Guide to buying developmentally appropriate gifts

By: Barbara Campbell, infant-parent therapist, Jamie Gleed, occupational therapist and Angela Zajcenko, early childhood resource specialist, Developmental Pediatrics and Rehabilitation


With the holiday season fast approaching many of us are on the hunt for that perfect gift! It can often be challenging to pick toys for children or teens that are developmentally appropriate, but it’s an important thing to consider when you’re gift giving.

For some children, chronological age does not match developmental age. Many children develop more quickly or slowly than their peers, so purchasing gifts based on chronological age isn’t always the most appropriate option. Developmental age gives us more information on where a child is socially, emotionally, physically and intellectually. When you buy toys for a child’s developmental age, you are more likely to pick a toy that is the right fit for their skills, and will help them learn new things as well.

Remember that a child may not be at the same developmental age for all areas of their development. Consider their developmental stage in different areas like gross motor skills, fine motor skills, communication and more when selecting a gift.

The toys listed below are examples of toys that would be developmentally appropriate at different stages. We’ve tried to pick toys that help with fine and gross motor skills, cognition, communication and social skills and are of course FUN! Keep in mind that this list is not comprehensive and there are many alternatives that could also meet your child’s interests.

Recommendations for developmental age

In this developmental stage, many new skills are emerging. Infants are working on developing the strength and control of their arms and legs for later crawling, walking, self-feeding and of course play! This is also the stage where early interaction skills start emerging – cooing, smiling and intentionally playing with toys.

Children in this stage are typically working on tummy time, rolling, crawling or pulling to stand. They will also be starting to grab at and grasp toys so those that are easier to hold (such as the Winkle) are recommended. Parent and child interaction is important to build your child’s social and emotional wellbeing.

Toys that would appropriate at this developmental stage may include:

1. Tummy Time Books

2. The Winkle

3. Stacking Rings

4. Board Books

5. Activity Table or Cube

Developmental Age of 1-2

In this developmental stage, children are becoming more exploratory. Their hand skills allow them to play with more complex toys. They are developing some early language skills and their interest in interacting is increasing. Most children will be mobile (crawling, walking, running).

Children in this developmental stage tend to enjoy toys that involve pouring or dumping, building or demonstrate cause and effect. Children are also starting to understand the purpose or role of common objects (i.e. a barn is where animals live). Little People sets are a great toy to foster imaginative play, language and development of hand skills. Toys that encourage turn taking or waiting are also a good fit. For children who are more active, a small basketball or soccer net can be a great way to work on hand eye coordination and gross motor skills.

Toys that would be appropriate at this developmental stage may include:

1. Little People

2. Sports Zone

3. Whacky Ball

4. Foam Building Blocks

Developmental Age of 3-4

In this developmental stage, children are starting to become more independent in their play. They are typically very good at giving direction to other children or adults around how they want to play with the toy! Pretend and imaginary play are emerging. Many children are interested in dressing up as and taking on different characters. Children also start to become more physically active during this stage. Many children are interested in kicking or throwing a ball and pedaling a tricycle. Their hand and finger skills continue to develop and most children will start to practice holding a crayon and working with puzzles with smaller pieces.

This is a great stage for dress up clothes which encourage children to ‘take on’ the role of someone else. This help build a child’s ability to understand different perspectives, an important skill for positive peer interactions.

Children at this stage have better control of their shoulder, arm and hand muscles. They are also able to use their fingers with more dexterity and accuracy. Children in this developmental stage are ready for puzzles with smaller knobs or those that have a magnetic wand. For children that enjoy crafting, Mosaics may be a fun idea.

Construction type toys such as Duplo or blocks are also a great fit for this age group to encourage them to work on their imagination, hand skills and language. Construction type toys can be used for a variety of play activities, because they are open ended and allow the child to create as they go.

Toys that would be appropriate at this developmental stage may include:

1. Dress Up Clothes

2. Magnetic Wand or Small Knob Puzzles

3. Duplo, Building Blocks or Brillo Block

4. Mosaics

Developmental Age of 4-6

Children during this developmental stage are continuing to develop their hand and finger skills, and are learning more about constructional, imaginative and social play. Hand eye coordination and gross motor skills continue to become more refined.

Toys like Magformers or Squigz provide children in this stage more complexity in open ended play. These toys also require more hand strength and finer movements. They will also challenge kids to be creative in their play ideas. Kinetic sand is a mess free sensory rich activity that encourages children to work with their hands. The Velcro ball and mitt or scoops are a great active activity and a good fit for targeting children’s hand eye coordination and gross/fine motor skills. These toys are also a safe option for playing indoors in some homes. Both of these activities offer a great opportunity for children to begin to negotiate and cooperate during play. Magnatabs are another great fine motor activity and for kids who are resistant to working on their early pre-printing and printing skills they tend to be quite motivating!

Toys that would be appropriate at this developmental stage may include:

1. Squigz or Magformers

2. Kinetic Sand

3. Velcro Mitt and Ball or Scoop Ball

4. Magnatabs

Developmental Age of 6-10

Children at this developmental stage become more organized in their play and choice of games. Most children at this age have specific interests and hobbies. They often have improved memory and executive functioning skills (initiating, planning, organizing and stopping/starting play). Gross motor skills are more refined, and most children have mastered balls skills and riding a bike.

