The Well-Being of Canada's Young Children - Government of Canada Report 2008

Chapter 5 - What Do We Know About Family Influences on Young Children's Development?

5.1 Who are the Parents of Canada's Young Children?

5.1.1 Mother's and Father's Education

… More parents of young children have a college or university degree

Parents of young children are achieving higher levels of education. In 2004/05, 55.9% of all parents with young children reported having a college or university degree, up from 46.9% in 1998/99. The rates varied little by the sex of the parent, with 56.5% of mothers and 55.2% of fathers having a college or university degree. This is up from 1998/99 where rates were 45.3% and 48.7%, respectively.

Parents with young children living in urban centres tend to have more formal education than those living in rural areas. In 2004/05, a significantly greater number of mothers (18.4% versus 10%) and fathers (22.9% versus 11%) with young children living in rural areas did not complete high school as compared to their urban counterparts. At the same time, significantly more mothers (58.2% versus 43%) and fathers (57.3% versus 39.2%) with young children living in urban centres reported having a college or university degree as compared to their rural counterparts.

Why is this important?

Parents are key to a young child's development, by encouraging learning, being role models and providing an environment that encourages learning. The impact parents have on this development can vary depending on their level of education. Research shows that better-educated parents tend to spend more time with their children focussed on a variety of activities that nurture children's development and help them to make a successful transition into adulthood.⁵⁶

For young children, lower levels of parent education have been associated with lower receptive vocabulary, communication skills, number knowledge, and copying and symbol-use scores.⁵⁷ As illustrated in Figure 13, young children from 4 to 5 years of age with parents who had higher levels of education consistently performed better on all measures of cognitive development in the NLSCY.

Text description of Figure 13

5.1.2 Parent Work/Study Status

… The majority of parents with young children are working or studying

In 2004/05, 65.8% of young children in two-parent families and 62.9% of those in single-parent families lived in homes where all parents in the residence were working or studying. This is down from 68% and 71.1% respectively in 1998/99.

In 2004/05, children living in two-parent families in urban centres were more likely to have both parents working or studying than those in rural areas (66.6% compared to 60.1%). By contrast, children living in two-parent families in rural areas were more likely than those in urban centres to live in families where only one parent worked or studied (37.2% compared to 31.8%).

In 2004/05, young children living in single-parent families in rural areas were also more likely to live with a parent that worked or studied than those in urban centres (64% compared to 62.8%). This is consistent with previous cycles (60.5% versus 72% in 1998/99; 63.1% versus 68% in 2000/01; and 58.7% versus 69.3% in 2002/03).

Text description of Figure 14

… While internationally

Overall, Canadian mothers with younger children are less likely to be in the workforce than those with older children. According to the OECD's Society at a Glance, 2006, the participation rate of Canadian mothers with children under 3 years of age (58.7%) was slightly lower than OECD average (59%) and much lower than Austria (80.1%). However, the Canadian rate was higher than that of the United States (56.6%) and the United Kingdom (57.2%). In most countries, mothers' employment rates increased as their youngest child grew. Canadian mothers whose youngest child was 3 to 5 years of age had an employment rate of 68.1%. This was higher than the OECD average of 64.1%.

Text description of Figure 15

Why is this important?

With the increasing demands on work and family time, it can be challenging for parents to achieve work-life balance.⁵⁸ This can be particularly challenging for parents with young children – especially mothers – who often have higher, unpredictable demands on their time (e.g., child care arrangements, day care transport, care of sick child) that can result in conflicts between work and family responsibilities.⁵⁹ Although fathers have become more active in care provision in recent times, women are still more likely to devote more time than men in caring for young children. When this care is combined with responsibilities in the paid labour force, mothers are more likely to experience a “time crunch”.⁶⁰

At the same time, dual wage-earning families have become the norm and those outside this economic norm are far more likely to be living in low income.⁶¹ For example, single parent families with children under the age of six are more than four times more likely to be living in low income than two-parent families with children under the age of six. Section 5.1.3, “Level of Income”, provides a more detailed discussion of the relationship between family income and child development.

