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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 droit.auteur@cspq.gouv.qc.ca.
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
1
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.
6
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.
3
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:
tinytot@inspq.qc.ca
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.
7
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
9
■■ 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
10
■■ 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
12
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