Author Archives: Greatkids


Imagine a sweet 6-month-old baby girl tucked in the arms of her father as he reads her a bedtime story. She snuggles in close to his chest as he calmly sways her back and forth in a rocking chair. As he exaggerates his voice with the story, the baby reaches her hands for the book and pats the pages with excitement. The father continues with the story as the little one grasps for his face to find reassurance in his presence…the one who soothes her every night before she is put to bed. This beautiful moment occurs every night between this sweet father and daughter and it always begins with a book.

Reading to infants is encouraged in American society. Research has clearly confirmed the benefits children receive from being read to in the early stages of life. According to Murray and Egan (2014), we have known for a long time that there is a connection between language and literacy. Organizations like the American Academy of Pediatrics (2014), the Canadian Pediatric Society (2018), and the Centers for Disease Control and Prevention (2017) recommend that reading to children should begin during infancy. Despite the abundance of literature that encourages reading in early infancy, research suggests that, on average, parents begin reading with their babies at around 7 to 9 months (Murray & Egan, 2014). We may look at this research and think losing 7 to 9 months of reading time is not that significant considering parents have an infant’s entire childhood to read and tell stories. Though this research may seem insignificant when looking at the whole picture, researchers are finding that WHEN parents begin reading to their infants matters.

Researchers like Thacker (2014) explain that when caregivers can establish a reading routine before children turn 2 years of age, children can be exposed to a rich vocabulary that betters their language development and sets the stage for future exposure to reading materials. The American Academy of Pediatrics (2017) has released new research that suggests reading with young infants is linked to enhancing their vocabulary and reading skills four years later. Murray and Egan (2014) report that children undergo a rapid pace of development between 9 to 12 months of age. This explains why the amount of time a parent reads with their child at 9 months can predict a child’s vocabulary at 34 months and even at 58 months of age.

Research is consistent in demonstrating that reading during infancy can have a multitude of benefits for children. It supports their literacy, language, vocabulary, and writing development (American Academy of Pediatrics, 2017; Holland, 2007; Murray & Egan, 2014; Thacker, 2014). Most home visitors are aware of these developmental benefits, but did you know that reading during infancy is linked to more than just these developmental benefits? Research is now finding that reading during infancy does much more than provide a child with rich reading and vocabulary skills.

As we go about our day in home visiting, we know that each of us has one characteristic in common…we are all trying to promote parent-child engagement. Research is providing great news for home visitors! When reading begins early, children experience a stronger parent-child relationship (American Academy of Pediatrics, 2015). According to Thacker (2014), “As soon as an infant can sit on a caregiver’s lap, the child can learn to associate the act of reading with a sense of being loved” (p.16). How amazing is it that a tiny infant can learn that reading time means Mommy and Daddy love me? Reading to infants is so much more than teaching babies words; reading is an opportunity for a parent and child to spend time together enhancing their growing bond.

Home visitors understand that the idea of reading to an infant is challenging to some families for various reasons. Some caregivers may struggle with literacy, while others may not feel confident in their reading abilities. We must remember to be sensitive to the parents we serve, but we also have to spread the word that parents do not have to be great readers in order to have reading time with their babies. Research reminds us that until children attend school, they spend more time looking at pictures in books as opposed to the words (Thacker, 2014). The Canadian Pediatric Society (2018) shares that babies love to look at pictures in books and that simply talking to an infant about the pictures in a book is beneficial. As a GGK home visitor you also have access to amazing activities like the Talking Box Book where parents can simply tell a story using a decorated box. This means that parents can tell a story to their baby without having to read words. Also know that any Cues and Communication module can support you in encouraging parents to focus on vocabulary and language skills but be aware that there are activities and subsections throughout the curriculum that encourage reading parent-child reading time. Please see the provided list below:


GGK Birth to 12 Months

4-6 Months: Play and Stimulation

Activity: Picture Storybook

7-9 Months: Cues and Communication

Activity: Talking Box Book

7-9 Months: Physical and Brain Development

Subsection: Read Now…Read Forever

Activity: Read to Me

10-12 Months: Physical and Brain Development

Activity: Bedtime Stories

GGK 13-24 Months

13 to 15 Months: Play and Stimulation

Subsection: Reading: Making Words Live

Activity: A Book About Me

19-21 Months: Play and Stimulation

Activity: Going to The Library

22-24 Months: Cues and Communication

Subsection: Reading: Making Words Live

Activity: The Word for The Day

25-30 Months: Cues and Communication

Activity: Color Me A Story

31-36 Months: Cues and Communication

Subsection: Making the Most Of Storytime

Activity: Where, What, And Why Storytelling

As you go about your home visits this month, remember that a book is more than words; it is the start of a beautiful lifelong parent-child bond.



American Academy of Pediatrics. 2014. Healthy children radio: Reading aloud to infants.

Retrieved from:

American Academy of Pediatrics. 2015. Parent child reading and story time promote

brain development prior to kindergarten. Retrieved from:

American Academy of Pediatrics. (2017). Reading with children starting in infancy gives

lasting literacy boost. AAP News & Journal Gateway. Retrieved from:

Canadian Pediatric Society. (2018). Read, speak, sing to your baby: How parents can

promote literacy from birth. Retrieved from:

Centers for Disease Control and Prevention. (2017).  Developmental milestones.

Retrieved from:

Holland, J. (2008). Reading aloud with infants: The controversy, the myth, and a case

study. Early Childhood Education Journal35(4), 383-385. doi:10.1007/s10643-007-0203-6

Murray, A., & Egan, S. M. (2014). Does reading to infants benefit their cognitive

development at 9-months-old? An investigation using a large birth cohort

survey. Child Language Teaching & Therapy30(3), 303-315.


Thacker, D. C. (2014). Playing with the text: The importance of sharing books with

babies. International Journal Of Birth & Parent Education2(1), 15-17.

Retrieved from: Does reading to infan10.1177/0265659013513813



January has arrived and It is officially the new year! For many, the month of January represents a time of newness and change. January is famous for hosting the New Year holiday, but it is also well known for bringing about freezing temperatures, snow, and ice. Throughout the country, many have witnessed a dusting of snow, while others have already bundled up in multiple layers of clothing in an attempt to face the snowy sidewalks that pave their communities. Not everyone will face these changing temperatures, but many individuals will soon experience the bitter winds of winter and the chilling temperatures the season produces. As January begins, winter will make its appearance, thus sending many Americans to seek shelter in the warmth of their homes.

