicking
a ball.
Your preschooler may:

■■ ride a tricycle or a balance bike
■■ walk down stairs by alternating
their feet, like an adult does
■■ start to use their legs to help them move on a swing
Preschoolers need to be active for at least 180 minutes (3 hours) every day. This can be
done by providing your child with chances to play throughout the day.

Creative play

Your preschooler’s hands are growing
and getting more coordinated. At first,
your preschooler will pinch and poke the
treasures they find on their adventures such
as sticks, leaves and bugs. Then, they’ll be
able to stick on or peel off stickers and turn
knobs. Later, they’ll be more comfortable
using one hand to cut or colour, while the
other hand holds the paper.
Your preschooler can:

■■ use crayons or finger paints to colour a picture or draw simple shapes or pictures
■■ make objects out of clay, such as snakes and balls
■■ try to button up a coat, pull apart a snap, or pull a zipper up and down with more ease
■■ help plant seeds or dig with a small shovel
“ My 3 year old daughter loves playing with other children, but I noticed that
whenever we were in large groups with a lot of noise, she would just play on her
”
own. She had a lot more fun and social interaction when we set up playdates
with one or two other children her age.
~ Ellen, mom of two children

Pretend play
Pretend play is more complex for your
preschooler than it was when they were a
toddler. They often like to:
■■ pretend together with you or their friends
■■ take on different roles, such as being a bus
driver or a baby, playing house or creating
stories using puppets and toys
■■ sing, dance and act out short plays
■■ tell stories to each other
Pretend play helps preschoolers learn to

understand other’s feelings and roles. Your
child may like to pretend they’re a dad with a
baby, a construction worker, a bus driver or a
nurse. They may pretend that a row of chairs
is a bus. They may want paper and pencils to
make a shopping list, menus or a sign for their
restaurant.
As you watch your child play with others, you’ll see that they are also learning to
negotiate—they’re figuring out who will be who and who will do what. Who will be the
driver and who will be the baby? Who will come on the bus? What will they do at the zoo?
Resist your need to jump in to solve their problems for them. Watch and see if they can
work it out on their own.
If they are not able to,
offer your help if they
need it. What you see
and hear when your
child is playing with their
friends can be valuable.
You’re then able to talk
with them and praise
them for their ability to
get along with others as
well as teach them when
they need some help.


Preschoolers can now recognize and name their
emotions, such as happy, sad, mad or frustrated. You
may notice that they are starting to draw these feelings
in pictures. A preschooler’s emotions are just as strong
as they were in the toddler years, however they’re now
learning how to use their words, instead of their actions,
to tell you how they feel. They’re starting to learn to
self-regulate when they find ways to calm themselves
and cope when they feel emotions, such as frustration.
Your preschooler’s brain has better connections now

between the areas responsible for thinking and feeling.
With your help, they can now learn to:
■■ get along with others and show empathy (see page 74)
■■ focus, learn and solve problems
■■ use their thoughts to help manage their emotions and self-regulate
■■ be more comfortable being away from you, because they can now keep an image of
you in their mind and know that you’ll come back
■■ wait for short periods of time
As your preschooler gets older, they’ll start to:

■■ be less impulsive and better able to watch and think before they act
■■ use words to talk themselves through tough situations
■■ understand that other people have feelings that might be different from their own
■■ realize their actions have an effect on others
■■ remember events from the past
Preschoolers are getting better at managing their emotions. They can also have more than
one emotion at a time. For example, at a birthday party, they may feel excited, but also
upset that they don’t get the presents. They can still easily get overwhelmed, especially
when they’re tired. At times, preschoolers will still have tantrums and show their anger and
frustration with loud, physical outbursts. Tantrums are much less common by the time
they are 4 years old. For more information on tantrums, see page 363.
Talk to your health care provider if your child’s tantrums are happening more often, if the
tantrums are lasting longer or if your child is getting more aggressive.

Learning to get calm and problem-solve
Your preschooler may be ready to begin solving
their own small problems with your help. The
more they can practice solving their small
problems now, the better they’ll be at solving
them in the future.
Disagreements and problems can bring out

strong emotions. The most important first step
to solving these problems is to get everyone
involved to a calmer state. Your child can learn
to do this, however, they cannot do it on their
own. They’ll learn best by seeing you calm
yourself first and then by having lots of chances to
practice themselves.
Getting calm
When you’re having a conflict with your child or when your child is upset:
1. Calm yourself first.
2. Limit any behaviours that could harm your child or others (e.g., physically removing your
child away from another child if they’re hitting them).
3. Help your child get calm.
These steps are important before you try to solve the problem. Your preschooler will have
an easier time getting to a calmer state if you’re not upset. For information on helping your
child stay calm during a tantrum, see page 365.
Your preschooler may want to calm down with you, near you, or away from you. Every
child is different so find what works best for your child. If your child finds it easier to calm
themselves on their own, help them find a place where they feel comfortable. Ask them
what kinds of things or places help them feel calmer and create a cozy, comfortable space
at home that they can go to whenever they feel they need to take a break. If they need to
calm down away from you, help your preschooler think of a safe and comfortable place to
go. It needs to be a place that is okay for both of you.
Once you’re both calm you can work together to solve the problem.

Solving problems

Your preschooler is still learning. They’re just starting to be able to predict what will
happen if they act in a certain way. Try to understand what they might be feeling and
thinking. Then talk about how to solve the problem. Give your preschooler a chance to
think of their own solutions.
Steps for problem‑solving

1. Describe the problem without blaming or judging anyone. “You’re disappointed
because you wanted to wear your green socks, but they’re at grandma’s house.”
2. Think of different solutions together. Start by asking “How do you think we could solve
this problem?” or “What do you think we could do about that?”
3. Accept all ideas, even ideas that sound silly and add some of your own.
4. Decide together on the best solution that works for both of you. Try it out.
5. Talk about how well it worked. If it didn’t work well and the problem is still there, try
another solution from your list.
6. When a similar problem happens again:
Notice and comment if your child comes up with their own solution.
Remind your child of how you solved the problem together in the past if they can’t
think of any ideas.
Fears and anxieties

Preschoolers have usually overcome some of their earlier fears. However, as they begin
to think and reason in new ways, they may develop new fears. Many preschoolers may
become anxious or afraid of:
■■ real things, such as the dark, dogs and storms
■■ imaginary things, such as monsters and ghosts
■■ new experiences, such as going to preschool, flying in an airplane or moving to a
new home
■■ things they hear about, such as being in a fire or a car crash
New experiences can sometimes bring back feelings of fear and anxiety, including
separation anxiety (see page 321). For most children this usually lasts for only a few weeks.

You can help your child learn to manage their fear and anxiety by providing warmth and
structure. Here are some examples:

■■ Give your child time. They may cling to you ■■ Introduce your child to new places and
until they're comfortable. They may want to people ahead of time, like before they start
hold their favourite toy. Once they feel secure, preschool.
encourage them to try on their own. ■■ Talk with them about how well they handled
■■ Accept their fear—do not make fun of them. a fearful situation. “You were really worried
If your child thinks a monster is under the when you went to the clinic. It can be scary
bed, understand that they're scared. when you don’t know what's going to happen.
■■ Reassure them. Calmly assure them that Now that you know about the clinic, next time
they’re safe and you’re close by. it won’t be so scary.” Try to get them to talk
about the experience in their own words.
■■ Listen. Encourage them to talk about their
fears. Let them know that everyone is afraid
■■ Give them information. For example, if they're
sometimes. Remind them of how they got afraid of falling down the toilet, tell them
over an earlier fear. “Remember when you were they're safe and that this cannot happen.
nervous about staying at grandma’s, but then Although information won’t always make
you two had so much fun.” the fear go away, it may help them begin to
understand.
■■ Do not force your child into a situation
they fear.
■■ Show your confidence. Sometimes you
may be afraid of things too—try to model
confidence, even if you don’t always feel it.
If you’re concerned that your child is not adjusting to being somewhere without you,
talk with your friends or other support people who may have ideas or your health
care provider.
Understanding limits
Preschoolers are beginning to understand
that everyone has limits about what they
can and cannot do. It will take several
years for them to fully understand the idea
of limits.
Setting limits in your family is all about

finding balance. If there are too many rules,
your child may stop trying to do things for
themselves. If they have no limits, they may
have trouble learning what behaviour is
okay and what is not. The limits you set will
also need to change as your child grows.

Use a balanced approach
It’s a new experience for you to watch your child move out into a world of possible
dangers. Being too protective can make your child more afraid to try new things.
If you ignore or make fun of their fears, they will not feel safe or secure. Try a
balanced approach:
■■ Think ahead about how to make new experiences as safe as possible.
■■ Let your child feel the joy of being successful trying something new.

Preschoolers are often very social.
They’re moving from thinking about
‘me’ to thinking about ‘we’. They’re
learning how to get along with others.
At this stage, your preschooler:

■■ likes to be with you and do things
together
■■ likes to have you take notice of what
they’re doing
■■ needs to spend time with other children
■■ can understand and feel other people’s emotions
and may try to help them
■■ can understand that what they do can affect
other people and things
■■ may be more willing to try new things
Helping out at home

Your preschooler learns they’re an important part of
the family when they help at home. They’ll be able to:
■■ take dishes to the sink ■■ help make the bed
■■ help wipe up spills ■■ sort laundry into
■■ pick up toys and books colours

As your child’s skills develop, they may enjoy helping you to prepare food. Cooking
with your child teaches them many skills and they’ll love spending time with you. At
this age, your preschooler can do things like pouring from measuring cups, mixing
ingredients or making a simple sandwich or pizza. Children who help with growing,
preparing or cooking food are much more likely to enjoy eating a wide variety
of foods. To learn more about cooking with your child, visit the Links section at
Help your preschooler develop confidence and healthy self‑esteem

■■ Let them know they’re an important part of your family. Try to find some time each
day when you can give your preschooler your full attention. Even just a short amount
of time each day can make a big difference.
■■ Encourage their capability. Encourage your preschooler to do what they can and
thank them for the little things they do to help.
■■ Have patience. Children don’t always learn things right away. You may have to repeat
your words and actions many times, for weeks or even months. When you’re calm and
consistent, they’ll learn.
■■ Talk about what you expect. Let your preschooler know how to behave and why. For
example:
Tell them before you get to the store that you’re
only going to buy the food on your grocery list.
Remind them that grandma doesn’t allow running
in the house before you get there. Talk about what
they can enjoy doing together.
■■ Help them feel successful.
Have them pick out some items like carrots and
cereal when you go shopping.
Keep shopping trips short or make sure your child is well rested so they can help you.
■■ Be a good role model. Children learn by seeing, listening and doing. If you want
them to clear their dishes from the table after eating, let them see you take your own
dishes away.
■■ Talk about values that are important to you. Some examples of values are respect,
honesty, having fun, learning and politeness. Explain why your values are important
to your family and culture. Let your child see how your family values guide the way
you live.
■■ Help them learn from mistakes. Help your child see mistakes as a chance to learn.
Together, you can decide how a problem can be solved and what can be done
differently next time. When you make a mistake, talk about how you handled it.

Your preschooler’s self-esteem gets stronger when you help them feel that they’re loved,

capable, helpful and they belong.
Playing with others

Preschoolers like to be with other children. Although they often have fun together, at times
they may have trouble getting along. With more experience, your preschooler’s social skills
will improve.
At this stage, preschoolers:

■■ think everyone else sees and
thinks about things the same
way they do
■■ are learning to share and take
turns with other children
■■ are learning to understand
and follow the rules of
simple games, but they often
change the rules as they play
Encourage your child to play with other children

■■ Make time. Try to have play times with other children as often as you can.
■■ Make space. Your child needs space to play with other children—indoors and
outdoors. Move furniture to create space and visit local parks or green spaces.
■■ Be ready. Keep things that help children play pretend handy, such as dress-up
clothes, boxes and craft supplies.
■■ Find safe ways for rough and tumble play. Rough and tumble play (e.g., wrestling or
chasing for play) is how children learn what their bodies can do. They are starting to
learn how to tell others whether an activity is fun or too rough and how to ask others
to stop or be gentler. Your child may need an adult’s help to learn how to do this.
■■ Help them join in. Give them the time they need to be comfortable. If they seem
unsure, it may help to suggest ways to be part of the group. For example, you could
say something like, “It looks like you want to play firefighter with the others?” If they do,
you can encourage your child to go up and ask the group, “Can I be a firefighter too?”
If your child is still unsure, walk over to the group with your child to give them
support as they join in.