5.1.3 Level of Income⁶²

... Over 85% of young children are not living in low income

In 2005, according to the Survey of Labour and Income Dynamics, 86.6% of all families with children under 6 years of age⁶³ were living at or above the post-tax low-income cutoffs (LICO).⁶⁴ This is an improvement since 1999 when 83.6% of families with young children were living at or above the LICO.

Despite this overall improvement, a gap remains between the low-income rates of single-parent families and two-parent families with young children. In 2005, 40.8% of single-parent families lived below the LICO, compared to 9.3% of two-parent families. For both family types, these rates represent a decline from 1999.

Text description of Figure 16

Why is this important?

For young children, living in low income can have immediate and long-term consequences – higher family income is associated with better behavioural, physical, and cognitive outcomes for children.⁶⁵ In terms of behavioural development, in 2004/05, children from 2 to 5 years of age living above the LICO showed significantly fewer signs of hyperactivity (6% versus 8.9%) and were significantly less likely to demonstrate behaviours associated with physical aggression (13.4% versus 17.4%) than their counterparts living below the LICO.

In addition, in 2004/05 significantly fewer children 4 to 5 years of age living above the LICO were considered delayed in their cognitive development (“Who am I?” scores) than children living below the LICO (13.8% compared to 19.4%). Similarly, those living above the LICO were significantly less likely to be delayed in terms of their vocabulary development (PPVT-R) (11.2% compared to 24.8%). Numeracy scores (Number Knowledge) were also significantly better for those living above the LICO compared to those below, with 13.8% considered delayed compared to 28.4% and 12% considered advanced compared to 6.8%.

5.2 What Do We Know About the Child Care Arrangements of Families with Young Children?

... In 2004/05, slightly more than half of children from 1 to 5 years of age, with parents who were working or studying, were in non-parental child care

In 2004/05, 55% of children from 1 to 5 years of age, whose parents were working or studying, were in some form of non-parental child care, and 45% were being cared for by their parents. The proportion in non-parental care is down from 56.3% in 2002/03, but up from 53.7% in 1998-99. Young children in urban centres were more likely to be in non-parental care than those in rural areas, 55.2% compared to 53.5% in 2004/05.

Of the non-parental child care arrangements used, parents are most likely to rely on care in someone else's home. In 2004/05, 45.2% of children from 1 to 5 years of age who were in non-parental care were being cared for in someone else's home. This is down slightly from 45.6% in 2002/03 and down since 1998/99 (50.2%). Parents in urban centres were less likely to use this type of care than parents in rural settings – 43.9% compared to 55.3% in 2004/05.

At the same time, the use of daycare centres has been increasing, from 19.2% in 1998/99 to 30.5% in 2004/05. Urban parents were more likely than rural parents to use this form of non-parental child care – 31.1% compared to 25.4% in 2004/05.

Table 4: Primary Child Care Arrangement for Children from 1 to 5 Years of Age by Type of Child Care Used, 1998/99—2004/05

	Year	Parental Child Care	Non-Parental Child Care	Non-Parental Child Care
				Care in Someone Else's Home	Care in Child's Home	Daycare Centre	Other
E Use with caution F Too unreliable to be published Source: National Longitudinal Survey of Children and Youth, Cycles 3 (1998/99) through 6 (2004/05).
All Children	2004/05	45.0%	55.0%	45.2%	18.5%	30.5%	5.8%
	2002/03	43.7%	56.3%	45.6%	21.0%	28.4%	5.0%
	2000/01	46.3%	53.7%	48.5%	23.1%	24.5%	3.9%
	1998/99	47.7%	52.3%	50.2%	25.4%	19.2%	5.2%
Children Living in Urban Settings	2004/05	44.8%	55.2%	43.9%	18.7%	31.1%	6.3%
	2002/03	43.4%	56.6%	44.2%	21.5%	29.1%	5.2%
	2000/01	45.8%	54.2%	47.4%	23.5%	24.9%	4.3%
	1998/99	46.3%	53.7%	49.7%	25.3%	19.5%	5.4%
Children Living in Rural Settings	2004/05	46.5%	53.5%	55.3%	17.1%	25.4%	F
	2002/03	45.9%	54.1%	57.2%	17.1%	22.7%	3.0%E
	2000/01	50.2%	49.8%	57.9%	19.7%	21.2%	F
	1998/99	57.8%	42.2%	54.9%	25.4%	16.4%	3.3%E