At this age children are usually very social and interested in peer play, however they also tend to be good at independent play. They may enjoy a challenge and they will have the patience to persist with more complex activities. Games and puzzles that require cooperation and problem solving are a good option.

Toys that would be appropriate at this developmental stage may include:

1. Board Games – Eye N’ Seek, Yoga Spinner or Headbanz

2. Balance Board Maze

3. Marble Tower

Development Age of 10-12

Most children/’tweens’ at this age have well developed interests and ideas. Many children at this age enjoy working in small groups. There tends to be a strong influence by peers at this age.

Activities that encourage positive peer interactions, such as multiplayer games, make great gifts. We also see many children moving from concrete to more abstract thinking so toys and games with increased problem solving and complexity work well.

Toys that would be appropriate at this developmental stage may include:

1. Board Games – Telestrations, Cranium or Labyrinth

2. Lego or Robotics Sets

3. Rainbow Loom

Developmental Age of 12 +

This can be one of the most challenging developmental stages to buy for! Teens are this age tend to have varied interests and they might not always relate to a typical toy or gift.

Activities that encourage independence are suggested. For some teens, gift certificates to preferred stores or activities where they can practice money management, socialization and communication may work well. This may be also be a good stage to work on time management, so gifts like watches or clocks can be useful.

Gifts like board games or books can never be underestimated. Both have endless possibilities for enjoyment while also encouraging socialization, communication and motor skills.

A woman washes her hands under a faucet

The power of proper hand washing

It’s no secret that proper hand washing is one of the simplest and most effective ways to prevent the spread of germs. The key word being “proper.” The way you wash your hands makes a big difference to how many germs remain when you’re done.

Follow these steps:

1. Wet your hands with clean, running water.
2. Apply soap.
3. Lather the soap all over your hands. Scrub your palms, the backs of your hands, between your fingers, and under your nails for at least 20 seconds. Singing “Happy Birthday” twice will help you keep time.
4. Rinse your hands well under clean, running water.
5. Dry your hands using a clean towel, paper towel, or an air dryer.
6. Use a paper towel to turn off the tap.

Alcohol-based hand sanitizer is a good alternative to hand washing, provided you use a generous pump, and rub it all over your hands. Ensure it has fully dried before touching anything.

See for yourself!

Want to see the difference proper hand washing makes? Just look!

Watch this video with medical microbiologist, Dr. Cheryl Main.

We tested handwashing techniques with a simple experiment in our Microbiology Lab at Hamilton General Hospital. We printed our fingers in petri dishes before hand washing, after poor hand washing, and after proper hand washing, then incubated them overnight to allow the bacteria to grow. The results were clear: poor hand washing leaves a large number of bacteria on the hands, while proper hand washing removes nearly all bacteria. Each of the dots you see represents thousands of tiny bacteria.

a petri dish with bacteria growing on fingerprints
Bacteria growth after no hand washing at all

A petri dish with bacteria growth on fingerprints
Bacteria growth after poor hand washing

A petri dish with very few dots of bacteria on it
Bacteria growth after proper hand washing

To dry or not to dry?

Proper hand washing isn’t enough! You must also dry your hands thoroughly. We also tested well washed, but undried hands in our experiment, and here’s what we found. LOTS of bacteria. Bacteria love moist surfaces, so they thrive on wet hands.

moderate bacteria growth in a petri dish
Bacteria growth after proper hand washing, but no drying

How do germs spread?

Germs spread through the air in sneezes, coughs, or even breaths. They can also be passed from person to person by touching each other or common objects and surfaces. That’s why proper hand washing is so important.

There are two main types of germs: bacteria and viruses. Both can cause illness. In our experiment, only bacteria are visible, because viruses can’t survive outside a living cell. They tend to exist in the same places, so the germs you see remaining in the petri dishes we showed represent both bacteria and viruses.

During cold and flu season, lots of these germs are passed around, particularly in places where people gather, like schools, offices, and shopping malls.

Here are some more ways you can prevent the spread of germs:

• Always sneeze or cough into your elbow.
• Wash your hands often with soap and water, especially after using the toilet.
• Avoid touching your eyes, nose and mouth.
Stay home if you’re sick so you don’t bring germs to work or school.
• Clean and disinfect common surfaces and objects, including bathroom and kitchen counters and toys.
• Get all recommended vaccines, especially the flu vaccine every year.

As part of our experiment, we coughed into a petri dish to show just how many germs live in the spray that comes out of your mouth and nose. Eww!

strands and flecks of bacteria growth on a petri dish
Bacteria growth from a cough

The five second rule?

One last experiment, we promise! Have you heard about the five second rule? Or the ten second rule? Or depending who you ask, the thirty second rule? It doesn’t take long for germs to transfer from one surface to another.