Solving conflicts
All children will have some
conflict. When preschoolers
play together, they may
think that their way is the
only right way. They may
argue with a sibling or want
something that someone
else has.
When there’s a
disagreement, use the
situation to build your child’s
problem-solving skills:
1. Describe the situation. “Omar thinks the toy gorilla goes in the cage. Sarah thinks it goes
in the forest.”
2. Ask for their suggestions. “I wonder what might work best for both of you.”
3. Wait for them to think of possible solutions. This may take a few minutes.
4. Offer a few of your own solutions if they are not able to offer any. “Maybe the
gorilla could go in the cage for a while and then move to the forest in a few minutes?” or
“Maybe the gorilla could be in a cage in the forest?”
5. Stay close to see if the conflict has settled. Let them sort it out if they can.
Your child learns by watching you

■■ If you react to problems with anger, yelling or hitting, your child may do the same.
■■ When you’re very frustrated with your child or someone else, take time to calm down
before trying to solve the problem.
■■ High emotions and stress can lead to physical or emotional punishment and angry,
hurtful words. For more information about positive discipline, see page 29.
■■ You’ll have a more peaceful home if you practice and teach your child how to solve
problems in conflict situations.

Getting along with siblings

Brothers and sisters often
have times when they don’t
agree. Use these times to help
your children learn to get
along with each other.
If your preschooler and their

sibling or friend cannot settle
their differences and start
to argue or fight, here are
some things you can do to
help them:
1. Stay calm.
2. Let them sort it out if they
can. Be ready to step in.
3. Separate the children if anyone is being hurt with actions or words. Give them a
chance to calm down. Offer comfort and reassure them that you won’t let them hurt
each other.
4. After they’re calm, help them problem-solve to find a solution that works for all of you.
They may need your help (see page 400).
5. Notice and comment when they start to talk and get along.
Encourage your children to co‑operate

■■ Make family rules or expectations that everyone in the family follows, such as
helping each other, being gentle and kind, not hitting or making fun of each other.
■■ Treat them fairly. Avoid favouring or labelling your children by saying things such as,
“She’s always getting into trouble,” or “He’s just an angel.”
■■ Recognize children have their own temperaments—what works for one child may
not work for another (see page 24).
■■ Respect different opinions. Learning to talk about and respond to different opinions
is an important social skill for children to learn.
■■ Teach them problem-solving skills. When they practice at home, your child will learn
how to solve problems when conflict happens outside the home (see page 401).

Making sense of social expectations
Preschoolers are learning a lot about which behaviours are okay as they spend more time
with others. Their social world can be very confusing because adults may want them to:
■■ tell an adult when they see a big problem, such as when someone is hurting someone
else, but not when the problem is small. What is a small problem to an adult may be a
big problem to a child.
■■ use words rather than actions when they’re angry at someone, but not call them names
■■ use new words, but not certain new words (e.g., swear words)
Help your child understand social rules

■■ Listen to their concerns.
■■ Explain the rules that confuse them.
■■ Help them problem-solve when they have concerns.
■■ Talk about how their words affect other people. Say things such as, “It’s not okay to call
someone a hurtful name,” and suggest other words they could use instead to express
their feelings.
■■ When they use words that are not okay, tell them not to and explain why.
■■ Set a good example for them (e.g., by not using these words yourself ).
Fantasy and reality

Your preschooler is using their imagination more than ever. They’re starting to understand
the difference between what is and is not real. They won’t fully know the difference until
they’re 6 or 7 years old.
Your preschooler may tell you

things that are not true (e.g., a green If you have questions or concerns
!
dinosaur took their truck), because it’s about your child’s emotional or
part of their fantasy and they want social development, call Health
you to join in their game. They might Link at 811 or talk with your health
also tell you something that’s not true care provider.
because they’re afraid of getting into
trouble. Your child needs to know that
it’s safe to tell you what happened.

When your child comes to you with something they’re worried about or that you may

find upsetting:
1. Listen carefully without interrupting them.
2. Thank them for sharing something difficult and for telling you the truth.
3. Ask non-judgemental questions to find out more information.
4. Find a solution to the problem together (see page 401).
When your child tells you something that’s not true, play along with the fantasy if it’s not a
serious situation. Let them know that it’s okay to tell you what happened and you’ll calmly
help them problem-solve. For example, if they spilled milk and say that the dog did it:
■■ Help them clean it up.
■■ Talk about what happened.
■■ Work together to find a way they can pour milk without spilling it.
Children and media

Media has a strong impact on your child. It affects how they form images and ideas about
people and how they relate to each other. Decide what media you want your child to see,
hear and use. It’s easier to
set family guidelines while
your child is young. As they
get older, it will become
harder to set limits and
influence their choices.
media: computers, TVs, magazines, video games, tablets and smart phones

Things to think about when using media
■■ Spend time together when using media. To help your child relate to what they see to
the real world, ask questions and talk about what they see and understand. “What do
you think they’re going to do?” or “What would you do if that happened?”
■■ Limit screen time to no more than 1 hour a day. The less the better.
■■ Look for educational media that is suitable for your child’s age.
■■ Do not show your child any media that isn’t suitable for children, such as shows
with sex, violence, swearing, gambling, alcohol, tobacco, cannabis or other drug use.
Your child may not understand everything, however they may copy things they see
or hear.
■■ Choose the shows you want to watch with your child. Turn off the TV when you’re
not watching a program.
■■ Set limits on media devices using parental controls. Read the device’s
manufacturer’s instructions to learn more about these features.

Keep the volume down
sedentary behaviour, play and
screen time, see page 72. To help protect your child’s hearing, keep the
volume down when they’re listening to music.
Preschool, playschool or nursery school

Preschoolers are often ready for preschool, playschool or nursery school. You may want
to go on outings in your community or to a parent-child group first. This might help your
child get used to being with other children when you’re with them.
Going to preschool, playschool or nursery school can have many benefits for your child.
They’ll have fun practicing new
skills while learning how to be
with and get along with other
children and adults.
Many playschools and preschools

are licensed and inspected by
public health inspectors. For
more information or if you have
concerns about your child’s
preschool, see page 34.

Help your child get used to
preschool
■■ Visit the preschool.
■■ Read stories about going to preschool.
■■ Meet the teacher with your child.
■■ Pretend play about being at preschool.
■■ Go with your child on the first day.
■■ Volunteer at their school when you can.
Health Checkups
See your child’s health care providers as scheduled and based on your family’s needs.
This will help keep your preschooler as healthy as possible. Public health nurses and other
health care providers can help if you have questions or concerns about your preschooler’s
health, growth and development or other family issues.

Immunizations that are up to date protect everyone from many communicable diseases
(see page 82). Your preschooler is due for immunizations at their well child clinic when
they’re 4 years old. If their immunizations are not up to date, talk to your public health
nurse about how to get back on schedule. During your visit, your public health nurse will
also check things such as your child’s growth, ask about their health, as well as about how
you’re doing and answer any questions you may have (see page 78).
Vision
Have your child’s vision checked by an optometrist by the time they’re 3−5 years old or
sooner if they:
■■ often blink or rub their eyes
■■ avoid doing ‘close’ work, such as looking at books or making crafts
■■ don’t notice things that are far away

You don’t need a doctor’s referral
to have an optometrist check your Financial support
child’s vision. There is no cost to you You may qualify for financial support for
to have your child’s vision tested in health costs for your child through the
Alberta for children who are 17 years Alberta Child Health Benefit plan. You may
be able to get eyeglasses, prescriptions and
old and younger. To learn more, call
dental visits for your children at
Health Link at 811 or talk with your
no cost to you. To learn more,
health care provider. call toll-free at 1‑877‑469‑5437
Birth–2 2 4 6 12 18 2 3–4 5 years
months months months months months months years years and beyond

Doctor √ √ √
Immunization
√
with public √ √ √ √ √
(at 4 years old)
health nurse
Regular Regular Regular

checkups as checkups as checkups as
Dental √ recommended recommended
recommended
by your dentist by your dentist by your dentist
√
√
Early vision checkups with your doctor
at 3−5 years old)
Other
health care As needed As needed As needed
providers

Hearing

It can be difficult to notice if your child has signs of hearing loss, as children can often
adapt to a hearing loss until it’s quite bad. You can arrange to have your child’s hearing
checked if you notice any concerns, such as if your child:
■■ often asks you to repeat things
■■ speaks loudly
■■ often turns up the TV, tablet or phone volume
■■ starts talking later than expected, or if it’s difficult for you to understand what
they’re saying
■■ has trouble following simple commands, such as “Go get your pyjamas, please.”
Hearing tests are available at no cost in Alberta for children 17 years and younger. To learn
more, call Health Link at 811 or talk with your health care provider.
Preventing Injuries
Your preschooler’s adventures
can put them in risky
situations. They’re too young
to understand danger because
they’re still developing the
physical and thinking skills they
need to protect themselves.
Supervise them at all times and
be consistent with them about
safety rules so they can learn to
follow these rules all the time.
Children should not be given
choices in situations that have
to do with their safety.

Water safety
Never leave your child alone near water, like a
wading pool, dugout, pond or lake—even if
they know how to swim.
Get trained
Keep your child safe by making sure they wear
protective gear and get appropriate training
for whatever sport or recreational activity they
are doing.
your preschooler safe from injuries.
■■ Playing outdoors, see page 114 ■■ Playground safety, see page 121
■■ Helmets and bike safety, see page 118 ■■ Trampolines, see page 122
■■ Pedestrian safety, see page 120 ■■ Car seats, see page 123
■■ Poisoning, see page 107
Helmets save lives

Make helmets a habit for your
whole family. They reduce the
risk of head injury in a crash
by 80%.
For more information about how

to prevent injuries in the early
years, see page 104.


You’ll get a different view on
life when you see the world
through your child’s eyes. Being
a parent gives you the chance
to learn more about yourself as
you look back and learn from
your own childhood. You can
choose to keep the positive
things you learned from being
parented as a child—the things
that helped you learn and
grow. You can also choose to
let go of things that you now
realize might not have been very helpful for you.
As a parent, you can discover or re-discover your patience, humour and creativity when
you look at the world through the eyes of your child. You have a chance to develop a deep
bond with your child that will help prepare them for a lifetime of healthy relationships
with you and other important people in their lives. Your parenting is making a lasting and
valuable contribution to society both now and in the future. You cannot measure just how
valuable and important a parent’s role is!
Parenting can take a lot of your time and

Practice self-regulation energy, so be sure to make time for yourself
Be aware of how stress affects your and others as well. If you parent with
body and thoughts (see page 26) someone else, make sure you each have
and what you can do to self-regulate time to follow your own interests, even
(see page 27). Practice self-regulation if it’s only for an hour or so every week. If
throughout your day so that you can
you’re parenting on your own, see if family
be in a calmer state when you’re with
or friends can help or look for programs
your children. Continue to make notes
about the things that trigger your in the community where child care is
stress response and add to the list of provided. When you spend time with your
things that you can do about it. Your child and your family, you show them that
children need you to be calm, alert and they’re important. When you also take time
caring when you’re together. for yourself, you’ll have the energy to enjoy
being with your family and having fun.