... Young children are in non-parental child care arrangements for increasingly longer periods of time

Overall, children from 1 to 5 years of age whose parents were working or studying are spending more time in non-parental child care. In 2004/05, 35.9% of young children in non-parental child care spent 40 hours per week or more in their main child care arrangement – a steady increase from 33.6% in 1998/99. Young children in urban centres were more likely to be in child care for 40 hours per week or more than children in rural areas (37.1% versus 25.9% in 2004/05).

Table 5: Non-Parental Child Care for Children from 1 to 5 Years of Age by Number of Hours per Week, 1998/99 - 2004/05

	Year	Less Than 10 Hrs/Week	Between 10 to 23 Hrs/Week	Between 24 to 39 Hrs/Week	40 Hrs/Week or More
Source: National Longitudinal Survey of Children and Youth, Cycles 3 (1998/99) through 6 (2004/05).
All Children	2004/05	11.3%	24.1%	28.7%	35.9%
	2002/03	13.2%	25.1%	27.6%	34.2%
	2000/01	13.7%	24.7%	27.6%	34.0%
	1998/99	12.6%	25.4%	28.4%	33.6%
Children Living in Urban Settings	2004/05	11.0%	23.3%	28.5%	37.1%
	2002/03	12.8%	25.1%	27.3%	34.9%
	2000/01	13.4%	24.7%	27.4%	34.4%
	1998/99	12.3%	25.0%	28.4%	34.2%
Children Living in Rural Settings	2004/05	14.0%	30.0%	30.1%	25.9%
	2002/03	16.2%	25.0%	30.8%	27.9%
	2000/01	16.1%	24.8%	29.2%	29.9%
	1998/99	15.2%	28.9%	27.8%	28.1%

Why is this important?

Today, balancing the demands of work and family life can be a challenge for parents. Over the past few decades, the number of dual-earner and single-parent families has been on the rise. At the same time, the employment rate of mothers with young children has increased dramatically – between 1976 and 2004, the employment rate of mothers with young children under 3 years of age increased from 28% to 65% and for those with children from 3 to 5 years of age, from 37% to 70%.⁶⁶ In addition to changes in employment patterns, the labour market itself is shifting as non-standard work arrangements (e.g., contract work, self-employment and temporary or part time work) have become more common. With the increased pressure on families to find a balance between their earnings and caring roles, parents with young children are making use of a wide range of child care options.

5.3 What Do We Know About Prenatal Practices?

5.3.1 Tobacco Use During Pregnancy

… Maternal smoking during pregnancy continues to decline

Fewer mothers are smoking while pregnant. In 2004-05, 14.6% of children under 2 years of age had mothers who reported smoking while pregnant – down from 19.4% in 1998/99.

Mothers with young children living in urban centres are less likely to smoke while pregnant than their rural counterparts. In 2004/05, 13.8% of urban children under 2 years of age had mothers who smoked during their pregnancy, compared to 20.6% of their rural counterparts. This is down from 18.4% and 26.9% respectively in 1998/99.

Why is this important?

The negative health effects of smoking on the physical, behavioural and cognitive development of the child have long been documented. Smoking during pregnancy is associated with an increase risk of low birth rates, stillborn births and spontaneous abortions, as well as increased chance of developing respiratory illnesses.⁶⁷ For infants, prenatal smoking has also been associated with Sudden Infant Death Syndrome (SIDS).⁶⁸ For children of mothers who smoked during pregnancy, there is also an increased risk for hyperactivity, depression and later substance abuse⁶⁹ as well as cognitive deficits including “…language, reading and vocabulary, as well as poorer performances on tests of reasoning and memory has been reported.“⁷⁰

5.3.2 Alcohol Consumption During Pregnancy

... 84.5% of pregnant women did not use alcohol during pregnancy

Most mothers do not drink while pregnant. In 2004/05, 84.5% of children under 2 years of age had mothers who did not drink while pregnant, a slight increase from 84.4% 2002/03, but down from 86.1% in 2000/01 and 85.6% in 1998/99.

