Neonatal Follow-up Clinic

1. your child's health card
2. a list of the developmental resources that your child has been referred to or is receiving (e.g. infant/child development, physiotherapy, occupational therapy, speech-language pathology, etc.)
3. a list of medication and vitamins that your child is taking
4. completed ages & stages questionnaire (socio-emotional) that you received in the mail with the reminder letter. This is for 18 month and 48 month visits only.Please complete the ages and stages questionnaire before your appointment

Please complete the ages and stages questionnaire before your appointment

Visits could be long, so toys, snacks or a bottle of water or milk could come in handy.

Each appointment takes between 60-90 minutes. We'll send a report of the visit to your family doctor or pediatrician. Remember that appointments in this clinic do not replace regular checkups with your child's doctor. During the clinic visit:

• the nurse will ask questions about how things are going at home (e.g. do you have any concerns? how is your child eating? sleeping? behaving?)
• the nurse will weigh and measure your child
• a doctor or a nurse practitioner will see you and your child at each visit
• you'll see a physiotherapist at the 4 month visit, and only as necessary after that
• the psychologist will do a screening test only on very premature babies at the 18-month visit

Screening and developmental assessment tools are useful to guide the session and provide you with the most accurate information on the developmental status of your child. At the NNFC clinic we use the following tools:

• ages and stages questionnaire 3rd edition (ASQ3) screening tool helps the physician or the neonatal nurse practitioner to evaluate the developmental progress of your child; it assesses: communication and social development, gross and fine motor and problem-solving skills of your child
• AIMS (Alberta Infant Motor Scales) is used by the physiotherapist to evaluate the gross motor development of your child
• ASQ2 Socio-Emotional is to be completed by parents/guardians before the clinic appointment and will be scored by the clinic nurse
• neurological examination is conducted by the physician
• Bayley-Scale for Infant Development (BSID 3rd edition) is administered by the psychologist for infants born less than 26 weeks gestational age
• the psychologist may use other screening tools and tests to evaluate your child's strengths and needs

• Caring for Kids
• Parenting in Ottawa
• First Words
• Breastfeeding Resources Ontario
• Infant Hearing Program
• Safe sleep
• Ontario Early Years Centres
• Parent Resource Centre

• Phoenix Centre
• Eastern Ontario Health Unit
• Renfrew County and District Health Unit
• Leeds, Grenville and Lanark District Health Unit

eMentalhealth.ca is a comprehensive listing of mental health and related services in Ottawa and beyond.

While breastfeeding can be challenging for premature infants and their mothers, giving your baby breast milk is highly encouraged in the Neonatal Intensive Care Unit. Breastfeeding protects your baby against infections and gut problems, such as necrotizing enterocolitis.

Colostrum, first day breast milk that mothers produce, is given to babies to help them fight infections. Subsequent breast milk is provided as soon as possible by a tube feeding directly into the stomach and, when older, by bottle. Breastfeeding is encouraged as soon as your baby is able to safely suck and swallow — typically around 32 weeks gestational age. In the first months after bringing your baby home from the hospital, breastfeeding provides your baby with the vitamins and nutrients they need to protect them from acquiring infections and diseases. It is also an opportunity for mother and baby to bond and develop secure attachment.

Breastfeeding can be challenging for some mothers and babies, and is not always possible. For anyone struggling with breastfeeding, here are resources that can help:

• Healthy Babies, Healthy Children
• La Leche League Canada
• Caring for Kids

Sleep is essential for an infant's growth, cognitive and behavioral development. Sleep problems are frequent in children. Around 25 to 50 percent of newborns, toddlers and older infants experience sleep disturbances.

In the first month, babies — premature infants especially — do not have regular sleep schedules. Their waking and sleeping periods are based on three to four hour cycles and they don't realize the difference between day and night. Nevertheless it is good to slowly introduce regular sleep time routines while still responding to your baby's needs for comfort and feeding. It is important your baby learns that someone is there to respond to their needs.

Vitamin D isn't found in many of the foods we eat. We make Vitamin D in our skin when exposed to the sun, but Canadians don't get enough sun during the year to produce sufficient Vitamin D. Health Canada recommends that most Canadians take a Vitamin D supplement, especially in the winter. Babies need a Vitamin D supplement since their time in the sun should be limited and their bones are still growing.