Make the most of your time:
Outings don’t need
■■ Focus on what’s most important to you. to be expensive
Take time to do things you enjoy.
Try to do things together. It
■■ Set your priorities. Notice when you’re can be as simple as going
starting to do too much. You may need to say for a nature walk or going to
“No” to some activities in the community. the library.
Check out community facilities
■■ Let others know your values and priorities.
such as swimming pools and
This will help them understand your needs.
museums. Many have reduced or
■■ Have fun with your family. Family nights, no cost admissions at different
board games, walking the dog, kicking a soccer times in the year.
ball, riding bikes, swimming or skating are
activities you can do together.
■■ Try to keep your work at your workplace. Put your work and media away during your
family time. Explore flexible work arrangements, if and when you can.
Everyone has the occasional bad day. Try not to be too hard on yourself. If you yell or lose
your temper, apologize when you’re calm. You’re modelling to your child that everyone
makes mistakes and can take steps to make things right. However, if you notice this
happening frequently,
get help to identify
what is bothering you
and what you can do
about it.
“ I love having a preschooler. I feel so comfortable as a parent now. I feel like I

totally understand my child. He can talk to me and usually co-operates with our
”
day-to-day routines. There are tough days, but I feel really confident that we
can work things out together.
~ Ben, dad of one child

Young Children:
5 Year Olds

417
Young Children: 5 Year Olds
Your young child is meeting more people and going to new places. As they start
kindergarten and form new relationships, they’ll learn more about getting along
with others. They’ll begin to feel more comfortable and confident on their own,
with other children, and in new surroundings. As they explore further from home,
your child will still need your loving support when they come back to you with
their new thoughts and questions.
In this chapter, you’ll learn about your young child’s development which allows
them to participate more in taking care of themselves and engage in more
complex play on their own and with others. There is information on eating, playing
with others and problem-solving. You’ll also learn about how to keep them safe as
they become more independent and about your changing role as a parent.
418
Your Young Child’s Development
YO U N G CH I LD R E N: 5 Y E AR O LDS
As your young child reaches the age of 5, they’re eager to learn, do new things and begin
to develop a longer attention span. Your child can move with more purpose and skill. This
chart gives you information about the developmental milestones and tasks your child is
working on between the ages of 5 and 6 years. In this chapter, you’ll learn what you can do
to help your child as they grow and change.
5 year olds: The ‘identity’ and ‘power’ stage

Tasks Milestones
During this time, your Physical

child is continuing to ❑❑ develops more coordination and complex skills
❑❑ has stronger muscles
❑❑ moves with more purpose and is more accurate
■■ form an identity: start
❑❑ enjoys being active
to know who they are
and how they fit into ❑❑ draws and starts to print letters
the world ❑❑ may need more sleep due to the demands of school
■■ recognize personal
power: learn that they Emotional
have control over their ❑❑ has a better sense of right and wrong
actions and that their
behaviours have an ❑❑ begins to talk to themselves out loud to get calm
effect on others ❑❑ may not like being corrected
■■ develop industry: ❑❑ is easily upset by things that are not fair or ‘not right’
begin to enjoy the
process of figuring Social
things out and solving ❑❑ becomes more competitive
problems
❑❑ enjoys games with rules
❑❑ feels more empathy for others
❑❑ has a best friend
❑❑ has more adults in their lives that influence them, such as their
teachers and coaches
❑❑ likes to please

5 year olds: The ‘identity’ and ‘power’ stage

Tasks Milestones

❑❑ has a longer attention span
❑❑ talks with more detail, using sentences and correct grammar
❑❑ says most words correctly
❑❑ is easily understood by you, siblings, friends and strangers
❑❑ tells longer stories on the same topic
❑❑ tells stories with a beginning, middle and end
❑❑ likes telling jokes and riddles
❑❑ begins to understand death and may ask many questions about it
To use an interactive tool about your young child’s development, visit the Tools section
at healthyparentshealthychildren.ca/resources
If you have questions about your child’s development, call Health Link at 811 or
talk with your health care provider. You can also go to a Parent Link Centre and ask
about the Ages and Stages Questionnaire (ASQ). To learn more, visit the Links section at
Young Children
This is a year of change for you and your
child. Even if children are used to child
care or preschool, starting kindergarten
is a big step. Your child is developing
a longer attention span and craves
answers and information. At this stage,
they not only ask, “Why?” but also,
“What if?”
“ Being a parent has made me a better person. I’m way more patient and
”
empathetic than I was before. It has made me a better sister, daughter,
partner and friend.
~ Kim, mom of two children

Each child grows at their own rate and their growth pattern may be different from their
siblings and friends. In addition, you can expect that they’ll:
■■ grow in spurts—they may seem to stay the same size for weeks and then grow taller
almost overnight
■■ get stronger and want to test their new abilities as their body grows
If you have concerns about your child’s growth, call Health Link at 811 or talk with your
Feeding Your Young Child

A healthy feeding relationship helps develop healthy eating habits for life. When you
take time to eat meals together as a family, it also supports healthy eating and builds
stronger relationships.
To help keep your young child

healthy, offer:
■■ 3 regular meals and 2–3 snacks
spaced evenly throughout the day
■■ a variety of foods from Canada’s
Food Guide
■■ water throughout the day
For more information about the

feeding relationship, eating together
and healthy eating for your child, see
page 49.
Breakfast
Breakfast is important for children going to school. Children have trouble learning when
they’re hungry. If your child doesn’t like to eat in the morning, look at the rest of your
routine and decide what you might be able to change. It might help to:
■■ think of ways to make your morning less rushed, such as getting up 10 minutes earlier or
getting things ready the night before
■■ eat breakfast with your child

■■ get rid of distractions such as TV, cell
phones or toys Vitamin D for your young child
Your child needs a daily supplement of
■■ make sure your child is getting
400 IU vitamin D to help meet their needs.
enough sleep
Continue to give this supplement all
■■ provide a variety of healthy food throughout childhood and adult years.
choices
Lunches and snacks at school

For many children, going to
school means eating lunches
and snacks at school. It may
take time for your child to
get used to this. They may
find snack time or lunch time
too busy, exciting or stressful
to focus on eating.
Check your school’s policies

about the types of food
children can bring to school
and when they can eat.
Prepare your child by explaining to them what these rules are and why they are in place,
so they’ll know what to expect. Encourage your child to help you make and pack their
lunches and snacks. They may be more interested in eating the foods they make and help
to pack.
To help your child get the nutrition they need:

■■ pack a variety of foods in separate containers for lunch and small snacks—foods such as
fresh vegetables, fruit, cheese, whole grain muffins or yogurt make good snacks
■■ ask them to let you know what food they like eating and talk to them about it—do not
punish them for not eating everything
■■ pack hot or cold foods in insulated containers
■■ send a water bottle
If you have questions or concerns about your school’s food policy or about food programs
at school, talk with your child’s teacher. To learn more about healthy snacks and lunches,

Everyday Care
As your young child develops and grows, they’re able to take
a more active role in their care. They’ll need your help to
develop daily habits for grooming, hygiene, getting ready in
the morning, and going to bed at night. They can now dress
themselves and might want to choose their own clothes.
Your child may be able to use the toilet on their own. They
may still need some help wiping after a bowel movement.
Remind them to always wash their hands every time before
they leave the bathroom.
Some children don’t like to use the toilet when they’re away from home. Prepare your
child for what to expect if they have not used a public bathroom on their own. If they’re
worried, try to find out why, reassure them, and teach them which adults they can ask for
help. Talk to your child’s caregivers or teachers to find suggestions to help if your child has
these fears and is not using the toilet.
Sleeping
School is hard work for children. They may feel very tired after being in a classroom for a
half or full day. Getting a good sleep every night can help your child adjust.
Your child needs sleep to restore their energy, to help them focus and learn. During sleep,
the brain sorts through and stores memories. Not getting enough sleep can lead to
problems with thinking, reasoning and memory. It affects your child’s health, behaviour
and all parts of their lives.
If your child is having trouble waking up in the morning or getting used to school, try
putting them to bed 30–60 minutes earlier for a week. Try not to have late nights when
your child has school the next day. Most school-aged children need about 9–11 hours of
sleep a night.
Growing pains
Many children in elementary school have growing pains in their legs and arms at times.
Growing pains are most often felt in the legs. Children often have them at bedtime and
during a growth spurt. The pain is usually gone by morning. Growing pains are believed
to be caused by a growth hormone released in your child’s body. They’re not a sign of
anything serious. To ease your child’s pain, try gently rubbing their legs.

If the pain is constant, there is redness or swelling, or if you’re concerned about your child’s
growing pains, talk to your health care provider.
Teeth and mouth

Baby teeth will begin to fall out when your child is
between 5–8 years old. As your child’s adult molar
Is your child still sucking
teeth appear at the back of their mouth, their
their thumb?
baby teeth at the front of their mouth will get Sucking their thumb beyond
this age may affect how your
ready to fall out. Their baby teeth will be replaced
child’s jaw and teeth grow. Help
by permanent teeth.
your child to stop sucking their
thumb before their permanent
Their front teeth will fall out and will be replaced
teeth come in—when your child
by permanent teeth around the same time as
is about 5 years old. For more
their first permanent molars (6 year molars) come information, see page 389.
in. Their permanent teeth will keep growing in
until they’re a teenager.
You’ll need to help your child brush and floss (see page 347) their teeth until they have the
skills to do it themselves, about the time when they’re able to write their name. With good
nutrition and dental care, most children will keep their permanent teeth for a lifetime.
For more information about teeth and mouth care, including preventing tooth decay, see
page 61.
Protecting molars
The molars have deep grooves and pits that trap food so it can be hard to keep them
clean, even with regular brushing. When permanent molars come in, the chewing surfaces
can be sealed with a thin, plastic coating (sealant). This protects molars from tooth decay.
While sealants protect part of the tooth, good dental habits are still needed for a healthy
mouth and teeth.
Dental sealants are available from your dentist and are offered in selected schools in
Alberta. To learn more, call your community or public health centre, talk to your dentist or
Injured teeth
As young children are active and adventurous, their chances of having tooth injuries
increase. If your child plays a sport, ask your dentist to suggest the right type of mouth
guard to use. If your child injures, breaks or knocks out a tooth, take them and the pieces of
their tooth to the dentist right away.

Your young child will go through many changes in just a short time, develop many
new skills, and enjoy being active. They’re thinking in new ways, experiencing complex
emotions and learning how to get along with others. All areas of your young child’s
development are interconnected and the development in one area affects development
in all other areas. Your child’s development is guided by their brain.
Physical
Emotional
Cognitive
Social

Your young child’s developing brain

The thinking part of your young child’s brain is really developing now and the brain cell
connections are becoming more complex. Positive relationships with you and other
important people in their life have created a strong base.
The brain is now developing executive

function skills that are essential for
learning and getting along with
others. Although it takes time for
these skills to fully develop, your child
is starting to be able to:
■■ notice when their body is
responding to stress and can
sometimes cope with those feelings
on their own

■■ remember information so they can use it when they need it
■■ be able to focus on a task and not get distracted
■■ cope with their impulses
■■ adapt their thoughts and feelings as situations change
Being able to self-regulate when they’re feeling stressed is one of the most important skills
you can teach your child. It’s the foundation for executive function, life-long learning and
health. For more information on self-regulation, see page 27.
There are many fun ways that you can teach your child to build executive function
skills—things like having to wait, using their memory and teaching them about emotions.
For more information on executive function, see page 21.
Brain cell connections also become stronger when you and your child engage in
serve-and-return interactions. Here are some examples of what typical serve-and-return
interactions might look like with your 5 year old:

5 year olds
Your child serves when they: You return their serve when you:
■■ write notes and stories with scribbles that ■■ let them help you make a shopping list using
look like writing drawings or pictures from a flyer
■■ want to dress and undress themselves and ■■ plan extra time to get ready in the morning
start to tell you what clothes they want so they can have the time they need to get
to wear dressed by themselves
■■ play games that need more physical skills, ■■ give them lots of chances to play and be with
such as tag, hide-and-seek and hopscotch other children
■■ ask questions about what's happening and ■■ look at the book cover before reading and ask
start to predict what will happen next your child to guess what the book is about.
Then, pause once in a while as you read and
ask them what they think will happen next
■■ are frustrated when they have to figure out ■■ acknowledge their feelings and work with
what to do when they have a problem them to think about solutions
For more information about your child’s developing brain, see page 19.