Why is this important?

Consuming alcohol during pregnancy can result in a wide range of negative, lifelong developmental outcomes. The Public Health Agency of Canada has warned that there is “[n]o safe amount of alcohol during pregnancy,” with research showing that as little as one drink a day can cause behaviour and learning problems in children.⁷¹

Fetal Alcohol Spectrum Disorder (FASD) is the broad term that describes the wide range of mild to severe symptoms and disabilities that can be experienced by children whose mothers drank while pregnant.⁷² FASD cognitive-related defects can range from developmental disabilities to difficulty in planning, organization, speech/language functioning, and verbal learning.⁷³ Physically, children with FASD can experience vision and hearing problems, deformed bones and limbs, organ damage and slow growth. In terms of emotional health and behaviour, these children are also at risk of a broad range of negative developmental outcomes, including hyperactivity, aggression, depression, obsessive-compulsive disorder and bipolar disorder.⁷⁴ Research also shows that children exposed to alcohol while in the womb are more likely to develop alcohol abuse or dependency later in life.⁷⁵

5.4 What do We know about Postnatal Care?

5.4.1 Breastfeeding

... The number of children being breastfed continues to rise

The number of children breastfed continues to increase. In 2004/05, 86% of children 3 years of age and younger had been or were being breastfed. This marked a steady increase since 1998/99 (79.9% in 1998/99, to 82.1% in 2000/01 and 84.2% in 2002/03).

Children in urban centres are more likely to be breastfed than those in rural areas. In 2004/05, 86.7% of children 3 years of age and younger had been or were being breastfed compared to 80.6% of those in rural areas.

Text description of Figure 17

... And children are being breastfed for longer periods of time

Of those mothers who do breastfeed, more are doing so for longer. In 2004/05, of children from birth to 3 years of age who had been breastfed in the past but were no longer being breastfed, 44.2% had been breastfed for seven months or longer – up from 34% in 1998/99.

Children in urban centres are more likely to be breastfed for seven months or longer. In 2004/05, of urban children from birth to 3 years of age who had been breastfed in the past but were no longer being breastfed, 45.1% had been breastfed for seven month or longer compared to 35.9% of those in rural areas. Comparing to 2002/03, these rates increased for children in urban centres (36.4%), but decreased slightly for those in rural areas (36.9%).

... While internationally

There is wide variation in the breastfeeding rates in European countries. For example, in 2000, the percentage of children aged six months who were at least partially breastfed was 80% in Norway and 72% in Sweden, but was 40% in Spain, 25% in the Netherlands and 21% in the United Kingdom.⁷⁶ By comparison, in the United States, in 2004, 41.5% of children were being breastfed at six months.⁷⁷

Why is this important?

Breastfeeding can positively influence a child's start in life. The World Health Organization recommends that infants be exclusively breastfed for the first six months of life. Breastfeeding provides the essential nutrition as well as other important benefits to an infant's physical, social and cognitive development. Health Canada promotes breast milk as “the best food for optimal growth” and recommends breastfeeding for up to two years and beyond.⁷⁸ In terms of physical health, breastfeeding has been shown to have a protective effect against illness, including gastrointestinal and respiratory infections, and may give some protection against SIDS.⁷⁹ In addition, it also has been shown to positively impact an infant's motor development, with infants who were exclusively breast fed for the first six months crawling earlier and more likely to be walking by one year of age.⁸⁰ Breastfeeding has been associated with improved cognitive scores and obesity prevention.⁸¹

Breastfeeding can also provide important benefits for the health and well-being of mothers. For mothers, breastfeeding has been linked to such health benefits as increased post-partum weight loss, decreased risk of breast cancer, decreased risk of ovarian cancer and a possible decreased risk of hip fractures and osteoporosis later in life.⁸² Mothers who breastfed also report lower levels of stress and negative mood and higher levels of maternal attachment than mothers who formula fed their infants.⁸³

5.4.2 Parental Depression

... Most parents of young children do not report high levels of depressive symptoms

In 2004/05, 90% of all parents with children 5 years of age or younger did not report high levels of depressive symptoms. While this percentage is down slightly from 2002/03 (90.7%) it is up from 88.8% in 1998/99.

