2016

WE’RE HERE FOR YOUR FAMILY, EVERY DAY OF THE YEAR! Your Jean Coutu affiliated pharmacists take the health and well-being of your little ones to heart and are available to make sure they grow up strong and healthy. Whether you need advice or simply want to share your concerns, your team of experts is here to guide you from the moment you learn a baby is on the way. When it comes to the health or care of everyone in your family, you can always count on your pharmacist.

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A practical guide for parents from pregnancy to age two 2016

www.inspq.qc.ca/en/tiny-tot

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2015-11-20 09:41

A practical guide for parents from pregnancy to age two 2016

Nicole Doré Danielle Le Hénaff Authors of the original text

www.inspq.qc.ca/en/tiny-tot Editor-in-Chief Chantale Audet For the 2016 update Acting Editor-in-Chief Amélie Bourret Assistant to the Acting Editor-in-Chief Mădălina Burtan Administrative and Technical Support Igor Baluczynski

Medical Advisors Danielle Landry Nicole April Scientific Coordinator Jean-François Labadie Scientific Superviser Réal Morin

First edition: 1988. Editions revised every year.

How to cite this book: Doré, Nicole; Le Hénaff, Danielle. From Tiny Tot to Toddler: A practical guide for parents from pregnancy to age two. Québec, Institut national de santé publique du Québec, 2016. 776 pages.

The sections regarding government programs and services have been adapted and published with the authorization of the ministère du Travail, de l’Emploi et de la Solidarité sociale. The information provided was recent when this edition of From Tiny Tot to Toddler was released. For updates, go to www.gouv.qc.ca.

Brand names of products described in this document are given as examples only. Fair use of this guide for research or private study is authorized under Section 29 of the Copyright Act. Except for illustrations and photographs, excerpts from this publication may be reproduced for educational, noncommercial purposes provided the source is acknowledged. Any other use must be authorized by the Government of Québec, which holds the exclusive intellectual property rights for this document. Authorization may be obtained by submitting a request to the central clearing house of the Service de la gestion des droits d’auteur of Les Publications du Québec, using the online form at www.droitauteur.gouv.qc.ca/en/autorisation.php or by sending an e-mail to [email protected]. Information contained in the document may be cited provided that the source is mentioned.

Legal Deposit – 1st quarter 2016 Bibliothèque et Archives nationales du Québec Library and Archives Canada ©Gouvernement du Québec (2016)

ISSN: 1711-411X (printed version) ISSN: 1911-6004 (PDF) ISBN: 978-2-550-74154-1 (printed version) ISBN: 978-2-550-74155-8 (PDF)

The guide is given free of charge as soon as pregnancy checkups begin. Depending on the region, the guide will be handed out at your doctor’s office, CLSC, test center, birthing center, or ultrasound appointment. For those who plan to adopt, the guide is available at a youth centre or certified international adoption agency. The guide is for sale for $22.95. You can buy From Tiny Tot to Toddler and Mieux vivre avec notre enfant de la grossesse à deux ans from Les Publications du Québec, in bookstores, by telephone at 418-643-5150 or 1-800-463-2100 or on their website www.publicationsduquebec.gouv.qc.ca. Free English and French versions are also available on the website of the Institut national de santé publique du Québec at: www.inspq.qc.ca/en/tiny-tot.

2016 Edition

Acknowledgements

Authors of the original text Nicole Doré, Danielle Le Hénaff

We would like to warmly thank all of the individuals and organizations who help make the guide possible; your individual contributions are vital to this collective work. Given the challenge of naming our many collaborators, we apologize if we forgot to mention your name, and we thank you all the more!

