Assistant Professor of Pediatrics in the Faculty of Medicine at the McGill University Health Centre in Montreal, Que.
Professor Emerita in the Faculty of Medicine at Memorial University of Newfoundland in St John's.
Can Fam Physician. 2019 Mar;65(3):183-191.
To describe the process and evidence used to update preventive care recommendations in the 2017 Rourke Baby Record to assist primary care providers' decisions around which maneuvers to prioritize and implement in practice.
A search of the literature from June 2013 to June 2016 was conducted, using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology to critically appraise primary research studies, and recommendations were changed where there was substantial support from the new literature.
The important changes in preventive care recommendations for children up to 5 years of age include the addition of body mass index monitoring as of 2 years of age; stronger evidence to support the introduction of allergenic foods without delay (strength of recommendation change from fair to good); the recommendation to ask validated questions regarding the effects of poverty; evidence showing no safe level of lead exposure in children; the recommendation of a daily sleep duration; the upgrade of recommendation strength from fair to good of items related to the prevention and detection of adverse childhood experiences, including assessment of bruising in babies younger than 9 months; and blood pressure monitoring only for children at risk.
Early childhood exposures and habits have short- and long-term health consequences. The Rourke Baby Record will continue to publish updates to ensure that primary care providers are equipped to promote lifelong health and well-being through evidence-informed care in young children.
描述 2017 年《Rourke 婴儿记录》中预防保健建议更新的过程和所使用的证据，以协助初级保健提供者在实践中优先考虑和实施哪些操作。
对 2013 年 6 月至 2016 年 6 月的文献进行了搜索，使用 GRADE（推荐评估、制定与评估分级）方法对主要研究进行严格评估，并在新文献提供实质性支持的情况下更改了建议。
0 至 5 岁儿童预防保健建议的重要变化包括自 2 岁起监测体重指数；有更强的证据支持无延迟引入致敏性食物（推荐强度从一般改为好）；建议询问关于贫困影响的验证性问题；有证据表明儿童铅暴露没有安全水平；推荐每日睡眠时间；与预防和发现不良儿童经历相关的项目的推荐强度从一般升级为好，包括评估 9 个月以下婴儿的瘀伤；以及仅对有风险的儿童进行血压监测。
儿童早期的暴露和习惯会产生短期和长期的健康后果。《Rourke 婴儿记录》将继续发布更新，以确保初级保健提供者能够通过循证护理在幼儿中促进终身健康和幸福。