Other things you can do to
help your child learn
Communicating with your young child

Your young child is starting to sound more like a grown-up. They use simple sentences
that are often 5–6 words long. When they tell a story, they may combine their sentences
by saying “and” or “and then.” They may say things like “mans,” instead of “men,” and “fum,”
instead of “thumb,” but other people can usually understand what they’re saying.
Your child is now using language to:

■■ tell people what they want and need
■■ make friends and express their feelings
and emotions
■■ share and learn more about their
interests and their world
■■ share their stories and jokes
■■ read and print
■■ solve problems
Have any questions or concerns about

your child’s speech, language and hearing Speech and language
answered before they start kindergarten development
by calling Health Link at 811 or talk with If you’re concerned about your child’s
your health care provider. speech and language development,
act early. They can receive speech and
language services at any age at no cost.

Encourage your child’s language and literacy
■■ Encourage them to explore and explain how things work. Take time to answer their
questions or ask what they think the answer might be.
■■ Do things together. Talk about what you’re doing while you cook, set the table or
make family meals together.
■■ Share their interests. Go on adventures together. Look at books or magazines at
the library.
■■ Look at family photos and keepsakes. Share stories about family memories and
events. Use lots of describing words. “The big, yellow moon was so round when we
went camping!”
■■ Sing and play with words. Sing
songs, listen to music, play word
games and have fun making up
silly rhymes.
■■ Read together every day. Take
turns reading to each other. Talk
about what you’ve read.
■■ Encourage them to draw and
print. Ask them to tell you what
they’ve drawn. Write the words
they say on the page. When
they start to print words, ask
what they’ve written.
Call Health Link at 811 or your health care provider if your child:
■■ acts like they’re not paying attention—especially in group settings like a
classroom
!
■■ appears more frustrated than other children
■■ has a hard time with learning
■■ cannot follow instructions
■■ trips or falls a lot
■■ has any other signs that concern you

Let’s play
Play builds healthy bodies and minds and
is important for your child’s growth and
development. Young children learn through
everyday experiences. They can help with
simple chores—they’ll enjoy feeling like a
grown-up while doing them. You may want
to walk to the store together to get milk or
rake the leaves in the yard. They also need
lots of time to play with others and on
their own.
Your young child will explore and play

in a new environment once they start
kindergarten. They may be tired from the
change in routine and being active in new
ways. They’ll need time for both play and rest
when they get home.
Active play
Your child needs lots of time to play freely—to climb, swing, run and jump. They
understand directional words such as left, right, up and down. You can support their
learning about directions by playing action games like ‘Simon Says’.
Young children need to be active through

energetic play. This includes ball games, riding Internet safety and
a bike or water activities. Depending on your screen time
child’s interests, they may enjoy playing at the Keep computers, TVs and other
park with their friends. They may also want to be electronic devices and games
in community sports or activities. At this stage, out of your child’s bedroom.
non-competitive physical activities are best. They Limit screen time to no more
help your child develop skills without the fear of than 2 hours per day (see page
failing or not being good enough. 72).
Your child may:

■■ throw and catch a ball that’s bounced or thrown gently to them
■■ jump over low objects and skip
■■ learn to ride a bike with or without training wheels

Your child needs 60 minutes
of energetic play that causes
them to sweat and breathe
a little bit heavier, such as
running or bike riding. They
also need several hours of
being active each day, such
as walking to and from
school, playing hopscotch or
playground fun.
Creative play
Your young child is learning to use and
control many objects. They prefer to use
one hand more than the other for complex
tasks. The other hand will help support the
objects or materials they’re using.
Your child’s hands need lots of practice

using a pencil, scissors, knife and fork. Your
child may enjoy building, fixing things,
cooking and making crafts. They learn a lot
about how to solve problems by creating
and using objects. They may:
■■ fasten buttons, Velcro® straps or zippers
■■ draw or copy lines, simple shapes and stick people
■■ cut on a line with scissors
■■ tie shoelaces
Pretend play
Your child may enjoy acting out stories from real life, books, TV shows or movies. At first
their stories may be mixed up. In time, they’ll become more connected. Their sense of
humour is really developing, so they may share the same funny stories over and over again.
They may like to put on puppet shows or plays for the whole family.

Through pretend play, your
child might try different
roles and figure out what
they would do, say or feel
in different situations.
Pretend play becomes more
creative. Rather than acting
out real-life situations, like
playing house or restaurant,
your child may pretend that
they’re from another planet
or that they’re a dog or a
superhero.

Your young child has more complex emotions than before, such as confidence, empathy,
frustration, jealousy, disappointment, pride or guilt. They may be confused when they have
mixed emotions (e.g., feeling worried, excited or happy and sad at the same time).
By the time children are 5 years old, they’re usually able to control and express their
emotions better. They may still struggle to find the exact words to describe their feelings.
Your child now understands that they can show their emotions in better ways than
pushing, hitting or other physical actions.
At this age, your child may:

■■ fear things that could really happen, such as getting hurt, someone dying, or having
their home broken into
■■ start to use self-talk to calm down. You can help by making suggestions. “Let’s take some
deep breaths.” Model calming down by using self-talk when you’re upset, for example “I
want to calm down. I’ll take some deep breaths so I can relax and think about what I can do to
feel better.”
■■ feel empathy. They may offer to comfort or help you when you’re sad.
■■ become overwhelmed by frustration or disappointment at times. They may have
tantrums once in a while.

Support your child’s emotional development
■■ Talk about and accept their feelings. To help them cope with mixed feelings, you
could say “It seems like you’re excited about skating with your friends. You’re also feeling
worried that you might get too cold. Sometimes I feel excited and worried at the same
time. It’s a little bit confusing, isn’t it?”
■■ Help them think of ways to show their emotions. “Sometimes we feel disappointed
when things don’t work out the way we want them to. It’s okay to feel disappointed. It’s
not okay to yell and throw things. What can you do instead?”
■■ Do not make fun of their fears. Listen carefully and tell them that everyone is afraid
sometimes. Reassure them that you’ll not let anything hurt them. Help them think of
things they can do to cope like taking deep breaths, keeping a flashlight close by or
playing soft music.
■■ Notice when they help and care for others. They’re showing that they understand
other people’s feelings and needs. Encourage and thank them for being helpful and
caring.
■■ Help them solve problems by suggesting words they can say to themselves, such as
“I can do this,” or “I’ll be okay,” or “It’s okay to be mad, but hitting can hurt someone.” For
more information on problem-solving, see page 400.
Talk with your health care provider if you have questions or concerns about your
child’s behaviour.
“ The best thing about being a parent is seeing things from a bigger perspective.
”
It allows you to realize how life is larger than any of us. It’s humbling and easy
to forgive the past with this new perspective.
~ Toni, parent of two children

Some young children want to spend a lot of time with other children. Others would rather
spend more time alone putting things together or looking at books. This is part of a child’s
temperament (see page 24). Work with their temperament to help them find a balance.
Your child needs time with other children, with you, and on their own.
Usually, children at this age:

■■ are naturally curious and eager
to learn
■■ like to be helpful
■■ want to be with more people
■■ enjoy group games and
activities
■■ like games with rules—although
at times they may want to
change the rules as they go
or get very frustrated when
someone is not following the rules
Helping out at home

Your young child may be eager to help you around the house. Be patient—it may take
more time and they may not do things perfectly. It may sometimes be easier for you to
do these tasks yourself, however letting your child do them today will help them develop
their skills and make a big difference later.
Here are some ideas of what your

child can do to help:
■■ clean up their toys
■■ pack their school bag
■■ help with setting the table
■■ put their lunch containers into
the sink or dishwasher
■■ help you cook or bake

Your child learns to help when you involve them
and let them help. They know that they belong Take time to teach
and that they’re an important part of the family When teaching children to do
when they have their own special jobs to do. As household chores, break the
their skills and interests change, they may enjoy task down into small steps to
gradually build their skills:
helping with more complex jobs. This builds their
sense of capability, knowing that “I can do it!” 1. You do it, they watch.
A sense of belonging and a sense of capability 2. You do it, they help.
are the two most important ingredients for 3. They do it, you help.
developing a healthy self-esteem.
4. They do it, you watch.
Playing with others

At this age, children are meeting
and getting to know more people.
They’re learning that they can
influence others. They can use
words to reason and negotiate or
to hurt and exclude others. They
co-operate with others to play fun,
active games or to be aggressive.
The way you and other adults act
towards each other has a powerful
influence on watchful children.
Your child is also learning how people respond to their words and actions. They need your
support and guidance to learn to use their words and actions in positive ways so that they
can get along with others.
Children usually enjoy being with other children, but they can also have disagreements. At
times, your child will want to set the rules and so will their friends or siblings.
Instead of rushing in to solve the argument, try to

wait and listen carefully. Let your child learn how
to do it by themselves—they can learn how to
problem-solve on their own. They will learn how
to reason and negotiate fairly over time and with
your help. Of course, you’ll need to get involved
if someone is getting hurt, something is being
damaged or if you need to involve the other child’s
parents (see page 406).

Problem-solving when friends or siblings argue
1. Calm yourself and help calm the children.
2. Separate the children if they’re hurting each other.
3. Once they’re calm, let both children take their turn telling you the problem as they
see it.
4. Repeat the problem back to them in a way that states both of their sides without
blaming or judging. “It looks like you both want to play with the same skipping rope at
the same time.”
5. Tell them you know they can find a solution that will work for both of them, and
you’re there if they need help.
6. Stay close by to monitor the situation and give them time to work it out.
7. Step back in to help only if you need to.
Bullying
When a child is being hurt by someone else’s words or actions, they’re being bullied.
When a child is hurting someone else with their words or actions, they’re bullying. In either
case, it’s time for adults to act and step in.
Bullying is a serious problem in schools, communities and society. You can help prevent
it by modelling healthy behaviour and relationships for your children at home and by
working together with your child’s school.
Here are some things that can help:

■■ Set a good example. Treat your child with respect and they’ll learn to treat others with
respect.
■■ Monitor media. Children are affected by the violence they see. Do not let them watch
TV programs, movies or play video games that show violence. If they do see violence,
talk about it with them so they understand that it hurts and it’s not okay.
■■ Have open communication. Teach your child to tell adults if they or someone else
needs help. Listen to your child when they come to you with concerns.
■■ Work together. Talk with your child’s teacher or principal about what policies are in
place at school and what they’re doing to prevent bullying. Ask them how you can help.

Help your child learn to get along with others
■■ Encourage them to spend time with other children. It’s through play that they learn
about themselves and others.
■■ Teach them about being kind and help them to think about how others might
be feeling.
■■ Explain your family rules and expectations when friends come to play.
■■ Listen to the sound of play. Children this age need to know that a caring adult is near.
Check in with them from time to time, even when things are going smoothly.
Be ready to step in if needed.
■■ Encourage sharing and co-operation.
■■ Model problem-solving to work out conflict. Let your child practice doing this on
their own—help only if they need it.
■■ Notice and comment when children are getting along with each other.
To learn more about ways to deal with bullying, call the Bullying Help Line toll-free at
1-888-456-2323 or visit the Links section at healthyparentshealthychildren.ca/resources
Starting school
Most children start kindergarten when they’re 5 years old and start Grade 1 when they’re
6 years old. Your child may be eager to learn new things and will likely be excited, nervous
or a little of both.
Registering for school

Check with the school your
child will be attending to find
out when and how to register.
You can find out details about
the program, such as whether
it’s half- or full-day.