Vitamin D plays an important role in cell growth, healing and the immune system. Premature babies are at risk of weak bones or the disease called “rickets” or “metabolic bone disease.”

For babies, Health Canada recommends a daily Vitamin D supplement of 400 units to prevent rickets. Babies who live in Northern Canada should take 800 units daily.

Most infant formulas have Vitamin D added. To get 400 units of Vitamin D daily, your baby needs to drink about one litre, or 32 fluid ounces, of formula every day. Your baby may have been prescribed a Vitamin D supplement in the NICU because they weren't taking enough formula.

Once your baby is able to take one litre or more daily, talk to your doctor about stopping the Vitamin D supplement. Don't worry if your baby is getting more than 400 units of Vitamin D daily; up to 1,000 units daily is perfectly safe.

Health Canada recommends supplementing Vitamin D from birth to one year. When your baby is one, you can introduce cow's milk into their diet, which is fortified with Vitamin D. If you are not planning to use cow's milk or a vitamin D-fortified alternative, talk to your baby's doctor about continuing a daily Vitamin D supplement.

For more information, visit Health Canada's page on infant nutrition.

Breast milk doesn't contain a lot of iron. During a normal pregnancy, the baby uses the third trimester to build up iron to use after they're born. Premature babies don't get a full third trimester and don't have enough time to develop their iron stores. In this case, we give a small dose of iron every day so they have some when their stores run out.

Iron is a mineral that we use to build red blood cells and transport oxygen around our bodies. An iron deficiency can lead to anemia, where there aren't enough healthy red blood cells to transport oxygen to other cells.

Iron-fortified infant formula has enough iron to prevent deficiency in some premature babies. If your baby was born below 1,000 grams (2 lbs, 3 oz), diagnosed with anemia or received a blood transfusion in the NICU they will need extra iron in addition to what is in their formula.

If your baby was prescribed an iron supplement because you were exclusively breastfeeding when they went home, but are now getting formula, talk to your baby's doctor about stopping the iron supplement.

Your baby needs a daily iron supplement until they have another source of iron in their diet. If you are no longer using breast milk, it is possible that your baby gets enough iron from their iron-fortified formula. If your baby is only getting iron-fortified formula, you can talk to your baby's doctor about stopping the iron supplement.

When your baby is six months, they are ready to try eating solids. Health Canada recommends starting with iron-rich foods, like meat or meat-alternatives (ex. eggs, tofu, legumes) and iron-fortified cereals. Once your baby is eating these foods, talk to your baby's doctor about stopping the iron supplement.

For more information, visit Health Canada's infant nutrition page.

Premature infants are more likely than term infants to experience reflux because their stomach valve is weaker and less developed. Elevating the head side of your baby's bed by a few degrees can be an effective treatment. Anti-reflux medication is occasionally prescribed when premature infants with reflux are irritable and feeding becomes difficult. These are often signs of esophagitis or inflammation of the esophagus. Other cases where medication may be prescribed include failure to grow, apnea associated with reflux and evidence of aspiration of milk in the lungs.

A course of medication normally lasts between three to six months. As your child grows, reflux tends to correct itself as the stomach valve gets longer and stronger, and your child begins eating solid foods.

These are signs you should seek medical attention if your baby:

• is unusually irritable after eating or refuses food
• isn't gaining weight
• spits up green, yellow fluid or blood
• consistently spits up forcefully, causing stomach contents to shoot out of their mouth (projectile vomiting)
• has blood in their stool

If you are concerned, please contact your family doctor.

The following resources may help you to better understand reflux:

• KidsHealth
• Mayo Clinic
• Stanford Children's Health
• Cincinnati Children's Hospital Medical Center

If your child was born premature or was sick at birth, they may be at a higher risk of having developmental issues and/or developing behavioral problems.

Feeling overwhelmed is a normal reaction.

Children can suffer from a variety of behavior problems that are difficult for parents and caregivers to manage. These include repetitive behaviors like difficulty self-regulating emotions, difficulty communicating basic needs and oppositional or persistent aggressive behaviors.

There are many resources available to help you cope. Discuss concerns and work on coping strategies with your family doctor during your child's neonatal follow-up clinic visit or by contacting the following resources for support:

• Crossroads
• Centre Psychosocial
• Valoris
• Phoenix Centre for Children and Families
• Children's Mental Health of Leeds and Grenville
• Open Doors for Lanark Children and Youth