Urban parents with young children are more likely to report high levels of depressive symptoms than rural parents – 10.2% compared to 8.4% in 2004/05. However, the incidence of depressive symptoms in both urban and rural parents is down since 1998/99, when the rates were 11.3% and 10.3% respectively.

Why is this important?

Depressed parents can be disengaged and less responsive to the needs of their children, which in turn can affect a child's social, behavioural and physical development. Prenatal depression in moms-to-be can have a negative affect on an infant's physical outcomes, such as higher chance of premature birth and low birth weight.⁸⁴ Postnatal depression can affect children's behavioural and cognitive development. Children with depressed moms are themselves more likely to be depressed or act aggressively,⁸⁵ and infants of depressed mothers are “less likely to approach and process novel objects and situations, and thus, benefit less from early learning opportunities.”⁸⁶

In 2004/05, a significantly greater number of children from 2 to 5 years of age with highly depressed parents displayed signs of emotional anxiety compared to those children with parents who did not report high levels of depressive symptoms (27.1% versus 13.2%). Similarly, young children with highly depressed parents were significantly more likely to show signs of physical aggression (27.1 versus 12.9%).

Text description of Figure 18

5.4.3 Parental Smoking

... Parental smoking continues to decline

In 2004/05, 67.2% of children under 6 years of age lived in homes where neither parent smoked. This is up from 59.8% in 1998/99.

Parents in urban centres are less likely to smoke than those in rural areas. In 2004/05, significantly more young children in urban centres lived in homes where neither parent smoked than those living in rural areas (67.8% compared to 63%) – this is up from 60.8% and 54.4% in 1998/99. When looking at households in which both parents smoke, again there was a significant difference depending on location. In 2004/05, significantly fewer young children in urban centres lived in homes where both parents smoked than those living in rural areas – 9% versus 12.2%. This is down from 11.8% and 18% in 1998/99.

Text description of Figure 19

Why is this important?

Parental smoking has a direct impact on the health and future well-being of young children. Exposure to second-hand smoke, particularly early in life, increases a child's risk for middle ear infections, bronchitis, pneumonia and the prevalence and severity of asthma, and SIDS.⁸⁷ Research also suggests that continued exposure to second-hand smoke before and after birth increases the risk for cancer (e.g., leukemia and brain tumours) in childhood.⁸⁸ In addition, exposure to second-hand smoking has been shown to “impact a child's attention, behaviour, and ability to reason and understand (cognition).”⁸⁹

5.5 What Do We Know About Parenting Practices?

5.5.1 Family Functioning and Parental Interactions

Text description of Figure 20

... The majority of young children in Canada live in well-functioning families

Overall, the number of young children living in well-functioning families has been increasing. In 2004/05, 91.3% of children from birth to 5 years of age lived in well-functioning families, up from 89.1% in 1998/99. Slightly more young children in rural areas (91.5%) lived in well-functioning families compared to their urban counterparts (91.2%).

... And have positive interactions with their parents

In 2004/05, 94.3% of young children had positive interactions with their parents, up from 90.6% in 1998/99. Young children living in urban centres were slightly more likely to have positive interactions with their parents than those living in rural areas (94.5% compared to 93% in 2004/05). When looking at positive interactions by sex of the child, there was even a smaller variance. In 2004/05, 94.5% of females had positive parental interactions compared to 94.2% of males. This was up for both genders since 1998/99, when 90.3% of females and 90.8% of males had positive parental interactions.

Why is this important?

