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Canadian Paediatric Society

An enhanced 18-month well-baby visit

With our better understanding of the links between early child development and later health and well-being, well-baby visits are now recognized as key opportunities to assess growth and positively affect life outcomes. For some families, the 18-month visit might be the last regularly scheduled visit with a primary care provider before a child enters school. This visit is a critical opportunity to examine and evaluate a child’s progress, to help parents nurture their child’s development, and to identify areas where there may be some difficulty. It is also a time to introduce parents to community resources and supports.

Well-baby visits focus on immunization and identifying abnormalities, but the 18-month check-up can also be a pivotal assessment of developmental health. Not only does it happen at an important point in a child’s development, it comes at a stage when families are dealing with formative issues such as child care, behaviour management, nutrition/eating patterns, and sleep. The 18-month assessment is an excellent opportunity to counsel and reinforce healthy behaviours, and to promote positive parenting, injury prevention and literacy. Screening for parental health issues, including mental health, domestic abuse and substance misuse can also take place at this visit.

The Canadian Paediatric Society supports a stronger system of early childhood development and care across Canada and recommends that all provinces and territories establish an enhanced well-baby visit with standard guidelines. A standardized developmental surveillance tool and a clinician-prompt health guide with evidence-based suggestions for healthier development should be used.22 In provinces/ territories where this enhanced visit is conducted by fee-for-service physicians, they should have access to office-based tools and a special fee code.

Province/Territory2012 status2016 statusRecommended actionsComments
British Columbia

Poor

Poor

Initiate an enhanced well-baby visit at 18 months, with standard guidelines. If the visit is conducted by fee-for-service physicians, they should have access to office-based tools and a special fee code.

Alberta

Poor

Poor

Initiate an enhanced well-baby visit at 18 months, with standard guidelines. If the visit is conducted by fee-for-service physicians, they should have access to office-based tools and a special fee code.

Saskatchewan

Poor

Excellent

Meets all CPS recommendations.

Public Health recently implemented an enhanced 18-month assessment in child health clinics, where 18-month immunizations are administered.

Manitoba

Poor

Poor

Initiate an enhanced well-baby visit at 18 months, with standard guidelines. If the visit is conducted by fee-for-service physicians, they should have access to office-based tools and a special fee code.

Ontario

Excellent

Excellent

Meets all CPS recommendations.

Quebec

Poor

Poor

Initiate an enhanced well-baby visit at 18 months, with standard guidelines. If the visit is conducted by fee-for-service physicians, they should have access to office-based tools and a special fee code.

New Brunswick

Poor

Excellent

Meets all CPS recommendations.

Nova Scotia

Poor

Poor

Initiate an enhanced well-baby visit at 18 months, with standard guidelines. If the visit is conducted by fee-for-service physicians, they should have access to office-based tools and a special fee code.

Prince Edward Island

Poor

Excellent

Meets all CPS recommendations.

Newfoundland and Labrador

Poor

Excellent

Meets all CPS recommendations.

Yukon

Poor

Excellent

Meets all CPS recommendations.

Northwest Territories

Poor

Excellent

Meets all CPS recommendations.

The “Well Child Record” is relatively new to health centres, and education to manage the referral process is ongoing. The CPS will be looking for progress toward full implementation.

Nunavut

Poor

Excellent

Meets all CPS recommendations.

Excellent

Province/territory has initiated an enhanced well-baby visit at 18 months, with standard guidelines. In provinces and territories where this enhanced visit is conducted by fee-for-service physicians, they have access to office-based tools and a special fee code.

Poor

Province/territory has not initiated an enhanced well-baby visit at 18 months.

Endnotes

  1. Clinton J, William R; Canadian Paediatric Society, Early Years Task Force. Getting it right at 18 months: In support of an enhanced well-baby visit. Paediatr Child Health 2011;16(10):647-50.