We dropped a cracker on the floor for five seconds and then printed it on a petri dish. The results aren’t pretty!

mouldy looking bacteria on a petri dish
Bacteria growth from a cracker that was on the floor for ten seconds

Hand hygiene in the hospital

In Canada, one in nine patients will develop an infection during their hospital stay. Many of these infections can be easily prevented through proper hand hygiene in the hospital. While healthcare providers have a big role to play in helping to prevent the spread of germs to their patients, germs can also be spread by patients on their own hands.

At Hamilton Health Sciences, many teams have initiated hand washing promotion initiatives that encourage open communication between patient and caregiver around hand hygiene. The key message? That it’s okay to ask your healthcare provider if they’ve remembered to clean their hands. Don’t feel shy about reminding someone to wash their hands before coming into a patient room!

For visitors coming to the hospital, we recommend cleaning your hands at the stations on the way in, before entering the patient’s room, and again when you leave.

The 5 most important times to wash your hands in hospital

If you or a loved one is in hospital, it’s important for you to know the five most important times to wash your hands:

1. Before touching your eyes, nose, or mouth.
2. Before eating or handling food.
3. After coughing or sneezing (it’s best to cough into a tissue or your sleeve)
4. Before entering shared spaces and when returning to your/your loved one’s room.
5. After using the washroom or a commode.

The preferred method of hand hygiene in a health care setting is to use alcohol-based hand rub. It’s important to rub it in all areas: the backs of your hands, in between your fingers, your finger tips, your thumbs.

If your hands are visibly dirty, you should use soap and water. See the steps above for this method.

A girl in a parka looks out at the snow

Can you get a sunburn in winter?

By Dr. Elaine McWhirter, skin cancer specialist


Are you aware of the risks of winter sun exposure?

If you pack away your sunscreen at the end of summer, you’re not alone.

Two thirds of Canadians don’t wear sunscreen during winter months.

Myths about winter sun

Winter sun isn’t powerful enough to cause a burn

Most people believe the sun’s rays aren’t powerful enough to cause damage in winter months. This is false. While the UV index, the scale used to measure power of the sun’s ultraviolet rays at a given time and place, is lower in winter, the sun is still powerful enough to damage your skin. Depending on how long you spend in the sun, you can get a visible sunburn in the winter.

It’s just windburn

Another common misconception is that windburn is to blame for redness during winter. People often mistake sunburn for windburn after a day spent outdoors.

A “base tan” will protect me from sunburn

You may have heard someone say they are getting a “base tan” before heading south for vacation. The idea behind this concept is that tanning in advance of exposure to strong sun will protect you from future sunburn. That’s a myth. First of all, a base tan only provides a sun protection factor (SPF) of about 3. That will give you almost no protection from the sun. Secondly, in order to get a “base tan” people often use tanning beds. Tanning beds expose you to high UV levels and are strongly associated with skin cancer.

Winter sports and sunburn

Staying active outdoors during winter is great! But it’s important to make sunscreen part of your winter sport routine.

UV rays are higher at higher altitudes. With every 1000 metre increase in altitude, UV levels increases by about 10 per cent. Keep this in mind when you are skiing or snowboarding!

Snow can also magnify the strength of UV rays. Fresh, white snow reflects the sun’s rays, and can up to double your UV exposure. The UV index is a bit lower in winter, but when doubled, it can be on par with summer levels. This exposure is common during activities like ice fishing, tobogganing, or skating.

How to protect yourself

Sun protection in winter months is simpler than in summer, because you will naturally be wearing more clothing due to cold weather. There are extra steps you should take to protect your skin, though.

• Wear a daily moisturizer with SPF 30 or greater.
• Wear sunscreen with SPF 30 or greater when you’re spending time outside.
• Cover exposed skin with clothing.
• Wear wraparound goggles or sunglasses with 100 per cent UV protection.
• Seek shade during peak sun hours (midday) or use a pop up shelter or umbrella if you’re spending a long time outside.

Going south for vacation?

• Check the Local UV Report. If you can, limit time in the sun when the UV Index is 3 or higher.
• Seek shade or make shade by using an umbrella, a UV protective tent or pop-up shelter.
• Wear comfortable clothes that cover as much skin as possible (even when swimming) or UV-protective clothing. Wear a wide brimmed hat that covers the head, neck, and ears.
• Apply plenty of sunscreen with SPF 30 or higher, labelled ‘broad spectrum’ and ‘water resistant.’ Reapply every 2 to 3 hours; more frequently if swimming, sweating, or towelling. Use a sunscreen lip balm.
• Wear close fitting/wraparound sunglasses with 100 per cent UV protection.

Sun exposure and skin cancer

When you get a sunburn, the cells in your skin are being damaged. Those damaged cells can develop into skin cancer, including melanoma.

Melanoma is one of the most preventable forms of cancer. When discovered early, it can also be very treatable. But if detected late, melanoma can spread to other parts of the body, growing into the deep layers of the skin and entering the lymph system. Once it spreads to other organs, it can be extremely difficult to treat.

Monitoring your skin carefully and regularly can help detect abnormal growths early. Click to learn how to do a proper skin check.


Flu shot myths: Fact or fiction?


Dr. Jeff Pernica is an infectious disease specialist at McMaster Children’s Hospital. He’s passionate about helping parents protect their kids from infection and knows that the flu vaccine is an important part of doing that. Correcting misinformation and making sure people understand the flu vaccine is another important part of flu prevention. He’s helping debunk myths about the flu shot and replace them with expert information.