Living in a family that is well functioning – members work together to solve problems and are supportive and communicate with each other – can be an important factor in young child's future outcomes and overall wellbeing. Research shows that high family functioning can offset the effects of low income and influences a range of childhood outcomes such as aggressive behaviour, pro-social behaviour, academic achievement and high school completion.⁹⁰

The quality of the interactions between parent and child can also be an important factor in a young child's development. Research shows that when parents are more punitive, children are more aggressive, have higher levels of anxiety and demonstrate lower levels of prosocial behaviours.⁹¹ In contrast, positive parenting – that is, consistently firm approaches, being responsive and reasoning with a child – can reduce a child's risk for having relationship problems, failing grades at school, having emotional problems or being aggressive.⁹²

5.5.2 Reading by an Adult

... Almost two-thirds of young children are involved in reading activities daily

Most children from birth to 5 years of age read or are read to daily. In 2004/05, 64.8% of young children read or were read to by a parent or other adult daily – a decrease from 67.3% in 2002/03 and 65.4% in 2000/01.

Text description of Figure 21

Females are more likely to be involved in reading activities daily than males - 66.6% of females compared to 63% of males in 2004/05.

Young children in urban centres are more likely to be involved in daily reading activities than their rural counterparts. In 2004/05, the rates were 65.1% of young children in urban centres compared to 62.4% of those living in rural areas. These percentages are down slightly from 2000/01 (65.8% and 62.8%) and 2002/03 (67.8% and 63.2%).

Why is this important?

Having strong reading skills is associated with higher academic skills and increased chance of life long success – and the path to becoming a skilled reader starts in the early years.⁹³ Home reading activities are important for child literacy and language development. More specifically, reading activities in the home have been shown to encourage language comprehension, reading achievement, and interest in reading and attentiveness in school – all of which contribute to a child's academic success.⁹⁴ For example, as illustrated in Figure 22, children from 4 to 5 years of age who are read to daily performed better than children read to a few times a week on all measures of cognitive development in the NLSCY.