It is second nature to many us of to switch our thermostats to the heat setting once we begin to feel our house getting cold, but it is easy to forget the dangers that can arise from heating a home. According to the United States Energy Information Administration (2013), using natural gas is one of the most common ways for Americans to heat their homes. When natural gas is used, there is a risk for carbon monoxide (CO) poisoning.

The United States Fire Administration (2017) explains that CO is a colorless and odorless gas that can be deadly. Due to CO being an invisible gas, individuals may not realize when they are being exposed to it. Accidental CO poisoning accounts for roughly 400 to 500 deaths and more than 15,000 emergency room visits in the United States each year (American Academy of Pediatrics, 2017). The beginning stages of CO poisoning can present with various symptoms. These symptoms include:

• headache

• fatigue

• shortness of breath

• dizziness

• nausea

CO poisoning impacts individuals of all ages, but children are particularly sensitive to the dangerous gas. The American Academy of Pediatrics (2017) explains that when someone breaths in CO, the gas impacts their ability to transport oxygen. This creates more of a danger for children because they breathe faster, meaning children inhale more of the CO per pound of body weight.

Since so many families use natural gas and other heating techniques that can release CO, it is critical for parents to know how to prevent CO poisoning. The American Academy of Pediatrics (2017) shares that in order to prevent CO poisoning, CO detectors should be installed near every sleeping area in a home and checked frequently to ensure the detectors are working properly. Organizations like the United States Fire Administration (2017) recommend that CO detectors should be tested at least once a month to ensure that the alarm works properly.

While installing CO detectors is an effective way to prevent CO poisoning, experts also suggest that heating sources should be inspected annually or as recommended by the manufacturer to ensure they also function correctly. This includes fuel burning appliances, fireplaces, woodstoves, and space heaters (American Academy of Pediatrics, 2017). Even though CO can create dangers for families, especially during the winter months, it is important that caregivers understand that CO poisoning is preventable when detectors are used, and heating sources are properly inspected.

When discussing how to safely heat homes in the winter, it is crucial to also discuss the dangers of fire. According to the United States Fire Administration (2017), home fires are most prevalent in the winter. Half of all home heating fires to occur in the months of December, January, and February. In fact, heating equipment is involved in 1 in every 7 home fires. Unfortunately, statistics also show that in 1 in every 5 deaths caused by a home fire, heating equipment is involved.

When we look at these statistics, we realize quickly that heating a home poses a risk for fires. However, just as with CO poisoning can be prevented, home fires can be prevented. The United States Fire Administration recommends the following so that home heating fires can be avoided:

  • Use a certified professional to inspect chimneys and vents to ensure they work        properly each year
  • Keep any object that could burn at least three feet away from heat sources such as a fireplaces, wood-stoves, space heaters, or radiators
  • Never plug more than one heat-producing appliance such as a space heater into   an outlet at time

In addition to these tips, the American Academy of Pediatrics (2015), recommends that all families install smoke alarms outside every bedroom and there should be at least one smoke alarm on every floor of a home. These smoke alarms should be tested monthly and every family should have and practice a fire evacuation plan.

As you read this blog, you might be asking yourself, “How can I as a home visitor make sure the families I serve stay safe when they heat their homes?” This is a great question to ask because home visitors only visit with families for about an hour each week, so it’s hard to ensure the families you serve are heating their homes safely.

Keeping this question in mind, did you know that Great Kids provides a tool for you so that you can have conversation about how to keep families safe from CO and fires? This tool is known as the Home Safety Checklist for Families with Babies 6 Months And Older. It can be found in the 7 to 9 Months Basic Care section of the Birth to 12 Months Manual. When you use this checklist with families, you’ll have the opportunity to discuss how to prevent CO poisoning, and if families have checked the batteries in their smoke detectors.

It is easy to simply make checks on this list and move along to the next topic of discussion with families. However, Great Kids encourages home visitors to take their time with this list and follow up with families on CO and fire safety. Please learn about the resources available in your community that helps families to obtain carbon monoxide detectors and smoke alarms. Some fire departments will provide smoke alarms for free! As we approach these winter months, pull out the Home Safety Checklist. Remember this checklist is more than a simple to-do list, it is a conversation guide that can help save lives. Let’s work to keep families safe, while families work to stay warm.


American Academy of Pediatrics. 2015. Fire safety what is the best way to keep my family          safe from a home fire? Retrieved from:

American Academy of Pediatrics. 2017. How to prevent carbon monoxide poisoning.  Retrieved from:

United States Energy Information Administration. 2013. Use of energy in the United States           explained energy use in homes. Retrieved from:

United States Fire Administration. 2017. Carbon monoxide safety outreach materials. Retrieved from:

United States Fire Administration. 2017. Winter fire safety outreach materials. Retrieved           from:

no smokingSitting down to write this December blog was more difficult than anticipated. Even though it is officially the holiday season and tons of topics are relevant to this time of the year, it was overwhelming to pick just one subject for this month. As I explored the past blog topics written around the holidays, I realized that many of my ideas had already been discussed on former blog postings. It never hurts to repeat certain information, especially information that is critical to the health and safety of children, but the more I read the former topics, the more motivated I became to discuss a different subject. After exploring the Centers for Disease Control and Prevention (CDC) website, a fact floating about their webpage caught my attention. It’s not usually a topic of discussion for the holiday season, but the more I studied the fact, the more I realized this is a subject that needs to be discussed year around. So, what was this fact that caught my eye? According to the CDC (2017), research shows that as of 2015, 1 in 5 adults were still using tobacco products. Of the 49 million tobacco users in the United States, cigarette smoking is the most common way to use tobacco. As someone who grew up in a generation where children were taught the dangers of tobacco usage, this statistic was shocking. Knowing that tobacco usage is still a public health concern for the nation makes this a topic that warrants time for discussion.

We have known for many years that smoking cigarettes poses a serious health concern, yet research is still suggesting that many people smoke. There are many reasons people take part in smoking. The U.S. Department of Health and Human Services (n.d.) shares that individuals begin smoking for stress relief, pleasure, or adhering to social situations. Research suggests that tobacco products can virtually harm every organ in the body, while smoking causes more deaths each year than Human Immunodeficiency Virus (HIV), illegal drug use, alcohol use, car accidents, and firearm-related incidents combined (Centers for Disease Control and Prevention, 2017). A major concern with smoking is that more than just the smoker can be affected by cigarette smoke. As time has progressed, we have learned that individuals who do not smoke, but are exposed to cigarette smoke can also face serious health concerns. This means that the children you serve through home visiting face health concerns when exposed to cigarette smoke.