Myth 1: Healthy people don’t need the flu vaccine.

Young children and people with medical conditions are at highest risk from the flu, but everyone can benefit from the flu vaccine.

Getting the flu—even if you never see a doctor or get admitted to hospital—often means several days of feeling miserable and missing school and/or work.

Also, during the time that you’re sick, you risk passing on the flu to someone more vulnerable than yourself. Infants, pregnant women, older adults and people with certain illnesses are at risk of getting seriously ill, or even dying from the flu. When you get the flu shot, you’re not just protecting yourself. You’re protecting them as well.

Myth 2: You can get the flu from the flu vaccine.

The flu vaccine does not contain a live flu virus, so it’s impossible to get the flu from the flu shot. Occasionally, people experience brief and mild side effects from the vaccine including pain and swelling in the arm where you got the shot, tiredness, muscle pain, fever and headaches.

Myth 3: Getting the flu makes your immune system stronger.

Getting the flu doesn’t make your body stronger, in general. People who get influenza are not more resistant to other infections compared to people who get vaccinated against the flu.

Myth 4: It’s too hard on the infant immune system to get the vaccine.

Infants under six months old can’t get the flu vaccine.

For babies six months and older, the flu vaccine is very safe. Infants and toddlers are at higher risk for infections and they are more likely to get seriously ill from the flu. That’s why is so important for them to get vaccinated.

Children between 2 and 17 can get the vaccine as a shot or nasal spray.

Myth 5: I can wait until later in the winter to get the flu shot. It doesn’t matter when I get it.

The flu vaccine doesn’t take effect immediately, so it’s best to get it as early in the season as possible. It takes about two weeks after the vaccine is given before you have maximum protection.

Myth 6: The flu is only contagious once a person starts showing symptoms.

The flu can spread 1-2 days before a person shows any symptoms. Symptoms typically appear 1-4 days after you’ve been exposed to the virus.

Myth 7: Getting the flu shot is too time consuming.

It takes less than 5 minutes to get the flu shot. Children under five can get the vaccine at the doctor’s office from their family doctor or nurse practitioner, or at a public health clinic. Anyone five and older can also get the flu shot at a participating pharmacy, often without an appointment. HHS pharmacies will also administer the flu shot to patients and families.

Myth 8: The flu shot is expensive.

The flu shot is free of charge.


The flu is just one of many infections we can all help prevent. Follow these tips to stop the spread of germs:
– Always sneeze or cough into your elbow
– Wash your hands often with soap and water
– Avoid touching your face
– Stay home if you’re sick so you don’t bring germs to work or school
– Clean and disinfect common surfaces like keyboards and phones

What you need to know about the “mystery virus” acute flaccid paralysis

An unexplained increase in cases of a rare “mystery virus” among children is causing concern across North America. Acute flaccid paralysis, also known as acute flaccid myelitis, is being compared to polio because it causes the loss of function in one or more limbs. Watch the video below to hear from Dr. Jeff Pernica, an infectious disease expert at Hamilton Health Sciences, on what we know about AFP, how to recognize it, and whether you should be concerned.

Important Notes:

  • Acute flaccid paralysis (AFP) is a condition that affects the nervous system.
  • Side effects include children having difficulty moving their limbs, moving the muscles in their face and swallowing.
  • Our neurologists and infectious disease specialists are experienced in providing the care needed for this condition.
  • AFP is not a new condition, though it is rare.
  • There have been sporadic small outbreaks over the years, the last being in 2014.
  • Due to the rarity of the condition most parents don’t have to worry about it happening to their children.
  • To help prevent the condition make sure children are washing their hands and are up to date on all vaccinations.

Dr. Bill Krizmanich, Hamilton Health Sciences emergency physician

Three things an ER doctor wants you to know

NOTE: ALWAYS call 9-1-1 if you think you’re having a medical emergency.

Written by: Dr. Bill Krizmanich, emergency physician, Hamilton Health Sciences

As an emergency doctor, a common concern I hear from my patients is that they’re not always sure where to turn for basic medical care. Often, the emergency department (ED) is seen as the best and quickest place to access a doctor’s expertise, but there’s usually a more convenient option. For health issues that aren’t emergencies, a family doctor or urgent care centre can offer the same level of expertise as an ED, and you’ll usually have a shorter wait.

The next time you’re feeling unwell, consider your options. There may be a better option for you than visiting the emergency department. Here are three things you should know:

Family doctors offer more services than you might think.

When it comes to managing your overall health, a family doctor is an excellent resource. From treatment for minor illnesses and injuries to support for mental health concerns, a family doctor can help you with a wide variety of issues. And, more and more, doctors’ offices are offering extended hours, after-hours clinics and 24-hour on-call services so that you can get the help you need, no matter the time of day.

If you’re unsure about the types of services available through your family doctor, check with their office to learn more. If you don’t have a family doctor, click here to find one.

Can’t wait to see your family doc? An urgent care centre can help.