Text description of Figure 22

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• ⁵⁶ Gauthier, A.H., T.M. Smeeding, and F. F. Furstenberg (2004). “Are Parents Investing Less Time in Children? Trends in Selected Industrialized Countries.” Population and Development Review.  30 (4): 647-671. ^{Click to return to reference}
• ⁵⁷ Thomas, E. M. (2006). “Readiness to Learn at School Among Five-year-old Children in Canada.” Ottawa: Statistics Canada. Available at: http://www.statcan.ca/english/research/89-599-MIE/89-599-MIE2006004.pdf. ^{Click to return to reference}
• ⁵⁸ Work-life balance is a self-defined, self-determined state of well-being that a person can reach, or can set as a goal, that allows them to manage effectively multiple responsibilities at work, at home, and in their community; it supports physical, emotional, family, and community health, and does so without grief, stress or negative impact. Work-family balance refers to the management of family responsibilities towards children, aging parents, a disabled family member, or a partner/spouse. (Human Resources and Social Development Canada, “Work/Life Balance and New Workplace Challenges — Frequently Asked Questions For Individuals.” Available at: http://www.hrsdc.gc.ca/en/lp/spila/wlb/faq/01individuals.shtml). ^{Click to return to reference}
• ⁵⁹ Duxbury, L and C. Higgins (2005). “Report Four: Who Is at Risk? Predictors of Work–Life Conflict.” Ottawa: Public Health Agency of Canada. Available at: http://www.phac-aspc.gc.ca/publicat/work-travail/report4/pdf/work-travail-rpt4_e.pdf. ^{Click to return to reference}
• ⁶⁰ Smith, A. (2004). “Who Cares? Fathers and the Time They Spend Looking After Children.” Department of Sociology Working Paper No. 2004-05 Oxford: University of Oxford, Nuffield College. ^{Click to return to reference}
• ⁶¹ Glossop, R. (2005). “Working for Love or/and Money: Submission of the Vanier Institute of The Family to the Government of Canada's Federal Labour Standards Review.” The Vanier Institute of The Family. Available at: http://www.vifamily.ca/commentary/labour.html#40. ^{Click to return to reference}
• ⁶² Two different data sources for income are used in this section: the Survey of Labour and Income Dynamics, which surveys the income of all individuals and families in Canada; and the NLSCY, which surveys children under 6 years of age. ^{Click to return to reference}
• ⁶³ This includes children from birth to 5 years of age living in “no parent” families. ^{Click to return to reference}
• ⁶⁴ Canada does not have an official measure of poverty; however, the commonly used measure of low income is Statistics Canada's low-income cutoff (LICO), which is based on the proportion of annual income spent on basic needs (food, clothing and shelter). A household is considered to be low income when its income is below the cutoff for its family size and community. LICOs can be calculated using pre- or post-tax income. The post-income tax (or disposable) LICOs are more commonly used for two reasons: first, post-tax low income rates better reflect the redistributive impact of the tax and transfer systems and second, because the purchase of necessities such as food, shelter and clothing is done using disposable income, it is more relevant to use an after-tax income definition in drawing any conclusions on the overall economic well-being of Canadians. ^{Click to return to reference}
• ⁶⁵ Phipps, S, and L. Lethbridge (2006). “Income and the Outcomes of Children.” Ottawa: Statistics Canada. Available at: http://www.statcan.ca/english/research/11F0019MIE/11F0019MIE2006281.pdf. ^{Click to return to reference}
• ⁶⁶ Statistics Canada (2006). Women in Canada: A Gender-based Statistical Report, Fifth Edition. Ottawa: Statistics Canada. Available at: http://www.statcan.ca/english/freepub/89-503-XIE/0010589-503-XIE.pdf. ^{Click to return to reference}
• ⁶⁷ Cnattingius, S. (2004). “The Epidemiology of Smoking During Pregnancy: Smoking Prevalence, Maternal Characteristics, and Pregnancy Outcomes.” Nicotine & Tobacco Research. 2 (6): S125-S140. ^{Click to return to reference}
• ⁶⁸ Shah, T.; K. Sullivan and J. Carter (2006). “Sudden Infant Death Syndrome and Reported Maternal Smoking During Pregnancy.” American Journal of Public Health. 96(10): 1757-1759. ^{Click to return to reference}
• ⁶⁹ Brennan, P. (originally published, 2003, revised 2005). “Tobacco Consumption During Pregnancy and its Impact on Psychosocial Child Development.” Encyclopedia on Early Childhood Development. Available at: http://www.child-encyclopedia.com/Pages/PDF/BrennanANGxp_rev.pdf. ^{Click to return to reference}
• ⁷⁰ Day, N. L. and M. D. Cornelius (2000). “The Effects of Tobacco Use During and After Pregnancy on Exposed Children.” Alcohol Research & Health. 24(4): 242-249. ^{Click to return to reference}
• ⁷¹ Loock, Christine et al. “Identifying Fetal Alcohol Spectrum Disorder in Primary Care.” Canadian Medical Association Journal. 172(5): 628-630. ^{Click to return to reference}