Secondhand smoke, a term that has become familiar to many individuals, refers to the smoke that a smoker exhales from their cigarette, pipe, or cigar. This smoke is made up of about 4,000 chemicals and 50 of these chemicals are known to cause cancer. (American Academy of Pediatrics, 2017). When children are exposed to individuals who smoke, they breathe in these dangerous chemicals. Even children who are raised by caregivers who choose to smoke outside still face health concerns caused by thirdhand smoke.

Thirdhand smoke is the smoke that is left behind by smokers (American Academy of Pediatrics, 2017). This means if a parent chooses to smoke in a car without their child present, when the child does ride in the car, they are still exposed to the leftover smoke. Smoking impacts both the smoker and those who are exposed to the smoke from the tobacco product. We know that children being exposed to cigarette smoke is not good, but how does this smoke harm children?

According to the American Academy of Pediatrics (2017), secondhand smoke can cause copious health concerns for children. These concerns include:

• Ear infections

• Coughs and colds

• Respiratory problems like bronchitis or pneumonia

• Tooth decay

In addition to these health concerns, secondhand smoke may cause more frequent and severe asthma attacks in children, and children who are exposed to secondhand smoke have a more difficult time recovering from colds. Smoking does not wait to affect only the post-natal child. Research has shown that when women who are pregnant smoke, their soon to be born infant may face serious health complications.

The American Academy of Pediatrics (2015) reports that when a fetus is exposed to a mother who smokes they are at risk for:

• Sudden Infant Death Syndrome (SIDS)

• Learning Problems

• Respiratory Disorders

• Adult Heart Disease

When we look at all the health complications that children face because they are exposed to secondhand and thirdhand smoke, we begin shouting in our heads that caregivers must stop smoking. Organizations like the America Academy of Pediatrics and the American Cancer Society even share that the only way to stop the dangers caused by smoking is to have individuals quit smoking (American Academy of Pediatrics, 2017; American Cancer Society, 2017). This task is a lot easier said than done.

The U.S. Department of Health and Human Services (n.d.) reminds us that cigarettes contain nicotine, which is an addictive substance. Quitting smoking is no easy task, but as home visitors, you have great resources that you can share with families to support them along their journey to being smoke free. If you work with parents who smoke, remember you can refer them to their local health department or healthcare provider, these places are usually excited to talk with individuals about the benefits of giving up smoking. Do not forget there are various modules that include subsections addressing the dangers of smoking for parents and children. These subsections include:

Growing Great Kids Prenatal Manual

Unit 3 Module 3: Healthy Pregnancy…Healthy Baby-Smoking And Fetal Development  

Growing Great Kids Birth to 12 Months

0-3 Months Module 1: Basic Care…Infant Safety/Preventing Shaken Baby Syndrome

4-6 Months Module 1: Basic Care…Smoking: Facts About Exposing Children

10-12 Months Module 1: Basic Care…Smoking Revisited

In addition to these subsections that directly address smoking, know that you can always use your Body Builders Daily Do to discuss the dangers of smoking as this concern is addressed by this Daily Do. Smoking can be a difficult topic to discuss with families you serve, but know that you have so many resources that are available to help ease these conversations with families. Remember that having these kinds of difficult conversations with families provides them optimum opportunities for growth. Please help America become smoke free!


American Academy of Pediatrics. 2017. The dangers of secondhand smoke. Retrieved        from: 

American Academy of Pediatrics. 2017. Where we stand: Smoking during pregnancy.        Retrieved from:

American Cancer Society. 2017. The great American smokeout. Retrieved from: 

Centers for Disease Control and Prevention. 2017. Smoking & tobacco use health effects   of cigarette smoking. Retrieved from:

Centers for Disease Control and Prevention. 2017. One in five US adults still using tobacco products in 2015. Retrieved from:

Centers for Disease Control and Prevention. 2017. Smoking & tobacco use fast facts.        Retrieved from:

U.S. Department for Health and Human Services. (n.d.). Reasons people smoke. Retrieved           from:

suhyeon-choi-251615Today we are going to start our discussion by painting a picture with our minds. Envision the sights, sounds, and even smells of this description and drift into the shoes of this couple that is about to be described. It’s the beginning of November, the air that once felt like fall now brings about the chilling winds of winter. A couple expecting their very first child rushes about their home early in the morning to prepare for their work day. The aroma of breakfast cooking on the stove fills the home as the expectant mother slowly sits down at the kitchen table to have a morning meal. Only moments after taking a seat, the mother’s water breaks. Shrills of excitement fill the mother’s and father’s voice as they rush to deliver their baby at exactly 40 weeks. Delivery is difficult of course, but after a long night, a beautiful baby is placed in the arms of the mother. After spending a couple of days in the hospital, the couple is sent home with their new bundle of joy. We wish every single delivery could go as smoothly as the one described, but we know this scenario is not the reality for so many parents.

Parents all hope for routine deliveries that provide them with a healthy baby who can return home in just a few short days, but many babies are born into this world before spending 40 weeks in the womb. In these emotionally trying times, babies are not sent home after delivery, but usually placed in the Neonatal Intensive Care Unit (NICU). No parent should have to watch their precious newborn from afar, but thousands of parents have to visit their baby in the NICU each year. As November marks National Prematurity Awareness Month, let’s take an opportunity to discuss prematurity further and how parents can promote a healthy and full-term pregnancy.

Prematurity among infants is a public health concern in the United States. Each year, roughly 400,000 babies are born preterm leaving about 1 in 10 infants to face prematurity in the year 2015 (Barfield, 2016; Centers for Disease Control and Prevention (CDC), 2017). These numbers pose a serious threat to babies as preterm birth has been listed as one of the top 5 leading causes of infant death in past years (CDC, 2017). The American Academy of Pediatrics (2015) explains that a baby is considered preterm when they are born before 37 weeks of pregnancy. Infants born prematurely can face a number of concerns. These concerns include: respiratory problems, feeding difficulties, cerebral palsy, developmental delay, and problems with hearing and vision (CDC, 2017). As a home visitor, it is highly likely that your heart breaks at the thought of a baby being born into a world where they have to fight extra hard to keep up every day. Prematurity is a difficult topic to discuss as we don’t want to think that the smallest humans in the world are starting out life with struggles. Luckily, research is showing there are precautions that can be taken to promote a healthy and full-term pregnancy.