Writers Nicole April, Chantale Audet, Christiane Auray-Blais, Lucie Baribeau, François Beaudoin, Céline Belhumeur, Amélie Blanchet-Garneau, Julie Boissoneault, Luce Bordeleau, Marie-Andrée Bossé, Nicole Boulianne, Amélie Bourret, Lise Brassard, Marie-Ève Caty, Brigitte Chaput, Isabelle Charbonneau, Catherine Chouinard, Aurore Coté, Rosanne Couture, Cécile Fortin, Denis Gauvin, Christian Godin, Édith Guilbert, Julie Guimond, Anne Harvey, Mélissa Lafrenière, Danielle Landry, Josée Laroche, Richard Larocque, Julie Lauzière, Johanne Laverdure, Michel Lavoie, Sylvain Leduc, Lyse Lefebvre, Céline Lemay, Anne Letarte, Patrick Levallois, Chantal Levesque, Sylvie Lévesque, Michel Lévy, Nadia Maranda, Jean‑Claude Mercier, Caroline Morin, Christina Morin, Réal Morin, Laurie Plamondon, Julie Poissant, France Poliquin, Marie-Claude Quintal, Faisca Richer, Hélène Rousseau, Marie-Josée Santerre, Isabel Thibault, Lucie Thibodeau, Diane Tousignant, Lucie Tremblay, Roch Tremblay, Jean-Jacques Turcotte, Mylène Turcotte, Pascale Turcotte, Hélène Valentini, Annie Vallée Translation Anglocom Cover photo Courtesy of mommy Émilie Revil and baby Mathias

Graphic design and computer graphics Sophie Charest Julie Desrosiers Publicity CPS Média Printing Imprimerie Norecob inc.

Individuals Jérémie Allain, Christiane Auray-Blais, François Beaudoin, France Bilodeau, Réal Binette, Marie‑Josée Bolduc, Josée Bouchard, Nicole Boulianne, Nicholas Brousseau, Pauline Chauvette, Aurore Côté, Jocelyne Côté, Hélène Couture, Renée Cyr, Suzanne Dionne, Danièle Donaldson, Nathalie Drouin, Pierre‑André Dubé, Isabelle Dufresne, Richard Fachehoun, Sabrina Fortin, Christian Godin, Édith Guilbert, Nicole Lapointe, Michel Lavoie, Sylvain Leduc, Céline Lemay, Benoît Lévesque, Nathalie Lévesque, Monique Messier, Caroline Morin, Marie-Claude Paquette, Hélène Rousseau, Monik St-Pierre, Julie Tranchemontagne, Mylène Trottier, Gisèle Trudeau, Mathieu Valcke Groups The regional coordinators in charge of distributing From Tiny Tot to Toddler at the Directions de santé publique of the CISSS and the CIUSSS: Thank you for your unconditional support; without you the guide would not make its way into the hands of Québec parents. Organismes Info-Santé; Santé Canada; Services Québec Parents Many parents have supported us throughout the production of the guide by reading and commenting different versions of the texts. We greatly appreciate this invaluable support, as do the experts who collaborate with us. You know who you are: our gratitude goes out to you! Parent-photographers We also wish to thank all the other parent-photographers whose pictures appear in the guide. Thank-you for letting us into your day-to-day life by sending us your colourful pictures. We greatly appreciate your generosity. A very special thank-you to Émilie Revil, who provided our cover photo.

Update of the Foods chapter The Foods chapter has been revised for the 2015 edition. Adjustments have also been made to the Food-related problems chapter. The work was carried out by authors working in collaboration with the Institut’s team, and with the support of numerous contributors whose cooperation we would like to acknowledge here. Coordinated by Chantale Audet et Amélie Bourret Writers Chantale Audet, Amélie Bourret, Danielle Landry, Jean-Claude Mercier, Laurie Plamondon Contributors to the writing team Nicole April, Lise Bélanger, Vicky Bertrand, Réal Morin, Hélène Rousseau Individuals consulted Marie-Hélène Audet, France Bilodeau, Manon Bouchard, Marie‑Eve Carrière, Chantal Chantigny, Marie Chouinard, Annie Côté, Mireille Desjardins, Suzanne Dionne, Jean-Philippe Drolet, Johanne Dubé, Sarah Fournier, Christian Godin, Catherine Gravel, Laura Haiek, Sophie Hamelin, Louise Isabelle, Sylvie Jourdain, Caroline Lamontage, Christine Laurendeau, Mélina Leporé, Patrick Levallois, Hélène Lowell, Julie Marcil, Jennifer McCrea, Sandrine Melki, Josée Paquin, Marie‑Eve Plourde, Marie-Josée Rainville, Sylvie Renaud, Julie Savard, Louise Sirard, Marie‑Pier Thibault, Lucie Tremblay, Huguette Turgeon‑O’Brien, Annie Vallée