Except in the event of emergencies, urgent care centres (UCCs) are excellent options for medical issues that need quick attention, or when your family doctor is unavailable. Many people don’t know this, but Hamilton has two urgent care centres which are open 7 days a week, 365 days a year and are staffed by emergency-trained doctors. Our UCC teams are qualified to deal with minor fractures, sprained ankles, respiratory illnesses, and even minor cuts that need stitches.

Aside from the high level of expertise you’ll receive at a UCC, you’ll probably also wait for less time than at an emergency department, where the sickest patients are always prioritized to be seen first.

For information about Hamilton’s two urgent care centres, click here.

Sometimes, the best remedy is ‘home sweet home’.

None of us like being sick. Illnesses like the cold or flu are uncomfortable and take us away from our daily activities like work, school and family time. And while it’s tough to wait out that pesky cough or runny nose, the best remedy is usually to stay home, get rest, and drink plenty of fluids.

If you’re ever unsure about what you’re feeling or where to find care, call your family doctor for advice. As always, if you think you’re having an emergency, call 9-1-1 right away.

For more information about your healthcare options in Hamilton, visit

Preparing for flu season

As flu season approaches, it’s even more important to protect yourself and those around you from infection. The first step is getting your flu shot. Learn more about the flu shot and other ways to prevent the spread of flu.

a man sits at a desk with a notepad and laptop

Desk stretches to reduce pain and injury

What are desk stretches?

Why should you consider desk stretches? Making time for short breaks in your daily routine can reduce risk of injury. These “micro-breaks” should be taken before you start to feel pain, discomfort, or tiredness. That’s why it’s important to plan for them when you schedule your day.

Desk stretches don’t take much time. Other productive micro-breaks could be a quick walk up and down the stairs, or a walking meeting. These activities give your eyes and muscles a chance to recover if you spend a lot of your time at a computer.  They improve blood flow, relieve tension, and reduce the risk of eye strain.

Learn more about stretching and moving more in your workday by watching this video with Janice Jaskolka, an ergonomist in Health, Safety, and Wellness at Hamilton Health Sciences.

A visual reminder in your workspace can help you remember to make time for short exercise breaks. The infographic below provides basic instructions for the stretches highlighted in the video, plus a few others. Click the poster to download a copy so you can keep it handy in your workspace.

an infographic depicting different stretches you can do at your desk

Natural breaks from repetitive activities

Many of us need to perform repetitive tasks as part of our job. This could be typing for long periods of time, stocking products, or many other activities. There are a variety of ways to give your body a break from this repetition, in addition to desk exercises.

  • Micropauses are brief breaks to look away from your computer monitor, or pause what you’re doing and relax your arms at your sides.
  • A break from repetitive work might arise when you need to take a phone call, or when a coworker stops by for a discussion.
  • Deliberate changes in tasks can give you a break. Alternate between tasks that require different movements.
  • Formal breaks are important. During your coffee and lunch breaks, take time to relax and move around.

Rethinking your workspace

The way your workspace is organized can also have an effect on your body. Reorganizing items at your workstation can help to create a comfortable work space. A good way to start is to think about the items around you in terms of how frequently you use them in a work day.

Check out this post on creating an ergonomic workspace.



Risks and signs of teen cannabis use

Recreational marijuana is legal in Canada as of October 17. This means those over 19 years of age in Ontario will be able to legally buy and use marijuana (with some restrictions). Cannabis consumption will not be allowed in public places or within cars and there will be legal implications for using as a minor or selling to a minor.

Waterloo-Wellington-Hamilton-Niagara-Haldimand-Brant LHIN data from the 2017 Ontario Student Drug Use and Health Survey (OSDUHS) reported 30% of students grades 9-12 used cannabis in the past year and 58% said cannabis is easy to get.

Teens can use cannabis for a variety of reasons, from social pressures to a coping mechanism. As recreational cannabis becomes legal in Canada, we share some risks and signs of teen cannabis use, as well as strategies for parents to have an open conversation with their teens.

The risks

THC is the chemical that gives cannabis its “high” effect. In today’s cannabis, THC is on average, 2-4 times more potent than it was 30 years ago. Health risks of regular cannabis use in adolescents include:

• Difficulties with relationships at home, school, and work
• Impact on brain functions like memory, concentration, learning, decision-making, and handling emotions
• Increased risk of serious mental health problems like depression and psychosis
• Physical health problems that affect the lungs and respiratory system
• Risk of dependency/addiction

It remains illegal to drive while impaired by cannabis and other drugs after legalization of cannabis use. Cannabis affects decision-making and judgement, as well as cognitive and motor functions, making for a dangerous driving combination.

Rolling a joint

The signs

It is sometimes hard to distinguish cannabis use from typical youth behavior. The best way to find out if your teen is using is to ask them. Here are some signs to watch out for:

• Getting into trouble at school, with the law, at work, or at home
• Potential drop in grades and poor attendance at school
• Changing groups of friends
• Distancing themselves from family
• Changes in sleep habits, appetite, mood (feeling irritable and paranoid), and other behaviours
• Spending less time on activities they used to enjoy
• Borrowing money or having more funds than usual

Teen cannabis use & the developing brain

Dr. Christina Grant, a Hamilton Health Sciences pediatrician who specializes in adolescent health, says the adolescent brain is still developing up until the mid-20s, including the pre-frontal cortex, “the seat of reason.”