It is important to mention that even what seems like the healthiest of pregnancies can end in a preterm birth (CDC, 2016). There is no way we can guarantee parents that their pregnancy will be problem free. Despite this, research has identified factors that can increase the risk of preterm labor (CDC, 2016; Thomas, Copen, Kirmeyer, 2016). These factors include:

• Cigarette smoking

• Substance abuse

• Stress

• Depression

• Short interpregnancy intervals

Many of these factors may seem out of your control, but there are ways you can help. That’s right, you as a home visitor have wonderful opportunities to talk with parents about how they can have a healthy pregnancy! You even have your Growing Great Kids (GGK) and Growing Great Families Curricula (GGF) available to you which provides conversation guides around what can be uncomfortable subject matter. For example, you might be thinking how do I even begin a conversation around using drugs or smoking while pregnant? These are extremely difficult conversations to have with parents, but not to worry. There are modules like Healthy Pregnancy…Healthy Baby that provide a conversation guide around prenatal smoking and drug use. GGF even offers numerous modules on stress which we learned can be a contributing factor in preterm birth. Before wrapping up this discussion, please review the list of GGK and GGF modules that can provide support for healthy pregnancies and help prevent preterm births.

Growing Great Kids Prenatal Manual

Unit 2 Module 3: Prenatal Depression In Moms And Dads Is Not Uncommon

Unit 3: Module 3 Healthy Pregnancy… Healthy Baby

Unit 4: Module 2 Power Down Stress…Power Up Happiness

Growing Great Families Manual

Unit 2: Module 2…Sizing Up Your Strengths…Reducing Stress

Unit 2: Module 5… Warning Signs For Stress Overload

Unit 3: Module 10…Planning A Family

Unit 3: Module 8…When Depression Is A Concern

November is a busy month as the holiday season begins and the new year approaches, but in the hustle and bustle of the month, don’t forget it is National Prematurity Awareness Month. Remember, you have the ability to help prevent preterm births using modules like the ones listed above. The factors that can cause preterm birth can be hard subjects to discuss, but there are already conversation guides created to make these conversations easier. We hope you have enjoyed this discussion and that have a wonderful November. Please go forth and share with parents how to turn healthy pregnancies into healthy babies!


American Academy of Pediatrics. 2015. Caring for a premature baby: What parents need to know. Retrieved from:

Barfield, W. 2016. National prematurity awareness month: Celebrating successes and taking           action. Retrieved from:

Centers for Disease Control and Prevention. 2017. Infant mortality. Retrieved from: 

Centers for Disease Control and Prevention. 2017. Preterm birth. Retrieved from: 

Thomas, M. E., Copen, C. E., & Kirmeyer, S. E. 2016. Short interpregnancy intervals in     2014: Differences by maternal demographic characteristics. Retrieved from:



October is often associated with fun fall activities. Those who celebrate Halloween will fill their front porches with decorative pumpkins, while others will head to the nearest apple orchard to pick the fresh fall fruit. The sports fans will cheer on their favorite football teams and others will find themselves getting lost in the fun of a corn maze. October truly is a wonderful month for many individuals, but there is a characteristic of the month that is often forgotten. The tenth month of the year marks Domestic Violence Awareness Month. A public concern that is familiar to adults and children alike. Children living in homes where domestic violence is occurring experience the unfortunate consequence of toxic stress.

Violence has become a part of our everyday life. Children can experience violence in various settings…schools, neighborhoods, and even within their own homes (American Academy of Pediatrics, 2016). Researchers now warn that violence experienced within the family is considered the most damaging type of violence for children (Maneta, White, & Mezzacappa, 2017). This research raises concern as it is estimated that 20 to 30% of American children have witnessed violence between their parents (Fowler, Cantos, & Miller, 2016). Among the children who are exposed to intimate partner violence, roughly 57% of these children report being maltreated at some point in their lifetime (Kiesel, Pieschar, & Edleson, 2016). Unfortunately, various researchers are finding that domestic violence and child maltreatment co-occur (Casanueva, Smith, Ringeisen, Dolan, & Tueller, 2014; Katz, 2014; Kiesal et al., 2016). Some researchers are even discovering that children who live with domestic violence witness between 70-85% of the abuse (Katz, 2014). As you read these statistics, you may be wondering why such devastating numbers are being shared with you. The reason is that you, as a home visitor, can empower caregivers to prevent this violence. Domestic violence causes toxic stress for children, however, you can support parents to prevent toxic stress within their families, by guiding them as they increase their understanding of its impact.

What is toxic stress? You may know the answer to this because you have worked through the GGF module that discusses toxic stress. Maybe you have not gotten to this module yet, but you have heard the concept tossed around among individuals or maybe you have seen toxic stress mentioned in the literature. Researchers describe toxic stress as the extreme or recurrent activation of the stress response, in the absence of a supportive adult to assist with co-regulation. The Center on the Developing Child at Harvard University (2011) describes in detail how the brain responds to stress. The Center explains that when the body experiences stress, the stress response system is activated. This activated response system causes increased heart rate and stress hormones. When a child experiences stress, but a loving and caring adult responds to the child, the stress response system can return to normal. However, when a child does not have an adult to respond in moments of extreme stress, like often is the case during domestic violence, the child’s stress response system stays activated. This continuous activation can cause a reduction in the connection between neurotransmitters in the brain comprised for learning and reasoning. Does this information remind you of any specific daily do? Yes, Brain Builders!

When discussing toxic stress that is rooted in domestic violence, think of the bubble brains. We know little brains that face trauma miss out on important connections that need to form in early childhood. Even though toxic stress can be a difficult topic to explore, the great news is you have various tools in your GGK Curriculum that can guide conversations around toxic stress and healthy brain development for children. Please see the list of useful modules or subsections listed below that can guide you as you support parents to prevent toxic stress and promote healthy brain development.

Growing Great Kids Prenatal

Unit 3 Module 4: Your Baby’s Developing Brain

Growing Great Kids Birth to 12 Months Manual

0-3 Months: Physical and Brain Development

Growing Great Kids 13 to 24 Months

16-18 Months: Physical and Brain Development-Building a Great Brain: Parental Influences

Growing Great Families 

Unit 2 Module 1: Protecting Your Children from Toxic Stress

Unit 2 Module 5: Warning Signs for Stress Overload

As you settle into October, please remember it is Domestic Violence Awareness Month. When raising awareness for this type of violence, don’t forget to be a voice for the children who are a part of this violence.