Groups consulted Équipe de nutritionnistes en petite enfance du CSSS de l’Ouest-de-l’île; Équipes de nutritionnistes en petite enfance du CSSS de Gatineau, du CSSS des Collines et du CSSS de la Vallée-de-la Gatineau; Équipe de nutritionnistes en petite enfance du CSSS Pierre-Boucher; Équipe d’infirmières et de nutritionnistes en petite enfance du CSSS Haut-Richelieu-Rouville; Équipe de nutritionnistes du CHU Sainte-Justine; Info-Santé; Santé Canada

Foreword From Tiny Tot to Toddler: A practical guide for parents from pregnancy to age two is offered free of charge to the following people to support Québec parents:

On behalf of the editorial team and all of our contributors, I’m delighted to present you with the 2016 edition of the guide From Tiny Tot to Toddler: A Practical Guide for Parents from Pregnancy to Age two. It is provided free of charge to you and all other soon-to-be parents in Québec. The arrival of your baby signals the start of a new chapter in your life, and we hope this guide will serve as a faithful travelling companion on this exciting journey.

• Prenatal workers of the CISSS

For over 35 years, From Tiny Tot to Toddler has been seeking to help parents make the best decisions for their babies and themselves, knowing they have many legitimate questions. To this end, all of our contributors share the same goal: to provide clear, accurate, scientifically based information. Contributors include health professionals, of course, but also parents, who guide us regarding the information they need to face the challenges that await them. They fuel our motivation to provide a relevant and useful resource.

and the CIUSSS

• Physicians and midwives providing health care to pregnant women and newborns

• Health care workers in community

organizations serving young families

• Lactation consultants and v­ olunteers supporting new mothers through breast-feeding support groups

Year after year, the team tracks new developments in scientific and practical knowledge to keep your From Tiny Tot to Toddler as up-to-date as possible. I hope you will find From Tiny Tot to Toddler useful over the next years. Happy reading! Dr. Nicole Damestoy Chief Executive Officer Institut national de santé publique du Québec

Three tips to help you use better your Tiny Tot

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2 Text boxes to attract your attention You will notice that information is presented in three types of boxes. The purpose of the boxes is to attract your attention to certain messages:

H

Essential information to remember.

Information to which you should pay special attention.

Information to comfort you and boost your confidence.

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A glossary to help you understand To make the guide easier to read, some definitions are provided as you go along. The defined words are printed in color in the text and the definitions are provided at the bottom of the page. The word is usually defined the first time it appears in the guide. For example:  Embryo: The early stage of new human life, growing in the mother’s belly, up to 10 complete weeks of pregnancy.

All the words and definitions are also presented in the Glossary on page 13.

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Contact us!

Tools for finding information in the guide The table of contents, for the main headings The Table of contents on pages 8 to 12 lists the headings of the guide.

If you have a few minutes, tells us what you think of the guide: [email protected] Your comments are invaluable and help us improve! Happy reading!

The index, to fine tune your search! You have a specific question? Looking in the index is the best way to find an answer in the guide. Just think of a key word and then look for it in the Index on page 756. You will quickly find the pages with the information you’re seeking. Numbers in bold type in the index refer to pages with definitions of words.

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Pregnancy ■■ Before you get pregnant Women19 Men22 Fertilization23 ■■ The fetus Length of pregnancy Development of the fetus Fetus’s environment

27 28 33

■■ Pregnancy day to day Physical changes 37 Emotional changes 44 Sexuality49 Personal care 50 Nutrition during pregnancy 53 Being active 77 Work79 Tobacco, alcohol, and drugs 79 Household products 84 Pets85 X-rays86 Travel and trips 87 8

■■ Health during pregnancy Professionals and services  Health care Prenatal care Warning signs High-risk pregnancies Domestic violence during pregnancy  ■■ Preparing to breast-feed Why breast-feed? Preparing to breast-feed Getting breast-feeding off  to a good start Learning how to breast-feed ■■ Preparing for the birth Planning ahead Hospital visit What to bring to the hospital or birthing centre Birth plan Vaginal birth after caesarean Breech presentation