This area of the brain is last to develop and is where skills like organization, balancing risks and harm about decisions we make, and trying to think ahead come from, she says. Regular cannabis use during this stage of development has been linked with brain changes and an increased risk of certain mental health issues.

“We don’t recommend cannabis for youth or young adults. However, if you are going to experiment with it, it’s important to wait until you are older.”

Dr. Grant says there is a relationship between regular use of cannabis and the development of psychosis.

“There is a doubling of the risk which is concerning, especially if a youth has a family history of psychosis so is already at an increased risk. There is also an association between cannabis use and depression.”

But one of the biggest risks is dependency.

“One in six teens who experiment with cannabis will go on to develop cannabis use disorder.”

Woman smoking cannabis

How to talk to your teens about cannabis

• Know the facts and be prepared to answer questions honestly.
• Gauge how your child feels about cannabis and how much they know about it.
• Gain insight into the pressures they may be feeling and put yourself in their shoes.
• Keep the conversation open and ongoing, knowing that you can both speak openly.
• Listen actively. Ask questions, concentrate, show interest in your body language, and paraphrase to ensure you’re getting the jest of what they are saying.
• Ask open-ended questions, for example, do kids at school talk about smoking pot/weed? Use language they are familiar with.
• Lead by example. Reflect on your own substance use and coping strategies.
• Focus on safety. Discuss physical effects, cannabis and driving, legal risks, and knowing their limits.
• Build trust and offer empathy. Avoid shaming or frightening.
• Keep a positive attitude and open mind. Thank them for sharing.

Dr. Grant’s advice to parents:

“Teens know what’s going on much more than we as parents give them credit for. Our words only go so far, but our actions speak volumes. Spend time with your youth, enjoying activities they like. Always be prepared to actively listen – even at inopportune times – when they talk about their lives. It’s a myth that youth don’t want to spend time with us as parents, or that they don’t want our opinions on facets of their lives, including for some, cannabis experimentation.”

Facebook Live

Dr. Grant hosted a Facebook Live Q&A about the signs and risks for cannabis use in young people. Watch for more information about how cannabis affects the young brain, and how to start conversations about cannabis with your kids.

Additional Reading

Cannabis in Canada (Government of Canada)

Cannabis Legalization (Government of Ontario)

Cannabis Talk Kit: Know how to talk with your teen (Drug Free Kids Canada)

Cannabis: What Parents/Guardians and Caregivers Need to Know (CAMH)


Risk Factors for Simultaneous Use of Alcohol and Cannabis (Public Health Ontario)

Getting ready to leave the hospital

When you, a friend or a family member makes a trip to the hospital, the focus is usually on medical treatment rather than what is going to happen when it’s time to go home. Yet planning for the journey home is an important part of a hospital stay that should start when a patient is admitted. Being prepared when it comes time to leave the hospital can help ensure a smooth and safe transition from hospital to home for both the patient and/or caregiver.

Five tips to help prepare you for going home

Get packing

The items people choose to help prepare for leaving hospital are diverse, but there are some essentials that you won’t want to be without: clothing, footwear, and personal care products (such as toothbrush, toothpaste, hair products, and brush or comb, and deodorant). Don’t forget a pen and notepad to jot down questions, and answers and important information when meeting with your discharge team.

Be sure you have transportation home

Whether you’ve had a long or short-term stay in hospital, or a visit to the emergency department, you are responsible for arranging and paying for your own transportation home. If a friend or family member cannot pick up and drive you home, there are other transportation options to choose from. Your health care team can help you decide which options are best suited to your needs. You will need to contact the transportation company directly to arrange to pick you up. It’s a good idea to ask for a quote before you book your trip. For information about transportation options, visit our brochure.

Call on a friend

If possible, arrange for one friend or family member to be your point person on discharge day. Even though there may be several loved ones looking out for you, having one person in charge of helping you to handle your discharge information will streamline the process and make your discharge run smoothly.

Know your discharge plan

Your discharge team will work with you to ensure a plan for your recovery and any support you may require. Before leaving the hospital, you will have a conversation with your discharge team and receive written instructions. These instructions will include information about diet, activity, medications, services and supports you may need. It’s important that you take time to review the instructions and ask questions if there is anything you are unsure of before you leave. It’s helpful to repeat what you have been told, and make sure that anyone who is helping with your transition home understands too. Know who to contact in case you have questions after you arrive home.

Follow up is important

After you leave the hospital, you may have a follow up appointment with a physician or another health care provider. Be sure to note any appointments so that you do not miss them. Have a plan for transportation to and from your appointments. Follow up is an important part of your recovery.

If you’re anticipating a hospital stay, or know someone who is, share this helpful list of tips so they can prepare.

school age boy and girl

HPV can cause six types of cancers – but it’s preventable

By Dr. Dustin Costescu, gynecologist

You may have heard about the human papillomavirus (HPV) in the media or from friends. It’s the most common sexually transmitted infection. It’s also the cause of nearly all cases of cervical cancer, and is known to cause five other cancers – anal, vaginal, vulvar, penile, and head and neck. It can also cause genital warts.