American Academy of Pediatrics. (2016). Childhood exposure to violence. Retrieved from: 

Casanueva, C., Smith, K., Ringeisen, H., Dolan, M., & Tueller, S. (2014). Families in need of domestic violence services reported to the child welfare system: Changes in the         national survey of child and adolescent well-being between 1999-2000 and 2008-        2009. Child    Abuse and Neglect, 38, 1683-1693. Retrieved from:

Center on the Developing Child Harvard University.  (2011). Three core concepts in early           development. Retrieved from:

Fowler, D. R., Cantos, A. L., & Miller, S. A. (2016). Exposure to violence, typology, and     recidivism in a probation sample of domestic violence perpetrators. Child Abuse &       Neglect, 59, 66-67. Retrieved from:

Johnson, S. B., Riley, A. W., Granger, D. A., & Riis, J. (2013). The science of early life      toxic stress for pediatric practice and advocacy. Pediatrics, 131,319-327. doi:     10.1542/peds.2012-0469

Katz, C. (2014). The dead end of domestic violence: Spotlight on children’s narrative        during           forensic investigations following domestic homicide. Child Abuse and          Neglect, 38, 1976-1984. Retrieved from:

Kiesel, L. R., Pieschar, K. N., & Edleson, J. L. (2016). The relationship between child           maltreatment, intimate partner violence exposure, and academic performance.     Journal of Public Child Welfare, (10) 4, 434-456. doi:         10.1080/15548732.2016.1209150

Maneta, E. K., White, M., & Mezzacappa, E. (2017). Parent-child aggression, adult-partner           violence, and child outcomes: A prospective, population-based study. Child abuse & Neglect, 68, 1-10. Retrieved from:





As summer comes to an end, fall quickly approaches. Many people await the season with excitement as the leaves begin to change and the temperatures slowly drop. Despite the refreshing changes the season brings about, it also comes with lots of sneezing, sniffling, and coughing. Yes, the fall season is infamous for the flu. Though this virus  is well known, it is easy for caregivers to forget how dangerous it can be for infants and children. As yesterday marked the end of summer, our discussion today will focus on how to prepare for the arriving flu season.

Influenza, commonly known as the flu, can often be mistaken for the common cold, but usually strikes more suddenly and makes you feel much worse than a cold does (Canadian Pediatric Society, 2015). According to the Canadian Pediatric Society (CPS) (2015) and the Centers for Disease Control and Prevention (CDC) (2017), infants and children can experience a wide range of symptoms from the flu. These symptoms include:

• Fever or feeling feverish

• Dry cough and sore throat

• Headache

• Muscle/body aches

• Fatigue

• Runny or stuffy nose

• Vomiting and diarrhea, especially common in children

Most people recover quickly from the flu, but it is crucial for caregivers to understand that young children are at a high risk for developing complications (CPS, 2015). A bout of the flu can lead to pneumonia, bacterial infections, croup, and bronchiolitis in children. Unfortunately, the virus is highly contagious and spreads easily among groups of children -  particularly in childcare settings (AAP, 2016). Even though infants and children can easily catch the flu, there are several steps caregivers can take to keep their little ones protected.

The CPS (2015) and the CDC (2016) recommend the following precautions this flu season:

  •  If you have a child who is 6 months or older, speak with a healthcare provider about the flu vaccine
  •  Wash hands frequently, especially after coughing, sneezing, or wiping noses
  •  Avoid touching your nose, eyes, and mouth as these areas allow for spreading of germs
  •  Clean and disinfect areas that could be contaminated with flu germs
  •  Avoid letting your child share toys that other children have placed in their mouth
  •  Do not share cups, utensils, or towels
  •  When coughing or sneezing, use a tissue to cover your mouth or nose

There are no GGK modules that specifically discuss the dangers of the flu virus for infants and children, but there are various subsections that can support caregivers in keeping their little ones healthy and free of illness. When preparing for upcoming home visits, please keep the following sections in mind:

Growing Great Kids Birth to 12 Months Manual

0-3 Months: Basic Care - When Baby Is Sick or Needs Health Care

4-6 Months: Basic Care - Keeping Your Baby Healthy

4-6 Months: Basic Care - Body Builders Daily Do Introduction

10-12 Months: Basic Care - Keeping Your Baby Healthy

Growing Great Kids 13 to 24 Months Manual

13-15 Months: Basic Care - Body Builders Daily Do

13-15 Months: Basic Care - Routine and Responsive Health Care

As you enjoy the break that Fall brings, don’t forget to protect your family from illness! Remember, even though young children are susceptible to viruses, there are lots of things caregivers can do to keep kids healthy this upcoming flu season.



American Academy of Pediatrics. 2016. Preventing the flu: Resources for parents and child care     providers. Retrieved from:

Canadian Pediatric Society. 2015. Influenza in children. Retrieved from:

Centers for Disease Control and Prevention. 2017. Flu symptoms & complications. Retrieved          from:

Centers for Disease Control and Prevention. 2016. Preventive steps. Retrieved from:


madi-robson-113924“As Ben and his mom walked to a store, they saw a woman sitting on the sidewalk with a young child hugging her.  The woman had a box of candies and a container for money in front of them. As soon as Ben realized he could help the family, he turned to his mom and asked, “Mom can I have money to give to them?” His mom, who knew how sensitive and empathic Ben is to homeless people, responded “Yes… my son, you can have this money to help the family!” He put money in the container, but most importantly he gave them a sincere, warm smile and a tender look. This is a true story I recently experienced and it inspired me to reflect on the challenges that homeless families face in our communities. Ben, who is only 10-years-old, has the capacity to leave any judgment out AND the ability to respond with empathy and genuine care. What a gift to be a compassionate human being! Sadly, many times these families sense our judgment or anger, or, even worse they experience our indifference; they have become invisible to us. I wish many of us could see through the lens of compassion and kindness, just like Ben did.

Today, we will devote our blog to homeless families who, despite their struggles and financial limitations, can give their children love and security.  We will support our discussion with research around this topic, as well as national statistics that indicate that the number of homeless families and children is on the rise in our country.  Additionally, we will review The Growing Great Kids and Growing Great Families Curriculum tools and resources around this topic. We’ll conclude by and discussing how you can support parents as they build bridges to self-sufficiency.