Delivery 91 96 115 124 132 136

139 145 148 150

153 154 156 158 162 165

■■ The start of labour Recognizing the start of labour When should I go to the hospital or birthing centre? Continuous support during childbirth Understanding and managing pain ■■ The stages of labour First stage: Opening of the cervix Second stage: Descent and birth of your baby Third stage: Delivery of the placenta Possible interventions during labour Caesarean section ■■ The first few days Skin to skin Your stay at the hospital or birthing centre When the unexpected happens Physical recovery of the mother Get some rest

169 171 173 174

179 182 186 188 194

199 200 203 210 214

Baby blues Depression  Sexual desire Birth control

215 215 217 218

Baby ■■ The newborn Fetal position 227 Size and weight 227 Skin227 Eyes228 Head228 Genitals230 230 Swollen breasts Spots231 Sneezing231 Hiccups231 The need for warmth 231 Urine232 Stools233

■■ Talking with your baby Crying235 Colic or excessive crying 237 The need to suck 241 Touch242 Taste and smell 244 Hearing245 Eyesight246 ■■ Sleep Sleeping safely Sudden infant death syndrome Preventing a flat head Sleep in the first weeks Sleep at around 4 months Sleep between 1 and 2 years old

249 251 255 256 257 260

■■ Your child’s development Bonding266 Temperament267 To interact is to stimulate 269 Playing to learn 270 Toys270

Questions about language Setting limits Stages of growth Toilet training Reading and writing

271 276 282 306 308

Feeding your child ■■ Feeding your baby An act of love 313 Hunger signs 313 314 Feeding schedule Is your baby drinking enough milk? 316 Growth spurts 318 Hiccups318 Burping318 Gas320 Regurgitation320 Colic321 Social pressure 322 Baby’s changing needs 322 Feeding a premature baby 323 Vitamin D: Not your ordinary vitamin! 324

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■■ Milk Which milk is best? Mother’s milk Producing breast milk The composition of human milk Handling expressed milk Commercial infant formula (commercial milk) Handling commercial infant formula Other types of milk

327 329 330 331 338 342 346 353

■■ Breast-feeding your baby Learning the art of breast-feeding 359 Getting help 360 362 Your breasts during nursing Breast-feeding, step by step 365 How often to nurse—and how long? 375 Breast-feeding phases 381 Is breast-feeding still possible? 388 Expressing milk 396 Combining breast and bottle 406 Weaning410 Breast-feeding problems and solutions 412

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■■ Bottle-feeding your baby Choosing baby bottles and nipples How much milk? Warming milk Bottle-feeding your baby Bottle-feeding problems and solutions Cleaning bottles, nipples  and breast pumps ■■ Water When to give your baby water Boil water for babies under 4 months Choosing the right water Municipal tap water Private well water Bottled water Bulk water Water coolers Water treatment devices Water problems

442 443 445 446 447 451

455 455 456 457 458 459 460 460 460 461

■■ Foods When should I introduce foods? 463 How should I introduce foods? 466 Choking risk: Be extra careful until age 4 474 Honey—never for babies under age 1 476 Baby food basics 476 6 to 12 months—your baby’s first foods 484 484 Start with iron-rich foods Continue with a variety of foods 485 Grain products  486 489 Meat and alternatives Vegetables and fruit  494 Milk and dairy products  501 Fats  503 Food ideas for your baby 504 From 1 year onward—sharing meals with the family 506

■■ Food-related problems Food allergies 515 Lactose intolerance 523 Anemia524 527 Poor appetite Chubby babies 528 Stools and foods 530 Constipation530

Health ■■ A healthy baby Holding your newborn 537 Caring for the umbilical cord 539 542 Bathing your baby Cutting your baby’s nails 547 Choosing diapers 547 Neonatal screening 550 Medical checkups 552 Consulting health professionals 552 Your baby’s growth 553 First teeth 555 Vaccination560

■■ Common health problems A well-stocked medicine cabinet 568 Newborn jaundice 568 Thrush in the mouth 570 Pimples, redness, and other  skin problems571 Eye problems 576 Allergies579 Common childhood infections 581 Preventing infections 581 Fever586 Fever and skin rashes (contagious diseases) 596 Colds and flu 599 Stuffed-up or runny nose 602 Cough604 Sore throat 605 Ear infection 606 Diarrhea and vomiting (stomach flu or “gastro”) 607 ■■ Keeping baby safe Travelling safe: Car seats Babyproofing the nursery