Help your child have a good start at school
■■ Take them for health checkups. Up-to-date immunizations and checkups such
as medical, dental, vision and hearing will help your child be ready to learn (see
page 76). Some health problems can get in the way of learning and a checkup may
find a problem early.
■■ Talk about what to expect at school, like how they’ll get there and what they’ll do in
class. Let your child know what you’ll be doing when they’re not with you.
■■ Teach them self-care skills such as putting on their jacket and shoes, going to the
bathroom on their own, and washing their hands.
■■ Take a school tour and meet their teacher and principal. Your child will be able to see
the classroom, front office, bathroom, library, gym and playground. Try to remember
the names of one or two other children on the tour.
■■ Start your new routine a month or so before school starts. Shift slowly to a regular
time for getting up, having meals and going to bed.
■■ Read books about starting school. This will help your child understand more about
what school will be like. You can find these books at the library.
■■ Respect your child’s temperament (see page 24). Children adjust to change in
different ways. Your child may adjust to school differently than other children.
■■ Be positive with your child about starting school. Share fun memories of teachers you
had and things you enjoyed doing at school. Your child will enjoy it more if they know
school is important to you.
To learn more about being a partner in your

child’s education, what your child will learn
in school and ways to prepare your child for
school, visit the Links and Printables sections at
Supporting your child in school

School is an exciting adventure for
children. You’ve been your child’s
first and most important teacher.
When your child starts school, their teachers
will also become important people in their life.

Support your child’s learning by showing them that education is important to you:
■■ Share your child’s
interests, strengths and
challenges with their
teacher. Ask what you can
do to help them at home.
■■ Find out the best way to
keep in touch with their
teacher—by phone, email
or sending notes with
your child.
■■ Take time to talk to your
child about their day. Ask
them open questions like, “What was the best thing that happened at school today?” or
“What did you learn about today?” Be sure to share things about your day too.
■■ Show them you value their work by asking them to tell you about it and if it’s okay to
hang it on the fridge or the wall so everyone can see it.
■■ Encourage them to tell the rest of the family and other important people in your lives
about their school activities.
■■ Read and share stories with your child
every day. Supporting their learning
Show your child that you think school is
■■ Go to school events, learning
worthwhile.
celebrations and meetings when you
can. This will help you find out how When you support your child’s learning,
their teachers and their school, you help
things are going for your child and the
them to succeed.
rest of their class. It also shows your
child that you think school is important.
■■ Think about volunteering in the
classroom or on field trips or joining the
school council if you can.

Helping your child adjust to school
Children sometimes get tired of school once the excitement of starting something new
wears off. Your child may come home from school very tired and need some time to relax.
Your child might be anxious if they’re not used to being away from you. They might think
they’re missing out on things at home.
Here are some ideas that

may help:
■■ Make sure they get enough
sleep (see page 423). Your
child may need extra sleep,
especially at first.
■■ Offer healthy meals and snacks.
■■ Spend extra time together on
days when your child doesn’t
have school.
■■ Don’t plan too many activities
before or after school.
If your child strongly resists going to school or seems to always be complaining about
something like a stomach ache or headache, find out more:
■■ Ask your child what they think might help.
■■ Talk to their teacher for suggestions.
■■ Talk to other parents to see if their children have similar problems.
■■ Arrange for them to have a checkup with your health care provider.
Young children and overscheduling

Organized activities like child care, preschool and kindergarten need a certain level
of attention from children. A young child uses a lot of energy staying focused in
school. They need free time once they get home to burn off some physical energy
and reconnect with the ones they love. Try not to schedule too many activities and
appointments in your child’s free time.

Health Checkups
Keep seeing your child’s health care providers as
scheduled and as needed to help your child and
family thrive.
Your health care provider or public health nurse

can help if you have questions or concerns about
your child’s health and development or other
family issues.
For more information about keeping children

healthy and safe at any age, see page 76.

Your child’s last immunization in the early years is due at 4 years old. If their immunizations
are not up to date, talk with your public health nurse about how to get back on
schedule. Keeping immunizations up to date protects your child and family from many
communicable diseases. Immunization becomes even more important for preventing
outbreaks once your child is in school and organized activities. During your visit, your
public health nurse also checks things such as your child’s growth, asks about their health,
as well as about how you’re doing and answer any questions you may have (see page 78).
For more information about immunizations, see page 82.
Oral health
Regular visits to the dentist are
important as your young child’s baby Financial support
teeth are falling out and adult teeth You may qualify for financial support for
are coming in. health costs for your child through the
Alberta Child Health Benefit plan. You may
be able to get eyeglasses, prescriptions and
Vision dental visits for your children at
no cost to you. To learn more,
Visit your child’s optometrist once a call toll-free at 1‑877‑469‑5437
year to have their vision checked—you or visit the Links section at
don’t need a doctor’s referral and healthyparentshealthychildren.ca/resources
there’s no cost to you.

Birth–2 2 4 6 12 18 2 3–4 5 years
months months months months months months years years and beyond

Doctor √ √ √
Immunization √
Regular checkups Regular checkups

Dental √ as recommended as recommended
by your dentist by your dentist
√
√
Early vision checkups with your doctor
at 3−5 years old)
Other health
As needed As needed
care providers
Preventing Injuries
As your child moves into
their larger world of friends
and school, they still need to
be supervised by an adult,
but not as closely as when
they were a preschooler.
Your child needs a little more
freedom to explore and play,
but they’re still too young to
know all the dangers around
them or how to protect
themselves. Stay nearby, pay
close attention and think
about ways to reduce possible risks. Remind your child about safety rules often. They may
remember simple rules, but may not always follow them when they get excited. Make sure
that your child follows the rules when they’re with you. This will make it more likely for
them to follow the rules when they’re on their own. Situations involving safety are not a
time to offer choices at any age.

Being safe on the
playground
Keep play safe by not
allowing your child
to wear clothing with
drawstrings. Take off
helmets and scarves,
and tie back loose hair.
Be sure your child has
proper footwear on, such
as running shoes.
your child safe from injuries.
■■ Playing outdoors, see page 114 ■■ Playground safety, see page 121
■■ Helmets and bike safety, see page 118 ■■ Trampolines, see page 122
■■ Pedestrian safety, see page 120 ■■ Car seats, see page 123
■■ Poisoning, see page 107 ■■ Head injury, see page 102
■■ Playing safe in rural areas, see page 122
School bus safety

The biggest risk to children riding on a
school bus is when they’re getting on and
off the bus. To learn more, visit the
Printables section at

How quickly the years fly by. As your child begins school, their world expands and a new
adventure begins. You may find yourself celebrating this new chapter in their life, or you
might find their growing independence a challenge. It might be hard for both of you to
learn how to be separated from each other. You may worry about them eating their lunch
or how they’re going to manage with taking the bus. It may seem hard to believe, but your
young child will learn to do all these things and more. All the time and effort you have
spent with your child in the early years has prepared them to be ready to move into the
bigger world.
Your changing role

Your role as a parent is changing too, and the next few years will be a time of adjustment.
As a parent, up until now, you’ve been your child’s protector, nurturer and teacher. Now
you also become their advocate, coach and counsellor.
“
As your child becomes more
independent, it may seem like they When our son was first born, it seemed
challenge you more and listen to like each day was a year, but these early
you less. They have more people years went by so fast! I know the changes
who influence them now, including are just beginning, but I feel like we are
”
new friends and teachers. As they prepared knowing that he is off to a
learn about other people’s ways of good start!
doing things, it’s natural for them
~ Hope, mom of one child
to question more things. They’re
developing ideas of their own.
Throughout their life, your child will benefit from warmth and structure (see page 11). Your
child still needs to be shown how important they are to you, although the way you show
them may change as they grow. Your child still needs comfort and direction from you.
You’re still a very important person in their life.
Once your child starts school, they’ll need to think things through and solve their own
problems using the skills you’ve taught them during these first 5 years. You can help them
continue to build on these skills when you provide loving guidance so they can figure out
their own solutions. They may need a lot of help coming up with ideas at first, but with
practice, they’ll soon be solving small problems on their own. Let them know that you’ll
always be there when they need you.

You can support your child as their world expands by:
■■ talking to them about what interests ■■ connecting with love and being
them interested in what they have to say
■■ meeting their friends when they return home
■■ getting involved in their school and other

■■ being there to comfort them when they
activities in whatever ways you can—get need you
to know their teacher, read newsletters, ■■ helping them figure out how to solve
go to school and sports events or problems on their own
volunteer in your child’s class, on their
sports team or in the community
Take time for yourself:

■■ Enjoy having some extra time to focus ■■ Try not to let your work commitments
on yourself and your interests. take over family time outside of school
■■ Take a class or go for coffee with a friend. and work hours.
■■ Meet other parents at your child’s

■■ Continue to explore ways to self-
school—talk about your new experiences. regulate (see page 27) for more effective
parenting, better relationships at home
■■ Check to see if flexible work arrangements and work and for your own health and
are possible for you to be able to drop happiness as well.
off or pick up your child from school, to
attend school events, or for sick days.
“ If there’s one piece of advice I would

give it would be that, while you’re
taking care of your family, don’t forget
to nurture the relationship with your
”
partner. Your children will benefit just
as much as you both will.
~ Shalla, mom of two children

The Journey Continues
What an amazing journey you have undertaken. Raising and caring for
another human being is one of the most important things you can do in
life. As you look back and think about the day you brought your new baby
home, consider all the changes you have gone through and the skills you
have learned.

445
The Journey Continues
Just as the early years are foundational for your child’s healthy development, they’re also
foundational for your life as a parent. Continue to:
■■ explore each stage as your child grows
■■ learn about typical child development for all the stages to come
■■ provide the warmth and structure your child needs to flourish
Transitions will be smoother when you’re prepared with skills and information. Honour
your child’s uniqueness and celebrate their successes, no matter how big or how small.
You’re the most important person in your child’s life—continue to build on the skills you
have learned and you’ll be much more prepared for what is to come. We wish your family
health, happiness and an amazing journey in the years ahead.
“ It was an amazing experience as a parent watching my baby go from the

newborn stage to learning to walk and talk and then to starting school. There
were some challenges, but mostly it was so rewarding to watch this tiny person
”
grow and learn. There were so many changes in such a short period of time. I
can’t wait to see what the next stages bring!
~ Nicole, mom of two children
Feedback
We want to hear from you. Please email your feedback to us at [email protected]

Index
INDEX
A B
Abuse (family/domestic violence) Baby blues (postpartum baby blues), 261
brain development (effects on), 23 Baby clothes, See clothes/clothing
cycle of abuse, relationship health, 38-42 Baby food, See solid foods
getting help, 42 Bath/bathing baby, 233-236
Air quality, 102-103 Battery (safety), 108
Alberta Adult Health Benefit, 131 Bed sharing/bed share, 159, 221
Alberta Child Health Benefit, 79, 412, 440 See also, safe sleep
Alcohol (drinking) Bedtime routines, 60-61, 305-306, 309, 338-340, 341-342
breastfeeding, 174, 182, 187, 189-190 See also, sleep
Canada’s Low-Risk Alcohol Drinking Guidelines, 138 Bedwetting, preschooler, 388
depression and anxiety, 262-263 Behaviour
safety for baby/child, 37, 107, 138, 187 toddler (1 and 2 year olds), 333-334, 361-365, 371-372
safe sleep, 221 preschooler (3 and 4 year olds), 400, 403-408
Allergy/allergies/allergic young child (5 year olds), 419-420, 431-435
breastfeeding, 173 Bike safety, 118-119, 135
food, 193, 295, 298 Blocked milk ducts, 179-180
immunization/vaccine, 85 Body temperature, See temperature
infant formula, 193 Booster seats, 123-124, 129-131
mould (air quality), 102 Bottle feeding (expressed breastmilk and infant formula)
skin, 97 how to bottle feed, 190-191
Anger preparing and storing expressed breastmilk, 170-172
tantrums, 29-30, 362, 363-365, 378, 399, 431 preparing and storing infant formula, 191-200
Anxiety/anxious See also, expressed breastmilk
baby/child, 24, 289, 361, 401-402, 431-432 See also, infant formula, preparation and storage
parent, 133, 259-260, 260-264, 285, 325 Bowel movements, stools/poops (dirty diapers), 95-96, 153,
separation anxiety, 307, 321-322, 330, 368-369, 401 164-165, 203-204, 215, 295
Aspirin (acetylsalicylic acid/ASA), 85, 91, 95 See also, stools/bowel movements/poops (dirty diapers)
Attachment BPA-free plastic containers, 191
newborn baby (birth-2 months), 149, 209-210, 246 Brain development
young baby (2-6 months), 269-271 alcohol, tobacco and tobacco-like products, cannabis,
older baby (6-12 months), 319, 321 139, 143, 174, 175
toddlers (1 and 2 year olds), 356, 368 brain cell connections (serve-and-return, executive
building a secure attachment, 25-26, 209, 319 function, toxic stress), 19-23
definition/description, 17, 25, 207, 209 See also, serve-and-return
Autism, 83