More than 75% of men and women are infected at some point in their lives, and most will show no symptoms. Others can go on to develop genital warts, and some will develop pre-cancer or even cancer. There are more than 100 types of HPV, and some carry a higher risk for cancer than others. The good news; HPV is preventable.

One of the most promising, and yet frustrating, aspects of HPV-related cancers is that they are among the only cancers that are highly-preventable.

Since it’s a sexually transmitted infection, practicing safe sex and limiting your number of sexual partners are ways to prevent HPV. Those practices, combined with the HPV vaccine, provide the greatest protection. The vaccine protects against the most common types of HPV, including the two that cause the greatest risk of cancer. Since the vaccine can’t protect against all types of HPV, it is still important for women to get regular Pap tests to screen for cervical cancer.

The vaccine was first introduced in 2006 and is recommended for both females and males age 9 to 26 since anyone can get HPV and HPV-related cancers. Since 2006, the vaccine has resulted in a reduction in HPV causing cancers as well as genital warts.

The vaccine is proven to be very safe and doesn’t increase a young person’s likelihood of taking sexual risks. We aim to vaccinate girls and boys early, before their sexual début, as that’s when the vaccine is most effective. Due to this, the vaccine is available through the school immunization program to all grade 7 students in Ontario. Click here for more information on Ontario’s HPV immunization program.

If you were not vaccinated in school but would like to be, please talk to your doctor or pharmacist.

One of the most promising, and yet frustrating, aspects of HPV-related cancers is that they are among the only cancers that are highly-preventable. Since we have the tools to protect ourselves, we should use them.

a measuring tape wrapped around a sandwich

Pitfalls of the lifestyle ketogenic diet

By Jennifer Fabe, registered dietitian

The therapeutic ketogenic diet has been used as a treatment for epilepsy for nearly a century. In recent years, we’ve learned even more about its potential role in treating other medical disorders. But lately, the lifestyle ketogenic diet has been getting a lot of attention for the wrong reasons. It has become a popular weight loss trend, and many people are jumping on the bandwagon without considering potential risks.

How does the ketogenic diet work?

In a typical diet, more energy comes from carbohydrates than from protein and fat. The reverse is usually true in a ketogenic diet, which is higher in fat and lower in carbohydrates.

Fortunately, our bodies can use two sources of fuel for energy—glucose, which comes from carbohydrates like bread, fruit, and rice, and ketones, which come from fats like butter, cheese, and oil. Because we typically eat more carbohydrates, our bodies use glucose as their primary fuel since it is easy to access. When there isn’t enough glucose available, our bodies will switch over and start using ketones for energy.

The therapeutic ketogenic diet is medically supervised. It intentionally deprives the body of glucose, which helps trigger a switchover to a state called ketosis. The diet prescribes fat rich food choices, often in very precise amounts. With limited access to carbohydrates and increased access to fat, the body adapts to using ketones as its primary fuel. We don’t know precisely how it works, but ketones seem to help stop or reduce seizures in many people who follow this diet strictly.

Therapeutic ketogenic diet versus lifestyle ketogenic diet

The therapeutic ketogenic diet is used to control seizures and other conditions, and is done under strict medical supervision. Just because it’s considered a “natural” therapy, doesn’t mean it doesn’t have risks. A therapeutic ketogenic diet:

• is customized for each patient, and only used when people meet certain medical criteria.
• is ideally started slowly over a period of weeks under close supervision to minimize side effects. Rapid initiation over a period of days is only done if absolutely necessary, and after serious medical consideration.
• may require a review, and/or adjustment of medications so they don’t magnify potential side effects.
• requires a commitment to daily consistency.
• is monitored regularly for effectiveness, tolerance, and side effects at home and by a medical team.
• is supplemented by vitamins and minerals needed for complete nutrition.

When people embark on a lifestyle ketogenic diet with the goal of losing weight, they often fail to consider the potential risks involved, and rarely get the medical monitoring that should accompany this diet. When it’s not being used for medical purposes, keto dieters are also more likely to “cheat.” And because it is so limiting, many people find it difficult to stay on the diet long term and maintain their weight loss.

Other potential risks

Starting the ketogenic diet without input from healthcare professionals can lead to negative effects. On websites promoting the keto diet, you may read that these side effects are normal and will go away if you persist on the diet. They are not normal, and shouldn’t occur if you are following the diet safely.

Keto “flu”?

Some people who follow a lifestyle ketogenic diet report feeling flu- like symptoms when they start, including headache, tiredness, nausea and aching. This should not happen. It is the body’s way of responding to rapid adjustment, but is unnecessary if the diet is introduced properly and under medical supervision.

Vitamin and mineral deficiencies

Fruits and vegetables, grains, and protein are important sources of vitamins and minerals in our diet. The keto diet restricts many of these foods. Without them, it’s hard to get the vitamins and minerals we need. A lack of certain vitamins and minerals can cause complications. For example, lack of selenium, a mineral that’s found in grains and some sources of protein, can cause an irregular heart rhythm.

