Health and Development in the Early Years: Health Services Consolidated Results

doctor and children

Health care services for parents and young children protect their health and are considered one of the determinants of health.  All aspects of care are important – including primary and community care, hospital care, screening services and specialized services such as genetics.  They are important across the continuum of development – from the prenatal period, through birth and postpartum, and through early childhood.  They are considered by many as a basic human right.

Prenatal care is important for both the health of the mother and her baby. Prenatal care is considered to be most effective if women begin their care early – in the first trimester – and continue it at regular intervals throughout their pregnancy.  The quality of care – that is what happens in each visit – is also important. The vast majority of Canadian women (almost 95%) start their care in the first trimester of pregnancy. Only 5.1% of women start prenatal care after the first trimester (14+ weeks gestation).  But having adequate prenatal care is not equally experienced by all women. Younger women, women with less education, and women with low income are more likely to start prenatal care late.  The average number of prenatal visits among Canadian women is 12.9.  There is little variation according to age, education or income.

Virtually all Canadian women have care when giving birth by a professionally educated attendant at birth. The majority of women, 70%, have an obstetrician/gynaecologist, 15% a family physician and about 4% have a midwife. This varies by province and territory.

Women stay in hospital only a short time following birth. This means that it is important that they have adequate care in the community to support their health and that of their babies. Postpartum services can be provided by hospitals, health centres, public health nurses and primary care providers. There are different kinds of services – telephone contact/triage, clinics and home visits. The majority of women in Canada, 93%, are contacted by a healthcare provider at home following the birth of their baby. This varies between provinces and territories. Contact after birth is not the same among all groups of women.  Women having their first babies and those living with adequate or high income are more likely to be contacted than those having a subsequent baby or those living in low income. Teenage women are most likely to be contacted among all women of all age groups.

For the most part the majority of women are satisfied with their postpartum care. This varies among the provinces and territories. Mothers are more likely to be satisfied with the care that their baby received than with the care that they received for themselves.

About 13% of women in Canada have their baby admitted to the intensive care or special care nursery after birth. This varies between provinces and territories. Women who have had a cesarean birth are more likely than women who have had a vaginal birth to have their baby admitted to the intensive care or special care unit. Younger women are also more likely to have this experience than are older women. There is no difference according to income.

Childhood immunization is an important public health measure that prevents significant illness, disability and death among Canadian children. In addition, immunization is a proven cost-effective health intervention. Childhood immunizations are also an important performance measure of the quality of primary care. Across Canada, publicly-funded immunization programs are provided for the routine administration of a number of childhood vaccines according to provincial and territorial immunization schedules. These schedules vary between jurisdictions. National standards for the reporting of immunization coverage in Canada were last published in 2005 and there are many provinces/territories who fall short of national immunization coverage standards.

Family physicians are key primary care providers throughout infancy and early childhood in all provinces.  They provide well-child care, immunizations, developmental surveillance/screening, and management of acute and chronic conditions. There are fewer family physicians in the rural areas of Canada. In the territories, family physicians mainly work in the capital cities, managing acute or chronic conditions, while public health/community nurses perform most of well-child care. Paediatricians provide an entire range of medical services for healthy as well as high-risk children (complex and/or chronic conditions) – as primary care providers or consultants, depending on the province/territory. Public health nurses and nurse practitioners also provide care in some jurisdictions.

The majority (84%) of Canadian families with children under 12 have a regular medical doctor. That varies modestly among provinces/territories with the exception of Québec (66%) and the territories (40%). Nurses are often the first point of primary care in the territories.

It is estimated that 5-10% of preschoolers are expected to have vision difficulties that may lead to poor development of visual acuity, and affect educational and social development. Guidelines recommend that all children between the ages of 3 and 5 years have vision screening. Seven of the Canadian provinces/territories have public health-funded vision screening programs.

When infants are born with hearing loss, significant problems in infant and child development can occur if the loss is not detected and treated. Infants who are diagnosed early and receive appropriate interventions tend to have better language skills, social adjustment and behaviour scores, compared with children who receive services late. The evidence shows that screening all newborn infants for hearing loss is very effective. While all provinces/territories have some form of hearing screening, only five have universal programs, fully implemented; the rest have partial programs, or offer screening for select populations.

Assessing/screening young children’s development can be helpful in identifying problems early. The Canadian Paediatric Society has advocated for a universal visit using a structured developmental assessment tool for all children at the 18-month well-baby visit. Six provinces and territories incorporate formal developmental surveillance or screening as part of an 18-month well-baby visit during routine visits, or around immunization schedules. There is variation in where the screening takes place, which health professionals do it, and the instruments used.

Many Canadian children suffer from early childhood dental caries, which means they have one or more decayed, missing, or filled primary teeth. While 98% of Canadian children over 2 are more likely to have seen a dentist than younger children, dental visits for children under 6 vary according to income. Young children living in low income are less likely to see a dentist. Financing for dental care in Canada is available through third-party insurance, private dental insurance, out-of-pocket payments, and some government-subsidized programs (not universally available).

Early childhood dental caries is the most common day surgery procedure among Canadian preschool children. The rate of day surgery for dental caries is about 12 per 1,000 children aged 1 to 4 years old. Across Canada, the rate of day surgery for dental caries ranges considerably.

Genetics is a rapidly evolving and complex field.  There are many genetic conditions which require screening, diagnostic services, counselling and support. Whether it be about genetic testing, screening, or a diagnosis, parents and children confront complicated issues, will have many questions and will need specialized care and support. Availability of genetic services – including geneticists, genetic counsellors and genetic laboratory services vary considerably across Canada.