Breastfeeding Breastfeeding (challenges)
call Health Link at 811 or your health care provider NOW, call Health Link at 811 or your health care provider,
153-154, 164, 179, 186, 215 (NOW), 164, 179, 186, 187, 215
affected by (supply), 154, 182 blocked milk ducts, 179-180
alcohol, tobacco and tobacco-like products, cannabis, breast fullness, 178
other drugs, 174-176, 182, 187, 189-190 engorgement/engorged, 178-179
bed sharing (keeping baby safe), 159, 221 leaking milk, 182
benefits of, 152 mastitis, 180-181
burping, 204 milk flows fast, 185
cluster feeds, 161 nipple shield (when used), 177, 182
colostrum/changes in milk (colostrum, transitional, not advised (when it’s), 189-190
mature), 147, 153-154 not enough milk, 182-183
compression (breast), 183, 186 sleepy baby, 186
cues (feeding), 149-151 sore nipples, 176-177
deciding how to feed your baby, 147-148 too much milk/oversupply, 184
diapers, wet (pee/urine) and bowel movements Brushing teeth, 61-62, 312
(meconium/poops/stools), 153, 164-165 Bullying, 435-436
eating healthy (mother), 172-173 Burns and scalds, 109
engorgement (breast), 178-179
exclusive breastfeeding, 147, 151-152
expressing and storing breastmilk, 166-172
C
feeding expressed breastmilk (how to), 190-193 Caffeine (coffee, tea, energy drinks), 53, 173, 293
feeding relationship, 49-50, 149-150 Canada’s Food Guide, 51, 132, 297
getting started (establishing ), 154-155 Cannabis (marijuana/weed/pot/hashish, hash oil)
goals, 151 breastfeeding/breastmilk, 175
growth spurts, 152, 154, 202, 213 safety for baby/child (health effects), 107, 142-143, 175,
how breasts make milk, 153-154 221
how long/often (frequency) to feed, 161-163, 272, Car seats and booster seats
291-292, 335 booster seats, 123, 129-131
is my baby getting enough, 164, 213 buying a used car seat, 123
latch, 160-161 forward-facing car seats, 123, 127-128
let down (milk ejection reflex), 153, 167, 180-181, 185 rear-facing car seats, 123, 125-126
massage (breast), 167 recalls, 124, 126, 128
meconium, 153, 164-165 Universal Anchorage System (UAS), 125, 127
pads (nursing/breast), 177, 182, 189 winter clothing and car seats, 115, 123, 239
positions, 157-161 YES Tests, 124-130
Pumps/pumping (breast), 169 Carbon monoxide, 103, 109
supplementing, 187 Cereal (infant, iron-fortified), 52, 59, 296, 297, 299, 300, 302
vitamin D (baby), 53, 115, 147, 273, 296, 335 Checkups, See health checkups
weaning (stopping), 188-189 Chickenpox/varicella, 83, 89

Child car seat, See car seats and booster seats Colostrum, 147, 153-154
INDEX
Child care Communicable diseases, 82, 187
babysitters, 37 See also, immunization
choosing child care, 34-36 Communication
helping your child adjust, 36 See cognitive development (thinking and
planning for, 368-370 communicating)
types of, 34 See development
what to look for, 35-36 Community Health Nurse, See Public Health Nurse
Choking Constipation, 96
call Health Link at 811 or your healthcare provider (NOW) Coping (parenting role), 258-262, 285-286, 444
definition of, 59 CPR (cardiopulmonary resuscitation), 35, 109
emergency, call 911 NOW, 108 Cradle cap, 251
feeding equipment, 191-193 Cribs, cradles and bassinets, 218-219, 222-223, 274
foods/feeding, 59, 303, 312, 335 See also, safe sleep
prevention (general), 107-108, 235, 276, 280 See also, sleep
Circumcision, 235 Croup
Clothes/clothing call Health Link at 811 or your health care provider
baby, 239-240 (NOW), 100
toddler, 346 description, 100
safety, 107, 110, 121, 123, 306 Crying (baby and child)
sleepwear, 110, 219, 239 call Health Link at 811 or your health care provider
temperature/weather, 115-116, 239 (NOW), 232
See also, safe sleep newborn baby (birth-2 months), 150, 207, 216, 229-233
Cluster feeds, 161-162, 202 young baby (2-6 months), 269, 275-276, 286
Coffee, See caffeine older baby (6-12 months), 308-310
Cognitive development (thinking and communicating) toddler (1 and 2 year olds), 339, 363
newborn baby (birth to 2 months), 19-21, 64-65, 207-208, coping with crying/parental self-regulation, 26-28, 74,
229, 240-243 229, 230-231, 232-233, 275- 276, 285-286
young baby (2-6 months), 269-270, 277-279, 286 crying plan, 229-233
older baby (6-12 months), 290, 313-315 See also, self-care
toddler (1 and 2 year olds), 330-332, 349-354, 359, 366 Cuddling, skin-to-skin, 209
preschooler (3 and 4 year olds), 384, 390-395 Cues
young child (5 year olds), 420, 425-428, 435 call Health Link at 811 or your health care provider
definition/description, 15-17 (NOW), 164, 187, 203, 215
Ages and Stages Questionnaire (ASQ), 17, 208 newborn baby (birth-2 months), 201-202, 208, 213,
215-218, 220, 229, 246
Parent Link Centre, 17
young baby (2-6 months), 64, 272-274, 279
See also, brain development
older baby (6-12 months), 296, 306
See also, development
breastfeeding, 155-156, 161-163, 183, 185, 187, 188, 190-191
Colds and coughs
definition of, 21-22
call Health Link at 811 or your healthcare provider (NOW),
100, 255 feeding (general cues), 49, 55, 149-151, 175, 190-191,
201-202, 272, 296
cause of colds, 99
coughs, 99-100, 102, 255
Colic, 232-233

D E
Dehydration, baby and child Ear infections, 100-101, 139-140, 283
call 911 NOW, 253 Eating, See feeding and eating
call Health Link at 811 or your health care provider Emotional development/emotions
(NOW), 96, 189, 215, 255 newborn baby (birth-2 months), 207-208, 246-247
preventing/signs of, 91, 96, 116, 214-215, 252 young baby (2-6 months), 269-270, 281
See also, fluids, baby and child older baby (6-12 months), 289, 319
Dental/dentist checkups, 62-63, 79-80, 131, 312-313, 348, toddler (1 and 2 year olds), 329-333, 361-365
424, 437 preschooler (3 and 4 year olds), 383, 399, 402
See also, teeth and mouth young child (5 year olds), 420, 431-432
Depression/depressed (parent), 246, 258-264, 285-286, 325 Ages and Stages Questionnaire (ASQ), 17, 208
Development definition/general information, 15-18, 25-26, 73-74
Developmental milestones, serve-and-return Parent Link Centre, 17
interactions Engorgement, engorged breasts (overfilled with milk),
newborn (birth-2 months), 207-208, 240-241 178-179
young baby (2-6 months), 269-271, 277-278 Exclusive breastfeeding, 147, 151-152
older baby (6-12 month), 289-290, 313-314
Expressed breastmilk (expressing), 166-172
toddler (1 and 2 year olds), 350-351
preschooler (3 and 4 year olds), 391
young child (5 year olds), 419-420, 425-426 F
Ages and Stages Questionnaire (ASQ), 17, 208 Falls (injury prevention, safety), 104-106, 221, 238, 284
Factors affecting child development, 15-26 Family doctor/doctor, 77
Parent Link Centre, 17 Family/domestic violence, See abuse
See also, brain development Fears and anxieties (baby/child), 289, 330, 340, 345, 401-403,
See also, cognitive development (thinking and 431-432
communicating) Feeding and eating
See also, emotional development newborn baby (birth-2 months), 213-215
See also, growth/physical development young baby (2-6 months), 272-273
See also, social development older baby (6-12 months), 291-304
Diaper rash, 98, 237-238 toddler (1 and 2 year olds), 335-337
Diapers/diapering, 237-239 preschooler (3 and 4 year olds), 386
Diarrhea young child (5 year olds), 421-422
call Health Link at 811 or your health care provider feeding relationship/healthy family food choices, 49-56,
(NOW), 255 132, 149-150
description, 95-96 call Health Link at 811 or your health care provider NOW,
Disabilities (differing abilities), 18 164, 187, 203, 215, 253
Discipline (positive discipline), 29-31 See also, breastfeeding, 151-172, 176-186, 187-190
Dressing your baby, See clothes/clothing See also, infant formula/formula feeding, 191-204
Drugs (illicit/street), 37, 107, 143-144, 176, 190, 221 See also, solid foods, 293-303

Fever (baby/child)
G
INDEX
call Health Link at 811 or your health care provider
(NOW), 96, 100, 255 Gagging, 301
emergency department, go (NOW), 256, 283 German measles, See rubella
after immunization, 85 Growing pains, 423-424
body temperature, 255 Growth/physical development, See physical development/
caring for your child, 91-95 growth
how to take your child’s temperature, 92-94

See also, temperature H
Financial supports, 131, 374, 412, 440
Haemophilus influenzae Type B (Hib), 87
Finger foods, 301, 303
Hand washing/washing hands, 56-57, 112, 345
Fire safety, 109-110
Head injury/brain injury/concussion, 102, 118
Flat head, See plagiocephaly, brachycephaly
Head shape
Flossing/floss, 62, 312, 347, 389, 424
Plagiocephaly, brachycephaly (flat areas on head), 211,
Fluids (baby and child)
224-225, 275
general information, 188, 292-293, 335-336
Health checkups
fluids not recommended, 53, 60, 293
newborn baby (birth-2 months), 249-250
juice, 52, 60, 293
young baby (2-6 months), 282-283
milk, See, milk
older baby (6-12 months), 322-323
sickness (during), 91, 94, 99
toddler (1 and 2 year olds), 374-375
water, 54, 58, 116, 195-196, 292-293, 386, 421
preschooler (3 and 4 year olds), 411-412
See also, breastfeeding
young child (5 year olds), 440-441
See also, infant formula
general information, 76-82
Fluoride toothpaste, 62, 276, 312, 347, 389
Hearing
Fluorosis, 62
checkups/testing, 65, 80, 81, 375, 413, 437
Fontanelles (soft spots), 211
newborn screening, 250
Food labels, 302
signs of concern, 101
Food safety
safety, 68, 410
Heat stroke, 114
(NOW), 215
Helmets (bike), 118-119, 442
botulism, 60, 298
Hepatitis B, 87
breastmilk (safe storage), 170-171
Herbal products, See medicine, supplements and herbal
choking hazards/prevention, 59, 303, 312, 335, See also,
products
choking
Hiccups, 252
infant formula (safe preparation and storage), 194-200
Hip dysplasia/developmental dysplasia of the hip, 227
safe food handling, 56-58, 60, 302
Homemade baby food, 60, 302
unpasteurized foods (not safe) 60, 187, 293, 297
Honey, 237, 298
well water, 58, 195
Human Papillomavirus (HPV), 83
Formula feeding, See infant formula
Humidity/humidifier, 101, 252