Lack of minerals can also cause cramps, which are common when people start the keto diet without supervision. If not properly monitored, the diet can pose a risk over time for bone weakness, and can result in compromised growth in children.

a blood sugar monitor and a bottle of vitamins

Interference with medication

The ketogenic diet can also interfere with some medications, which is why patients are carefully screened before being put on this diet to control conditions like epilepsy.
The diet can interfere with some diabetes medications, causing the body to pee out too much sugar. This loss of sugar can drop blood sugars to a dangerously low level.


In a practical sense, the lifestyle ketogenic diet can add expense to your grocery list. Although you may buy less carbohydrate rich foods, purchasing high fat foods can be pricey.

Advanced Planning

Planning your groceries and meals is a great strategy for staying on track with healthy eating. The lifestyle ketogenic diet requires careful advanced planning to make sure you get the nutrients you need, and aren’t left scrambling for something to eat. Before dining at a restaurant, or accepting a friend’s dinner invitation, you should consider what you are going to eat. It’s also important to carry snacks you are able to eat on the go in case you get hungry.

But I’m losing weight on the ketogenic diet…

The ketogenic diet is a nutritionally extreme option for weight loss when implemented in its strictest form. Most lifestyle ketogenic diets, however, are less restrictive in carbohydrates than their medical counterparts and more liberal in fats. Although small amounts of ketones can sometimes be generated from this ratio of foods, it is likely not the reason for the weight loss. While some people may find it effective for this purpose, it doesn’t generally work well long-term.

Why do people lose weight then? Weight loss works on a very basic principle: calories burned exceed calories consumed. Whenever our bodies don’t get enough calories in the food we eat, they start to use other calorie sources within the body, like body fat or muscle. People who lose weight on the ketogenic diet are losing weight because they are consuming fewer calories than they are burning.

There are a few reasons for this:
• Fats tend to fill you up, so you don’t eat as much on the ketogenic diet.
• Some lower carbohydrate foods in the diet, like leafy greens, are very low in calories.
• The diet requires you to modify foods so they fit within its boundaries, which makes eating on the run difficult—therefore dieters eat fewer calories from takeout, fast food, and junk food.

Ultimately, this calorie imbalance causes weight loss, but it is difficult to maintain.

Because it restricts many important food groups, the ketogenic diet can’t provide complete nutrition without added vitamin and mineral supplements. Restrictive diets also tend to make us want what we can’t have. If we can’t have bread on a diet, we may crave it. When we give into those cravings, our body goes back to using glucose for fuel and the ketogenic diet is no longer maintained.

If you are still interested in trying the ketogenic diet, or are on the diet and want to continue, I strongly urge you to talk to your family doctor or a registered dietitian about how to follow the diet safely and sustainably.

Healthier alternatives

The best way to lose weight is by making healthy lifestyle changes you can stick with in the long run. There is no weight loss diet that ‘fits all’ for our diverse Canadian population. I recommend making healthy food choices that suit your preferences, food availability, and budget.

To work towards your weight loss goal and healthy lifestyle:

• continue to eat a variety of foods from all food groups in moderation, and make healthier choices within those food groups.
• commit time to planning your groceries, meals, and physical activity.
• be mindful of your portion sizes.
• talk to your doctor or registered dietitian for strategies and support to help you achieve your weight loss goals.

Here are some helpful resources on selecting healthy foods and appropriate serving sizes: 

Jennifer Fabe is a registered dietitian in the Division of Pediatric Neurology at McMaster Children’s Hospital. She is the lead dietitian for the hospital’s ketogenic diet program, which helps kids with epilepsy use the medically supervised ketogenic diet to manage their seizures.

Don’t fall for it

Hamilton Health Sciences’ trauma team and Hamilton Paramedic Service are taking the first day of fall (September 22) as an opportunity to remind everyone to be cautious out on hiking trails and up on roofs and ladders.

“There are a lot of seasonal risks that people don’t consider,” says Dr. Tim Rice, a trauma surgeon at Hamilton Health Sciences.

“These incidents are almost always preventable.”

Falls from a height continue to be a leading cause of emergency calls and hospital visits. The trauma team sees about 100 patients a year for non-work related falls that have caused severe injury. This number does not include the many calls Hamilton paramedics respond to that require first aid and/or treatment in the emergency department.

“These incidents are almost always preventable,” says Dr. Tim Rice. “And they result in very serious injuries. We want to make sure people get the message that a fall can be life changing, even from 10-20 feet. We see patients with brain injuries, severely broken bones and major internal injuries.”

In 2016, Hamilton Paramedic Services responded to 323 falls from heights, 220 of which took place at peoples’ homes.

“When we respond to these calls, we often find that the person has put themselves in a risky position by making poor choices,” says Russell Crocker, deputy chief of Hamilton Paramedic Service. “We see people wearing inappropriate footwear, going off-trail on a hike or failing to secure a ladder before climbing it. We don’t want people to stop hiking or doing fall cleanup, we just want them to be smart about it.”

The team’s message is clear: “Don’t fall for it.” Taking a risk to capture a selfie or get a chore done more quickly just isn’t worth your life.