617 624

Babyproofing the kitchen Choosing toys Preventing falls Preventing drowning Preventing suffocation and choking Preventing burns Preventing dog bites Living in a smoke-free environment Preventing poisoning Protecting your baby from the sun Protecting your baby from insect bites

627 628 630 632 634 636 638 639 640 643 644

■■ First aid Bites647 Scrapes and cuts 648 649 Small object in the nose Nosebleeds650 Oral and dental injuries 651 Bumps and blows to the head 652 Burns654 Foreign object or chemical product in an eye 656 Insect bites 657 Choking658 11

Poisoning and contact with hazardous products664

Family ■■ Being a father A new role 672 Importance of the father/ child relationship674 Feeding baby together 675 ■■ Being a mother A new experience as a woman  Have faith in yourself Rest, rest, and more rest Feeding Mom

677 679 680 681

■■ Growing as a family Nobody’s perfect! 686 Take time for yourself and your partner  686 Grandparents687

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New families, new situations 688 Reaction of older children 689 Twins690 Being a parent of a baby who  is “different” 692 Taking Baby for a walk  694 697 Family activities  Getting a babysitter  698 Budgeting for Baby 699 700 Choosing clothes Caring for clothes 703 First shoes 703 Help is available 706

Useful information ■■ Becoming a parent Foreword711 Parental leave and preventive withdrawal 713 Financial assistance 718

Filiation and parental rights and obligations 730 Registering and choosing a name for your child 733 Childcare services in Québec 739 Adoption743 Mon arbre à moi campaign 745 Government of Canada programs and services: financial assistance and passport applications 746 Portail Québec 747 ■■ Resources for parents Telephone help line resources Associations, agencies and  support groups

749 750

■■ Index Index757

Glossary Allergic disorder An allergy-related problem such as a food allergy, asthma, eczema, or allergic rhinitis.

Egg Cell produced by the ovary. When the egg is fertilized, a baby may begin to form.

Amniocentesis Procedure that involves taking a sample of amniotic fluid for analysis.

Embryo Name given during the first full 10 weeks of pregnancy to the human being developing in the mother’s abdomen.

Antibodies Substances made by the body to fight off disease. Also called immunoglobulins.

Esophagus Muscular tube that carries food from the mouth to the stomach.

Areola Darker area of the breast around the nipple.

Express Pump or squeeze milk from the mother’s breast.

Birth defect Abnormality existing at birth but that developped during pregnancy.

Fertilization When a sperm penetrates an egg.

Diaper rash Skin irritation and redness in the area covered by the baby’s diaper.

Fetus Developmental stage of a human being in its mother’s womb, from the start of the 11th week of pregnancy until birth. 13

Genetic abnormality Error in the genes. Genes are located on the chromosomes of human cells. They pass along the traits of parents to their children. Hemorrhage Heavy bleeding. Inverted nipple Nipple that is retracted into the breast. Labour Process by which the baby passes from the uterus to the outside world, primarily through contractions of the uterus. Mastitis Inflammation of the breast. May also be an infection. Menstrual cycle The time between two menstrual periods. 14

Miscarriage A spontaneous abortion, which can have a variety of causes (e.g., a deformity or disease). Neural tube Part of the embryo that develops into the brain and spinal cord (inside the spinal column). Oxytocin A hormone produced by a gland within the brain. Oxytocin circulates in our blood, causing uterine contractions during childbirth and the expulsion of breast milk. Perineum The part of the body between the vagina and the anus. Pupil The black centre inside the coloured part of the eye.

Rhesus (Rh) factor One of the characteristics of blood. You are either Rh positive or Rh negative. Sperm Cell produced by the man. When it fertilizes an egg, a baby may begin to form. Spina bifida Birth defect of the spinal column. Sterile Product that is free of microorganisms and germs. Sternum Flat bone in the middle of the chest.

Thrombophlebitis Inflammation of a vein associated with clot formation. Ultrasound An examination using an ultrasound device that can see the embryo or fetus in the mother’s womb. Urinary catheter A flexible tube that allows urine to drain freely from the bladder. The catheter is inserted into the bladder through the urethra. Weaning Gradual phasing out of breast-feeding.

Sudden infant death syndrome The unexplainable sudden death of an apparently healthy newborn under the age of one.

15