According to The American Institutes for Research, recent data from the US Department of Education and the 2013 US Census estimates, 2.5 million children in America, one in every 30 children, go to sleep without a home of their own each year. The American Institutes for Research reported that child homelessness increased in 31 states and the District of Columbia from 2012 to 2013.  There are homeless children in every city, county, and state – this situation impacts every part of our country. It is important to note that statistics show significant progress is being made in reducing homelessness among veterans and chronically homeless individuals, but no special attention has been directed toward homeless children. This has resulted in an alarming increase for this group (American Institutes for, November 2014).  Families experiencing homelessness are obviously at greater risk. They often suffer economic and health challenges, and a wide range of social risks including poverty, job loss, disrupted relationships, substance abuse, and domestic violence. Children exposed to all these adversities are at higher risks for poor physical, emotional, and academic outcomes.

Some additional interesting research to point out in today’s discussion is the study done by Dr. Staci Perlman and a group of colleagues. Their study addresses the urgency of promoting positive parenting in the context of homelessness. In this study, they concluded that the parent-child relationship is affected by the parent’s experiences and by influences from the surrounding environment.  Some parents seem to be resilient to the risks associated with poverty and homelessness and can provide nurturing and supportive caregiving. While other parents struggle to provide responsive parenting and empathic discipline. Researchers found that poor parenting practices appear to be connected to the experience of being homeless in combination with co-occuring risk factors. Research has shown that parents experiencing homelessness have higher than average rates of chronic medical conditions, untreated emotional and behavioral disturbances, substance abuse, physical and sexual abuse, and emotional victimization. They also tend to have low education and job training, and in most cases, they have limited role models for positive parenting (Perlman et al., 2012). The combination of all these risk factors puts homeless children in a highly vulnerable position in terms of optimal development.

Now let’s discuss how the Growing Great Kids curriculum can promote positive parent-child relationships that support optimal development for their child, particularly with families who are facing homelessness. The Growing Great Kids curriculum includes eleven design features in every Growing Great Kids (GGK) and Growing Great Families (GGF) Module. All these design features work together to create opportunities for, and address the needs of, both vulnerable parents and their children. Each design feature is intentionally woven throughout each conversation guide to allow parents to become relationship based with their children, while growing their parenting and life skills.   A critical perspective utilized in The GGK curriculum is to draw parents’ attention to their strengths and motivations for growing their knowledge and skills. Every time parents experience a GGK module they are provided with opportunities to strengthen their parenting practices, problem solving skills, stress management ability, and other important life skills.  All families, including those living in transitional housing or shelters will benefit from experiencing the GGK and GGF Modules. We encourage you to partner with parents in selecting GGK and GGF modules, as well as Child Development activities, to maximize parents’ autonomy and choice.

At Great Kids, we believe every parent and every family has many strengths and core values that can be built upon to supporting families in getting what they want for themselves and their children.  The GGK curriculum includes extensive materials designed specifically to enhance parents’ confidence and competence, through practice, feedback, and reflection. Whether families are experiencing a temporary or long-term homelessness challenge, every child deserves to thrive in a healthy, safe, and loving environment.  Supporting homeless parents on their journey out of poverty and homelessness WHILE creating spaces for positive parent-child interactions, implementing quality parenting practices, and fostering child optimal development is an important part of the GKI vision.

Works Cited:

American Institutes for Research (November 2014). National Center on Family Homelessness: American’s Youngest Outcasts: A Report Card on Child Homelessness. Retrieved from


Perlman, S., Cowan, B., Gewirtz, A., Haskett, M., Stokes, L. (2012). Promoting Positive Parenting Within the Context of Homelessness. American Journal of Orthopsychiatry, Vol. 82, No. 3, 402-412. DOI 10.1111/j.1939-0025.2012. 01158.x




Today we are going to put a spotlight on a topic of critical importance to all parents of newborns…reducing the risks of Sudden Unexpected Infant Death (SUID). To enhance our understanding around this issue, we will review recent research and statistics along with recommendations from the experts. We will also talk about Baby Boxes, a new trend in US hospitals to reduce infant mortality. At Great Kids, Inc. this topic is a priority; thus, we will conclude today’s discussion by reviewing the specific Growing Great Kids Curriculum tools and resources that parents can incorporate to prevent SUID.

Let’s get started with some definitions. The Centers for Disease Control and Prevention (CDC) defines SUID as the death of an infant less than 1-year of age that occurs suddenly and unexpectedly, and whose cause of death is not immediately obvious before investigation. In 2015, the Centers for Disease Control and Prevention reported 3,700 SUIDs in the United States. SUIDs are reported as one of the three following types:

Sudden infant death syndrome (SIDS)

The sudden death of an infant less than 1-year of age that cannot be explained after a thorough investigation is conducted, including a complete autopsy, examination of the death scene, and a review of the clinical history. About 1,600 infants died of SIDS in 2015. SIDS is the leading cause of death among infants 1 to 12 months old.

Unknown cause
The sudden death of an infant less than 1-year old that remains undetermined because one or more parts of the investigation were not completed. About 1,200 infants died of Unknown Cause in 2015.

Accidental suffocation and strangulation in bed
In 2015, 900 deaths occurred due to accidental suffocation and strangulation in bed. The sudden death of an infant less than 1-year of age can happen because of

  • Suffocation by soft bedding—for example, when a pillow or waterbed covers an infant’s nose and mouth.
  • Overlay—when another person rolls on top of or against the infant while sleeping.
  • Wedging or entrapment—when an infant is wedged between two objects such as a mattress and wall, bed frame, or furniture.
  • Strangulation—for example, when an infant’s head and neck become caught between crib railings.

According to CDC data and statistics, the SUID rate has been in decline over the last 25+ years.   Initiatives such as Safe Sleep Recommendations and Back to Sleep campaigns by the American Academy of Pediatrics reduced the SUID rates significantly between 1992-2009. However, the SUID rate increased slightly from 87.5 deaths per 100,000 live births in 2014 to 92.6 deaths per 100,000 live births in 2015 (, February 1, 2017).

In October 2016, the American Academy of Pediatrics announced the New Safe Sleep Recommendations, which include

  • Place the baby on his or her back on a firm sleep surface such as a crib or bassinet with a tight-fitting sheet.
  • Avoid use of soft bedding, including crib bumpers, blankets, pillows, and soft toys. The crib should be bare.
  • Share a bedroom with parents, but not the same sleeping surface, preferably until the baby turns 1 but at least for the first six months. Room-sharing decreases the risk of SIDS by as much as 50 percent.
  • Avoid baby's exposure to smoke, alcohol, and illicit drugs (, October 16, 2016).