• ⁷² Ibid. ^{Click to return to reference}
• ⁷³ Green, Jennifer (2007). “Fetal Alcohol Spectrum Disorders: Understanding the Effects of Prenatal Alcohol Exposure and Supporting Students.” Journal of School Health. 77(3): 103-108. ^{Click to return to reference}
• ⁷⁴ Ibid. ^{Click to return to reference}
• ⁷⁵ Harvard Mental Health Letter (2007). “Alcohol Before Birth: New Studies.” Harvard Mental Health Letter. 23(7): 7. ^{Click to return to reference}
• ⁷⁶ World Health Organization (2005). The European Health Report, 2005: Public Action for Healthier Children and Populations. World Health Organization. Available online at: http://www.euro.who.int/document/e87325.pdf. ^{Click to return to reference}
• ⁷⁷ Centre for Disease Control (2007). Breastfeeding Report Card, United States 2007: Outcomes Indicators. United States National Immunization Survey, 2004 Births. Available online at: http://www.cdc.gov/breastfeeding/data/report_card2.htm. ^{Click to return to reference}
• ⁷⁸ Health Canada (2004). “Exclusive Breastfeeding Duration – 2004 Health Canada Recommendation.” Ottawa: Health Canada. Available at: http://www.hc-sc.gc.ca/fn-an/nutrition/child-enfant/infant-nourisson/excl_bf_dur-dur_am_excl_e.html ^{Click to return to reference}
• ⁷⁹ Health Canada (2005). “Nutrition for Healthy Term Infants - Statement of the Joint Working Group: Canadian Paediatric Society, Dieticians of Canada and Health Canada.” Ottawa: Health Canada. Available at: http://www.hc-sc.gc.ca/fn-an/pubs/infant-nourrisson/nut_infant_nourrisson_term_e.html. ^{Click to return to reference}
• ⁸⁰ Pérez-Escamilla, R (2005). “Influence of Breastfeeding on Psychosocial Development.” Encyclopedia on Early Childhood Development. Available at: http://www.child-encyclopedia.com/Pages/PDF/Perez-EscamillaANGxp.pdf. ^{Click to return to reference}
• ⁸¹ Ibid. ^{Click to return to reference}
• ⁸² American Academy of Pediatrics, Policy Statement (2005). “Breastfeeding and the Use of Human Milk.” Pediatrics. 115: 496-506. Available at: http://pediatrics.aappublications.org/cgi/content/full/115/2/496. ^{Click to return to reference}
• ⁸³ Woodward, L. J. and K. A. Liberty (2005). “Breastfeeding and Child Psychosocial Development.” Encyclopedia on Early Childhood Development. Available at: http://www.child-encyclopedia.com/Pages/PDF/Woodward-LibertyANGxp.pdf. ^{Click to return to reference}
• ⁸⁴ Psychosocial Paediatrics Committee, Canadian Paediatric Society (2004). “Maternal Depression and Child Development.” Paediatrics & Child Health.  9(8): 575-583. Available at: http://www.cps.ca/English/statements/PP/pp04/03.htm. ^{Click to return to reference}
• ⁸⁵ Ibid. ^{Click to return to reference}
• ⁸⁶ Sohr-Preston, S. L. and L. Scaramella (2006). “Implications of Timing of Maternal Depressive Symptoms for Early Cognitive and Language Development.” Clinical Child & Family Psychology Review. 9(1): 65-83. ^{Click to return to reference}
• ⁸⁷ DiFranza, J. R., C. A. Aligne, and M. Weitzman (2004). “Prenatal and Postnatal Environmental Tobacco Smoke Exposure and Children's Health.” Pediatrics. 113: 1007-1015. ^{Click to return to reference}
• ⁸⁸ Surgeon General of the United States of America (2006). "The Health Consequences of Involuntary Exposure to Tobacco Smoke: a Report of the Surgeon General.” Available at: http://www.surgeongeneral.gov/library/secondhandsmoke/. ^{Click to return to reference}
• ⁸⁹ Ontario Medical Association (2004). “Exposure to second-hand smoke: Are we protecting our kids?: A Position Paper by the Ontario Medical Association.” Toronto: Ontario Medical Association. Available at: http://www.oma.org/phealth/smoke2004.pdf. ^{Click to return to reference}
• ⁹⁰ Bornstein, M. et al. (2003). “Well-Being: Positive Development Across the Life Course.” Mahwah, NJ: Lawrence Erlbaum Associates, Inc. ^{Click to return to reference}
• ⁹¹ Statistics Canada (2005). “National Longitudinal Survey of Children and Youth: Home Environment, Income and Child Behaviour.” Ottawa: Statistics Canada. Available at: http://www.statcan.ca/Daily/English/050221/d050221b.htm. ^{Click to return to reference}
• ⁹² Landy, S. and K. K. Tam (1998). “Understanding the Contribution of Multiple Risk Factors on Child Development at Various Ages.” Human Resources Development Canada, Applied Research Branch. Available at: http://www.hrsdc.gc.ca/en/cs/sp/sdc/pkrf/publications/research/1998-000139/page01.shtml. ^{Click to return to reference}
• ⁹³ Canadian Council on Learning (2006). “Lessons in Learning – How Parents Foster Early Literacy.” The Learning Link, Virtual Bulletin. February 1, 2006. Canadian Council on Learning. Available at: http://www.ccl-cca.ca/CCL/Reports/LessonsInLearning/LiL-1Feb2006.htm. ^{Click to return to reference}
• ⁹⁴ Clark, C. (2007). “Why it is important to involve parents in their children's literacy development.” National Literacy Trust. Available at: http://www.literacytrust.org.uk/Research/Parental%20Involvement%20-%20a%20brief%20review.pdf. ^{Click to return to reference}