I Infectious diseases, 82
See also, immunization
Infant cereal (iron-fortified), 52, 59, 296, 297, 299, 300, 302, 335 Influenza (flu), 82, 89
Immunization Insect repellent, 116-117
checklist for child’s immunizations, 85 Injury prevention/preventing injuries
communicable diseases, 82 bike safety, 118-119
definition of/general info, 35, 82-83 blinds and curtains, 108
safety of vaccines, 83-84 burns and scalds, 108-109, 252
schedule, 84, 250 car seats and booster seats, 115, 123-131, 239
side-effects (expected), 85 choking and poisoning, 52, 59, 107-108, 121, 190-191, 235,
travel safety, 90 276, 280
vaccine-preventable diseases concussions, 102
diphtheria, tetanus, pertussis and polio, 83, 86 crying, 229-233
haemophilus influenzae Type B (HIB), 87
falls, 104-106, 221, 284
hepatitis B, 87
fire safety, 109-110
human papillomavirus (HPV), 83
first aid, 35, 109
influenza (flu), 82, 83, 89
helmets, 118
measles, mumps and rubella (MMR), 83, 88-89
pedestrian safety, 120
meningococcal disease, 88
pneumococcal disease, 83, 88 pet/animal safety, 112-113, 122, 221, 257
polio, 86 playground safety, 121, 442
rotavirus, 87 playing outdoors, 114-117
rubella (German measles), 89 protective gear, 104, 114, 414
shingles, 83 safe play in rural areas, 122
varicella (chickenpox), 83, 89 safe sleep, 106, 159, 218-224, 274-275, 280
Infant formula (baby formula, formula feeding) trampolines, 122
call Health Link at 811 or your health care provider NOW, water safety, 111, 376, 414
203, 215 window safety, 106
burping, 204 YES Tests, See YES Tests (injury prevention)
deciding how to feed your baby, 147-148 Internet safety, 73, 429
feeding equipment, 191-193
feeding relationship/cues, 49-50, 149-151
growth spurts, 152, 154, 202, 213
J
how much and how long/often (frequency) to feed, Jaundice, newborn baby
201-203 call Health Link at 811 or your health care provider
how to feed (bottle feeding), 190-191 (NOW), 254
is my baby getting enough, 191, 203, 213-214 definition, 186
liquid concentrate formula (preparing and storing), 198 sleepy newborn, 186
powdered formula (preparing and storing), 199-200 types of, 253-254
ready-to-feed formula (preparing and storing), 197 Juice, 52, 60, 293
supplementing with (when breastfeeding), 187
types of infant formula, 193-194
vitamin D, 147, 213, 273
warming infant formula, 200
water used to prepare (powdered and liquid
concentrate), 194-196

L Milestones, See development
INDEX
Milia, 210
Language development, See speech and language Milk
development
homogenized, 52, 188, 292-293, 297, 335-336
See also, cognitive development (thinking and
lower-fat (skim, 1%, 2%) 52, 297, 336
communicating)
milk and alternatives, 51-52, 297, 299
See also, thinking and communicating (cognitive
milk bank, 184, 187
development)
unpasteurized, 60, 187, 293, 297
Lanugo, 210
Latch, 160-161
See also, infant formula
Lead (chemical), 103, 195
Milk ducts, blocked, 179-180
Let-down (milk-ejection reflex), 153, 167, 180-181, 185
Milk ejection reflex, See let-down
Milk supply, See breastfeeding
M MMR (Measles, Mumps, Rubella), 83, 88-89
Multiple births (twins, triplets and more), 154, 221
Marijuana, See cannabis
Mumps, 83, 88
Massage, breasts, 167
Mastitis, 180-181
Measles, 83, 88-89 N
Measles, mumps, rubella (MMR), 83, 88-89
Naps, See sleep
Meconium/stool (baby), 153, 164-165, 203
Neglect, 23, 42-43
Medicine, supplements and herbal products (parents)
Newborn baby, how they look, 210-212, 235-236
breastfeeding (taking while), 173, 179-182, 186, 189-190
Newborn hearing screening, 250
financial supports, 131, 412
Newborn rash, 251
herbal products, 155, 173, 182, 221
Nicotine/nicotine replacement therapy (NRT), 35, 139-141,
prescription and over-the-counter medicine, 107, 141,
174
173, 190, 221
Night terrors, 331, 340-341
supplements, See vitamin and mineral supplements
Nightmares, 340-341
(parent)
Nipple shield, 177, 182
Meningococcal disease (meningitis), 87-88
Nipples (baby bottle), 187, 190-191, 200, 236
Mental health (parent)
Nipples (mother), 152-153, 161, 163, 176-179, 185, 236, 292
call 911 NOW, 263, 265
postpartum anxiety, 133, 259-264, 285, 325
Nosebleeds, 101
postpartum blues (baby blues), 261
postpartum depression, 133, 246, 250, 260-264, 285, 325
postpartum psychosis, 264-265 O
relationships (taking care of), 38-40, 136
Omega-3 fats, 173
self-care, 38, 43, 131, 136-138, 258-260, 265-266, 285-286,
Oral health, See teeth and mouth
325-326, 377-379, 415, 443
Over-the-counter medicine, 107, 141, 173, 190, 221
See also, abuse
See also, postpartum anxiety
See also, postpartum depression P
Mercury, 54 Pacifiers/soothers, 222, 230, 236-237, 312, 389

Parent Link Centre, 17 pedestrian safety, 120, 217, 414, 442
Parenting playground play, 121 (YES Test), 357, 383, 396, 442
adjustment to role, 11-15 rural play safety (farms), 122
growing and learning as parents, 25-26, 29-31, 43-46 trampolines, 122
self-care, 38, 131, 136-138, 258-260, 285-286, 325, 415, 443 water safety, 111
self-regulation/positive discipline, 25-29, 29-31, 74, 365, Playpens, 72, 218, 224
377-378, 415-416 Playschool/preschool/nursery school, 18, 34, 410-411
stress and emotions, See mental health (parent) Pneumococcal disease, 88
Pedestrian safety, 120 Poisoning/poisoning, 107-109, 139-140, 142
Pee, See wet diapers emergency call 911 (NOW), 108, 142
Pertussis (whooping cough), 83, 86 Polio, 86
Pet and animal safety, 112-113, 122, 221, 257 Positive discipline, 25, 29, 364, 406
Physical development/growth See also, warmth and structure
newborn baby (birth-2 months), 207, 213-214, 244-246 Postpartum anxiety
young baby (2-6 months), 269-270, 279-280 call 911 NOW, 263, 265
older baby (6-12 months), 289, 317-318 anxiety/anxious, 133, 259-260, 261-262, 263-264, 285, 325
toddler (1 and 2 year olds), 329, 331-332, 354-355, 357 symptoms, 261, 263-264
preschooler (3 and 4 year olds), 383, 395-396 See also, mental health, parent
young child (5 year olds), 419, 429-430 See also, postpartum depression
Ages and Stages Questionnaire (ASQ), 17, 208 Postpartum blues, baby blues, 261
definition/description, 15-18 See also, mental health, parent
growth spurts, 152, 154, 202, 213 Postpartum depression
Parent Link Centre, 17 call 911 NOW, 263, 265
sedentary (sitting or lying down for long periods), 72-73 depression/depressed, 133, 246, 250, 260-264, 285, 325
Plagiocephaly, brachycephaly (flat areas on head), 211, See also, mental health, parent
224-225, 275 See also, postpartum anxiety
Play Postpartum psychosis
newborn baby (birth-2 months), 244-246 call 911 NOW, 265
young baby (2-6 months), 279-281 symptoms, 264
older baby (6-12 months), 316-318 See also, mental health (mother)
toddler (1 and 2 year olds), 354-360 Preconception, 144
preschooler (3 and 4 year olds), 395-398 Prescription medicines, 107, 141, 173, 190, 221
young child (5 year olds), 429-431 See also, medicine, supplements and herbal products
sit less, play more, 72-73, 360 Psychosis, See postpartum, 265
toys, See toys Public Health Nurse, See well child clinic/immunization visits
tummy time, 66, 69, 226, 245-246, 273, 275, 280, 317 Punishment/punish, 30-31, 55, 364, 379, 389, 406, 422
types of play, 66-71 See also, positive discipline, 29
See also, falls
See also, playing outdoors
Playing outdoors
R
bike/bike safety, 118-119, 135, 429-430 Rash
general information, 114-117 call Health Link at 811 or your health care provider
helmet use (bike and other), 118, 414, 442 (NOW), 96-97, 255
emergency, call 911 (NOW), 298

diaper rash, 98, 237-238 Self-care (parent)
INDEX
food allergies, 298 newborn baby (birth to 2 months), 258-260, 265-266
newborn rash, 251 young baby (2-6 months), 285-286
signs of disease/illness, 88-89, 255, 283 older baby (6-12 months), 325
skin rash, 97, 240 toddler (1 and 2 year olds), 377-379
Relationships, parent preschooler (3 and 4 year olds), 415-416
abuse, 39-42, 136 young child (5 year olds), 443-444
healthy relationships, 38-39 general information, 38-39, 43, 131, 136-138
Respiratory syncytial virus (RSV), 99 self-regulation, 25-29, 74, 365, 377-378, 415-416
Rickets, 53, 147 Self-esteem and confidence (child), 68, 71, 73, 114, 334, 371,
Rotavirus, 87 385, 404-405, 431, 434
RSV (Respiratory Syncytial Virus), 99 Self-regulate/regulation (baby and child)
Rubella (German measles), 83, 89 toddler (1 and 2 year olds), 362-365
preschooler (3 and 4 year olds), 399-400
young child (5 year olds), 426
S supporting your child’s self-regulation, 25-26
Safe infant sleep Self-regulation (parent), 25-29, 74, 365, 377-378, 415-416
bed sharing (not advised), 159, 221 Self-soothe, 237, 269, 307-309
breastfeeding (reduces SIDS risk), 152, 222 Self-talk (inner speech), 71, 231, 359, 431
car seat (sleeping in), 219 Separation anxiety, 307, 321-322, 330, 368-369, 401
clothing/sleepwear (overheating), 239 Serve-and-return interactions (supports brain development)
cribs, cradles, bassinets, , 72, 106, 218-219, 222-224, newborn baby (birth-2 months), 240-241, 244
274-275 young baby (2-6 months), 277-278
pacifiers, 237 older baby (6-12 months), 313-314
playpens, 224 toddler (1 and 2 year olds), 350-351
room-sharing, 149, 220 preschooler (3 and 4 year olds), 391
sleep position (on back), 159, 218, 226, 227,280, 305 young child (5 year olds), 425-426
See also, sleep (baby and child) healthy development (how it supports), 20-21, 32
Safety (baby and child), See injury prevention Sexual health and development (child), 34, 75-76
Saline nose drops, 252 Sexual relationship (parent), 38, 40, 265
Salmonella, 112 Shaken baby
Sanitizing, 58, 102, 345 call Health Link at 811 or your health care provider
Scalds, 109 (NOW), 232
School coping with crying, 230-233, 275-276, 286
kindergarten, 418, 420-422, 427, 436-439 Shared parenting (parenting together), 43-45
school bus safety, 442 SIDS, See sudden infant death syndrome
See also, playschool/preschool/nursery school Sippy cups, 292
Screen time (TV, computer, tablet, mobile phones) Skin rash, 97, 240
guidelines for child’s age , 61, 72-73 See also, diaper rash
preschooler, 410 See also, rash
toddler, 339, 360 Skin-to-skin cuddling
Seat belts, 123, 126, 128-130 attachment and cuddling, 209, 245
benefits of and how to, 209-210
body temperature (regulating), 255
breastfeeding (supporting), 152, 155-156, 162, 183,
186-187, 189
formula feeding, 187, 189, 190, 201
crying baby (helping to calm), 150, 229-230
medical procedures, 81-82