Now let’s talk about a new trend in US hospitals intended to reduce SUID risks. Several hospitals across the nation now provide free cardboard boxes where babies can sleep safely, along with education resources and basic baby necessities. This year the state of New Jersey plans to distribute105,000 boxes; Ohio, 140,000; Alabama, 60,000 (, March 2017) along with hospitals in other major cities including Philadelphia and San Antonio, Texas. According to, proponents of baby boxes say the combination of educational tools and free resources will reduce America’s infant mortality rate (, March 2017).

Here are the highlights of a few of the many GGK tools and resources around this topic.

Growing Great Kids Prenatal

Unit 3: Module 7-The Baby is Coming Home…Get Ready!

Preparations for bringing the baby home, including supplies for basic care such as sleeping

Unit 4: Module 6-Cultural Influences on Caring for Infants.

Explores the family’s cultural influences on infant sleeping practices

Growing Great Kids B-12 Months Manual

0-3 Months: Basic Care – Sleeping. 

Discusses normal sleep patterns for infants, explores parents’ opinions regarding sleeping, provides researched information regarding prevention of SIDS, and provides infant sleeping safety guidelines

0-3 Months: Basic Care – Infant Safety Tips Handout.

Explores Safe Sleep Guidelines and information on SIDS

7-9 Months: Basic Care – Home Safety Checklist Handout.

Encourages parents to complete a home safety checklist and remove safety hazards

Check them out! These are great resources to share with parents. While SIDS can happen to anyone, it is also true that every family can make their baby’s sleep environment safer through simple preventative measures.

Works Cited:

Centers for Disease Control and Prevention (2017). About SUID and SIDS. Retrieved from

American Academy of Pediatrics (2016). AAP Announces New Safe Sleep Recommendations to Protect Against SIDS, Sleep-Related Infant Deaths. Retrieved from (2017). Ohio becomes 2nd state to offer free baby boxes to curb infant deaths. Retrieved from (2017). Hospitals Give Away Baby Boxes to Curb Infant Mortality. Retrieved from

Photo by Andrew Branch on Unsplash



nurpalah-dee-226216 (1)Not all praise is equal! Most of us have probably heard this phrase, but do we all know what it really means? Today’s blog will discuss the power of praising and its impact on child development. We will start our discussion by highlighting the 4 Steps to Success Daily Do, one of the most important strategies in the Growing Great Kids Curriculum. It is designed to provide parents the framework for helping their baby learn new things while experiencing fun and encouragement for their efforts. As with all our blog posts, we will review recent research and literature to support our discussion. Our conclusion will include curriculum recommendations to enhance parents’ skills in using praise to recognize the efforts and accomplishments of their children.

The 4 Steps to Success is a set of essential parenting skills designed to promote children’s self-esteem and motivation for learning. This strategy consists of four steps that, when incorporated into daily routines and family activities throughout every day, results in children feeling valued and competent. The idea is to leave them with the feeling that the effort they put into something is as important as the accomplishment itself. The fourth step in the 4 Steps to Success strategy is about “Praising the Child’s Effort and Pointing Out What She Has Learned.” When parents lay the foundation for children feeling good about learning, they are also helping their child build positive self-esteem and confidence.

The 4 Steps to Success Daily Do offers multiple benefits for the child, the parents, and the community. Just to list a few:

  • Children are more able to concentrate on learning
  • Children and parents feel proud of their efforts and accomplishments
  • Both parents and children also learn to be “patient”, because they understand that learning takes practice and effort
  • Children and parents are encouraged to be persistent in figuring out solutions
  • Within their community there is a value for putting effort into learning and accomplishing common goals

Now let’s review some research behind the 4 Steps to Success Daily Do. Stanford University Professor Carol S. Dweck has done significant research on the topic of praise. According to Mueller and Dweck (1998), in comparing behaviors of children praised for intelligence (i.e. “You’re smart”) with those children praised for effort (i.e. “You worked hard!”), they found that children who experience praise for their effort display persistence, enjoyment, and continued performance in the face of challenges. This is because they learn to attribute their performance to the effort, rather than to a stable ability, which is how praise for intelligence is often perceived. In other words, children who have been praised for their effort will interpret subsequent poor performance as indicating a temporary lapse in effort rather than as a deficit in intelligence (Mueller & Dweck, 1998).

In 2013, Elizabeth A. Gunderson and a group of colleagues conducted a study revealing similar findings to those concluded by Dr. Dweck regarding the impact of praising the effort. This study showed that praising children’s efforts encourages motivation to engage in challenging tasks and the ability to generate strategies for improvement. They concluded that children who received praise for their efforts tend to value learning over performance, view efforts as positive, and interpret a challenging situation as an opportunity to learn rather than an obstacle (Gunderson,, 2013).  This literature helps us understand that praising the effort plays a key role in positive parenting by creating possibilities for learning and motivation for achievement.

The Growing Great Kids Curriculum includes hundreds of child development activities that are connected to the 4 Steps to Success Daily Do. Each activity is crafted to support parents and children in building self-esteem and motivation for learning, while focusing attention on lots of opportunities to praise effort.  At Great Kids, Inc. we believe that every parent has the power to set their child up to feel confident, to be a good learner, and to feel successful in school.

Let’s not forget that “praising the effort” is not just about children; it applies to all of us in any role. As a home visitor, we encourage you to take every opportunity to point out parents’ efforts for growing their parenting style and practicing new parenting skills and/or life skills. Support them by praising their efforts and acknowledging the challenges they faced. This will foster motivation for continued learning and growth of new skills in the future.

We will conclude with a note that a man wrote to Dr. Dweck after he read some of her work (Dweck, 2007):

Dear Dr. Dweck,

                It was painful to read your chapter…as I recognized myself therein.

               As a child, I was a member of The Gifted Child Society and continually praised for my                            intelligence.  Now, after a lifetime of not living up to my potential (I’m 49), I’m learning to                     apply myself to a task. And also, to see failure not as a sign of stupidity but as lack of                             experience and skills. Your chapter helped me see myself in a new light.

                                                                                Seth Abrams

Works Cited:

Mueller, C. M., & Dweck, C. S. (1998). Praise for intelligence can undermine children's motivation and performance. Journal of Personality and Social Psychology: Attitudes and Social Cognition, 75(1), 33-52. doi:

Gunderson, E A., Gripshover, S.J., Dweck, C.S., Goldin-Meadow, S., Levine, S. (2013). Parent Praise to 1- to 3- Year-Olds Predicts Children’s Motivational Frameworks 5 Years Later. Child Development, Society for Research in Child Development, Inc. September/October 2013, Volume 84, Number 5, Pages 1526–1541. DOI: 10.1111/cdev.12064

Dweck, C. S. (2007). Mindset. The New Psychology of Success. How We Can Learn to Fulfill Our Potential. Ballantine Books, a division of Random House, Inc. New York.