Sleep (baby and child) Special needs (differing abilities), 18
call 911 (NOW), 91 Speech and language development
call Health Link at 811 or your health care provider newborn baby (birth-2 months), 243
(NOW), 164, 215, 253-254 young baby (2-6 months), 278-279
cues, 215-218 older baby (6-12 months), 292, 315
newborn baby (birth-2 months), 149, 162, 186, 201, 207, toddler (1 and 2 year olds), 352-354
215-218, 253 preschooler (3 and 4 year olds), 392-395
young baby (2-6 months), 269-270, 273-274 young child (5 year olds), 427-428
older baby (6-12 months), 289, 305-310 concerns about, 80-81 250, 396, 413
toddler (1 and 2 year olds), 338-342 general info, 16-17, 21, 50, 64-65
preschooler (3 and 4 year olds), 387 See also, cognitive development (thinking and
young child (5 year olds), 419, 423 communicating)
bedtime routine, 60-61 Spitting up, 252
bedwetting, 388 Stools/bowel movements/poops (dirty diapers)
cribs, cradles, bassinettes, 218-224, 274 call Health Link at 811 or your child care provider (NOW),
naptime, 289, 305-306, 338, 340, 387 204, 215
nightmares and night terrors, 331, 340-341 breastfeeding/breastmilk, 153, 164-165
patterns, 307, 338, 387 concerns, 95-96
playpens (sleeping in), 224 infant formula/formula-fed, 203, 295
safe sleep, 106, 159, 218-224, 227, 274-275, 280 Stork bites/hemangiomas, 211
self-soothing, 237, 269, 307-309 Street/illicit drugs, 37, 107, 143-144, 176, 190, 221
sleepy baby (more than usual), 96, 164, 186, 203, 215 Stress/self-care (parent), 38, 43, 131, 136-138, 258-260,
sleepwear, 110, 219-220, 239 265-266, 285-286, 325-326, 377-379, 415, 443
soothers/pacifiers, 236-237 Sudden Infant Death Syndrome (SIDS), 138-140, 152, 218-222,
swaddling, 227-228, 275 227, 237, 239, 274
See also, safe sleep See also, safe infant sleep
See also, sudden infant death syndrome (SIDS) Sun safety/sunscreen, 116-117
Sneezing, 57, 86-89, 99, 252 Supervising your child/supervision
Social development newborn and young baby (birth-6 months), 218, 224,
definition of/description, 16, 74-75 226, 244-245, 280
newborn baby (birth-2 months), 207, 248 older baby (6-12 months), 317
young baby (2-6 months), 269, 281 toddler (1 and 2 year olds), 354, 357, 366, 376
older baby (6-12 months), 289, 320-322 preschooler (3 and 4 year olds), 396, 413
toddler (1 and 2 year olds), 330, 366-368 young child (5 year olds), 441
preschooler (3 and 4 year olds), 408, 403-408 alcohol and cannabis, 138, 175
young child (5 year olds), 419, 433-439 always supervise/supervise for safety (general), 37, 105,
Soft spots (fontanelles), 211 111-112, 121-122
Solid foods (starting around 6 months) Supplementing (feeding baby)
finger foods/food textures, 301-303 expressed breastmilk, 187-190
food allergies, 298 infant formula, 190-191
iron, 273, 297, 299, 300, 302 vitamins and minerals, See vitamins and minerals (baby
and child)
homemade and store-bought baby food, 302-303
Supplements, vitamins and minerals, (parents), 132, 144, 173
tips for starting solids, 294-296
Support for parents, See parenting
what food, how much (quantity), and how often
(frequency) to feed, 295- 300 Swaddling, 227-228, 275
See also, feeding and eating (older baby, and toddler) Swollen breasts, See breastfeeding, challenges
(engorgement/engorged)
Soothers/pacifiers, See pacifiers/soothers
Sore nipples (mother), 176-177

T Toys
INDEX
newborn baby (birth-2 months), 226, 246
Talking, See speech and language development young baby (2-6 months), 280
Tantrums, See temper tantrums older baby (6-12 months), 289-290, 314, 318
Teeth and mouth (oral/dental care) toddlers (1 and 2 year olds), 331-332, 357, 366-367, 373
baby teeth (tooth chart/caring for), 61-63, 236, 292, 312, preschooler (3 and 4 year olds), 394, 398
346, 424
young child (5 year olds), 433
brushing and flossing, 312-313, 346-347, 389, 424
safety, 68, 102-103, 107, 219, 224
dental care/checkups (going to dentist), 62-63, 79, 250,
Trampolines, 122
312-313, 348, 389
Travel (preparation, health risks, safety), 90, 116-117, 124, 170
financial support for dental care, 79
Tummy time, 66, 69, 226, 245-246, 273, 275, 280, 317
sucking soother/pacifier, thumb or fingers, 312, 389, 424
Twins, triplets and more (multiple births), 154, 221
teething, 211, 276
tooth decay (check for, prevention), 61-63, 193, 293, 312,
336, 424 U
Temper tantrums, 29, 329, 331, 363-365, 378, 399-400, 431 Umbilical cord, 212
Temperature (body temperature) Urine/pee, See wet diapers
(NOW), 100, 283
go to the emergency department or call 911 (NOW), V
256, 283 Vaccine/vaccinations (immunizations)
body temperature, 85, 91-95, 114, 255-256, 311 definition of/general info, 35
See also, fever safety, 83-84
Terrible twos, 333 schedule, 84, 250
Tetanus, diphtheria and pertussis, 83, 86 side-effects, 85
Thinking and communicating (cognitive development) vaccine-preventable diseases, 35, 82-89
See also, cognitive development (thinking and See also, immunization
communicating) Vaginal discharge (baby), 212
Thumb sucking, 237, 389, 424 Varicella (chickenpox), 83, 89
Thrush/yeast infection, 98, 176-177 Vernix, 210
Tobacco and tobacco-like products Violence, See abuse
breastfeeding (use while), 174 Vision
definition of, 35 checkups/testing (optometrist), 79-80, 250, 375, 411-412,
second/third-hand smoke or vapour, 138, 140-141, 220 437, 440-441
sudden infant death syndrome (SIDS), 138-140, 220 development and learning, 17
See also, safe infant sleep financial support, 412
types of tobacco/tobacco-like products, 138-141, 142-143 signs of concern, 80, 375, 411-412
quitting, 138, 141-142, 175 Vitamin and minerals (baby and child)
Toilet teaching, 33, 343-345, 388 iron, 188, 193, 273, 296-297, 299-300, 302, 335-336
Too much breastmilk/oversupply, 184 omega-3, 173
See also, breastfeeding challenges vitamin C, 296-297
Tooth decay, See teeth and mouth vitamin D supplement, 53, 115, 152, 335, 386, 422
Toxoplasmosis, 112 Vitamins and mineral supplements (parents), 132, 144,
172-173

Vomiting (throwing up) Weaning (from breastfeeding), 188-189
call Health Link at 811 or your Health Care Provider Weight gain (baby/child), 152, 154, 202, 213-214, 249, 273
(NOW), 96, 165 See also, physical development/growth
vomiting, 85, 92, 95-96, 252, 255, 298, 311 Well child clinic/immunization visits
general information, 78, 80, 84-85, 156
W newborn baby (birth-2 months), 249-250, 261-262

young baby (2-6 months), 282-283
Waking and sleeping (newborn baby), See sleep older baby (6-12 months), 323
Walking/walk (baby and child) toddler (1 and 2 year olds), 374-375
older baby (6-12 months), 289, 317, 324 preschooler (3 and 4 year olds), 411-412
toddler (1 and 2 year olds), 17, 329, 331, 356, 357 young child (5 year olds), 440-441
preschooler (3 and 4 year olds), 383, 396 Wet diapers/pees (newborn baby)
young child (5 year olds), 430 call Health Link at 811 or your child care provider (NOW),
active living, 69, 72, 244, 355 164, 255
pedestrian safety, 120 breastfeeding, 164, 214
Warmth and structure formula-fed, 203, 214
older baby (6-12 months), 309, 321 Whooping cough (pertussis), 83, 86
toddler (1 and 2 year olds), 333, 342, 356, 363, 373
preschooler (3 and 4 year olds), 402
young child (5 year olds), 443-445
Y
adjusting to change, 33-34, 36 Yeast infection (thrush), 98, 176-177
definition/description, 11-12 YES tests (injury prevention)
supports learning and development, 16, 18, 30, 32-33, 64 bike helmet YES Test, 118
Washing hands (hand washing), 56-57, 112, 345 booster seat YES Test, 129-130
Water forward-facing car seat YES Test, 127-128
drinking, 54, 58, 116, 195-196, 292-293, 386, 421 playground YES Test, 121
ensuring safe drinking water (well water, lead, travel), 58, rear-facing car seat YES Test, 125-126
90, 103
preparing infant formula (sterilization), 195-196
oral health (supporting), fluoride, 62, 312
Water safety, 111, 233-234, 284, 376, 414
Weaning (from bottle), 292-293, 336

H E A LT H Y PA R E N T S , H E A LT H Y C H I L D R E N
The Early Years

Healthy Parents, Healthy Children: The Early Years is filled with everything that parents of
babies and young children want and need to know to help their children grow, learn,
play and be healthy. This book provides practical, up-to-date information to help you
build a strong foundation for your child during the first 5 years.
You can also find this book online at healthyparentshealthychildren.ca
Follow us on
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@AHS_HPHC

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Because they don’t come with a manual

My important contact information

Community or public health centre

The content in this book reflects Alberta Follow us on

2 The Early Years | Healthy Parents, Healthy Children

Emergency Services Health Link

Addiction AlbertaQuits Helpline Bullying Helpline

Child Abuse Family Violence Income Support

Medication & Mental Health Poison & Drug

myhealth.alberta.ca alberta.ca immunizealberta.ca

4 The Early Years | Healthy Parents, Healthy Children

Healthy Parents, Healthy

There’s a lot to know and learn

~ Farzana, mom of a young baby

6 The Early Years | Healthy Parents, Healthy Children

■■ text boxes that highlight:

Things to know Helpful activities

■■ text boxes that describe when to ask for help:

1. Open a QR code reader on your smart phone.

We also wish to acknowledge these organizations from which we adapted content:

8 The Early Years | Healthy Parents, Healthy Children

How parents learn and grow

Every family has their own way of raising

Provide warmth Provide structure

12 The Early Years | Healthy Parents, Healthy Children

Keep in mind that nobody is perfect. All

growth: changes in your child’s body (e.g., height and weight)

14 The Early Years | Healthy Parents, Healthy Children

~ Jenna, mom of two children

How Children Grow and Develop

Children’s development occurs in four main areas (domains):

All of the areas of development are linked and

Your child cannot learn and develop on their

16 The Early Years | Healthy Parents, Healthy Children

Development may not happen at a steady pace

Some parents feel frustrated at these

“ I have a fantastic doctor who went over some development milestones.

attachment: a two-way emotional connection between you and your baby

Each child is unique and will develop at

All parents need a system of supports,

18 The Early Years | Healthy Parents, Healthy Children

The developing brain

Things to know about your child’s developing brain:

To learn more about brain development, visit the Videos section at

Brain cell connections become healthier

When your baby is little, they ‘serve the

20 The Early Years | Healthy Parents, Healthy Children

Serve-and-return interactions will

22 The Early Years | Healthy Parents, Healthy Children

Toxic stress is a different kind of stress. It’s

You and your child need to be supported

Call Health Link at 811 or your health care provider if:

Knowing about your child’s

24 The Early Years | Healthy Parents, Healthy Children

The care you provide

Role modelling and supporting self-regulation

The stress response

26 The Early Years | Healthy Parents, Healthy Children

■■ loud, sharp, high-pitched or yelling ■■ tone is normal

■■ Imagine your mind has a gearshift like a

Children learn by watching you

28 The Early Years | Healthy Parents, Healthy Children