“Vaccination is one of the best ways parents can protect infants, children, and teens from 16 potentially harmful diseases.  Vaccine-preventable diseases can be very serious, may require hospitalization, or even be deadly – especially in infants and young children” (CDC, For Parents: Vaccines for Children, 2016). Due to the importance of immunizations in children’s health and physical development, today we will explore this topic by referencing the latest research on immunization and the benefits of well-child visits. We’ll put a spotlight on The Growing Great Kids Curriculum tools and resources around this topic and discuss how to support parents to be proactive and responsive regarding their children’s health. We’ll wrap up today’s discussion with additional online resources that you may want to pass on to your families.

The Centers for Disease Control and Prevention (CDC) National Immunization Survey found that the 2015 immunization rates for children aged 19-35 months sustained high coverage in the United States. More than 90% of children by age 2 years were up to date with vaccination against polio, hepatitis b; measles, mumps; rubella; and varicella. There were no significant coverage rate changes between 2014 and 2015 (CDC, Morbidity and Mortality Weekly Report, 2016).  Health care professionals feel that immunizations are one of the most effective health prevention strategies discovered in our society during the last century.  Other research indicates that the average life expectancy of US citizens increased by 30 years, primarily due to improvements in sanitation and development of vaccines and antimicrobial agents (Abramson and Pickering, 2002). National efforts and initiatives on vaccine education have resulted in the elimination of smallpox and polio from the United States.  It has also increased awareness around prevention of other serious diseases, including diphtheria, tetanus, whooping cough, hepatitis b, measles, mumps, and rubella. This has resulted in lower hospitalizations and deaths due to vaccine-preventable diseases, saving society more than $5 for each dollar spent on most of the vaccines that are recommended for children in the United States (Abramson and Pickering, 2002).

There is also some interesting information regarding immunization statistics provided by the Canadian Government. In 2013, the Childhood National Immunization Coverage Survey (cNICS) reported that most Canadian children, at age two, are immunized against vaccine preventable diseases including Polio 91%, DPT 77%, Hib 72%, MMR 89%, Varicella 73%, Meningococcal C 89%, and Pneumococcal 79%. The 2013 cNICS incorporated questions on parental knowledge, attitudes and beliefs related to vaccines and vaccination. This information allows the Canadian Government to identify trends over time in attitudes that may influence parental decisions regarding vaccination.  In 2013, the cNICS showed that 95% of parents believed that childhood vaccines are safe and 97% thought that vaccines are effective for keeping children’s health (Government of Canada, 2013).

Part of keeping children healthy is making sure that they are examined regularly by their Health Care Provider. According to the American Academy of Pediatrics (AAP), parents know who they should go to when their child is sick, but pediatrician visits are just as important for healthy children. The focus during these visits should be on developmental milestones, immunizations, physical examinations, nutrition, safety, the child’s and family’s emotional well-being, general health education, and teaching about injury prevention (, 2015).  To support parents to maximize their well-child visits, the AAP developed age appropriate pre-visit questionnaires. These tools are designed to allow parents to prepare for asking questions and discussing concerns related to the child’s health. They also help parents to plan for well-child visits based on the timing of recommended immunizations.

Let’s take a few minutes now to discuss how the Growing Great Kids Curriculum supports practices related to immunizations, reaching out to health care services, regular monitoring of developmental milestones, and other related topics. For every three months of a child’s development, GGK incorporates a Module on Basic Care.   Just to highlight a sample of topics:

  • 0-3 months: When Baby is Sick or Needs Health Care; Signs of Illness
  • 4-6 months: Keeping Your Baby Healthy; Well Baby Care and Immunization
  • 7-9 months: Changing Needs for Home Safety
  • 10-12 months:  Keeping Your Baby Healthy; Well Baby Care and Immunization; Preventing Animal-Related Illnesses
  • 13-15 months: Routine and Responsive Health Care
  • 19-21 months: Checking in on Body Builders
  • 25-30 months: Growing Healthy Kids

Another GGK essential tool is the Body Builders Daily Do, a parenting skill set designed to support excellent physical development and health in children. Through the Home Visitor’s use of GGK, parents are supported as they practice this Daily Do and reinforce the four main components of physical development and health: good nutrition, responsive and preventive health care, daily exercise, and predictable and safe environments.

One of the most important features of the GGK Curriculum is that all Conversation Guides are designed to offer anticipatory guidance about health, safety, and nutrition.  This approach allows parents to engage in reflective and proactive practices that allow them to be more prepared for every stage of their baby’s development--- including knowing when it’s time for immunizations and well-child visits.

While immunizations are considered one of the major public health achievements of the 20th century, there are still some challenges to overcome in this arena.  Some of these challenges include increased educational awareness regarding various vaccine safety concerns, the increased costs of vaccines, and shortages of vaccine supply. The Centers for Disease Control and Prevention regularly provides updates on these areas along with multiple tools and resources.

The following includes a list of tools provided by the CDC, check them out and pass them on to your families at

  • Immunization Schedules for Infants and Children (English and Spanish)
  • Immunization and Developmental Milestones
  • Interactive Make Your Immunization Schedule for Your Child
  • Immunization Tracker
  • Videos and Useful Lists
  • Infographics, Handouts, and Booklets
  • Parents’ Guide to Childhood Immunization Guide

The American Academy of Pediatrics provides the following online resources and tips, (, 2015):

  • Ask your healthcare provider.  He or she can give you the vaccine package insert or suggest other sources of information.
  • Call your local or state health department.
  • Contact the Centers for Disease Control and Prevention (CDC):

Works Cited:

The US Centers for Disease Control (2016). National Center for Immunization and Respiratory Diseases: For Parents: Vaccines for Children. Retrieved from

Government of Canada (2013). Vaccine coverage in Canadian Children: Highlights from the 2013 childhood National Immunization Coverage Survey. Retrieved from

The US Centers for Disease Control (2016). Morbidity and Mortality Weekly Report: Vaccination Coverage Among Children Aged 19-35 Months- United States, 2015. Retrieved from

Abramson, J.S. MD, Pickering, L.K. MD (2002). US Immunization Policy. Published by the Journal of the American Medical Association, Issue Volume 287(4) January 23/30, 2002 pp 505-509. (2015). Family Life: AAP Schedule of Well-Child Care Visits. Retrieved from