Children’s Health

The St. Michael’s Neonatal Intensive Care Unit (NICU) is a 20-bed Level 2 academic unit providing care to a high-risk inner-city population. Our multidisciplinary team includes neonatologists, pediatricians, nurse practitioners, a registered dietitian, social worker, lactation consultant, pharmacist, neonatal nursing staff and respiratory therapists. The NICU provides ventilatory and nutritional support for term and preterm newborns.

We are the leaders in neonatal resuscitation with presence on the Canadian Paediatric Society Neonatal Resuscitation Program executive hosting the National NRP Launch and running a novel Code Pink quality improvement simulation program. Annually, trainees from all levels and health care fields rotate through the NICU to learn about caring for this fragile population including but not limited to newborns exposed to drugs, HIV or high risk social circumstances antenatally. University of Toronto residents in pediatrics, obstetrics and family medicine all rotate through the NICU as part of their core curriculum to experience the care involved in caring for sick babies in the context of urban health.

New NICU coming soon!

Video tour of the new NICU

Join Dr. Douglas Campbell, director of the Neonatal Intensive Care Unit, on a tour of the new Neonatal Intensive Care Unit:

Contribute to continuous growth

We are committed to providing top quality care to our infants and their families. Financial donations made to the NICU help fund state-of-the-art equipment for babies and programs that support their families. Make a financial donation to the NICU.  The new Neonatal Intensive Care Unit will be located on the 15th Floor of the Peter Gilgan Patient Care Tower.

Getting to the NICU

15th Floor Cardinal Carter Wing
416-864-5232
Fax: 416-867-5309

Dr. Douglas Campbell, medical director, Neonatal Intensive Care Unit, shows you the way to the NICU, from Queen St. all the way up to the 15th floor.

Virtual tour of the NICU

Take a 360 degree tour of the NICU with Dr. Campbell.

When will my baby go home?

We don’t give a specific date; however we like to aim for your due date. But be prepared, it could be a couple of weeks earlier or later.

Why can’t I hold my baby whenever I want?

If it is safe to do so, we encourage you to hold your baby anytime you like. Your nurse will let you know when you cannot.

Will my baby always be in the bed space he/she is in now? Why does it change?

We may need to move your baby to accommodate other admissions, for safety, for nursing workflow or for unforeseen circumstances. It may not be possible to stay in the same bed spot your entire admission.

Why are there scheduled care times? Why do they change? Can I request a special care time?

We encourage family members to participate in the care of their baby. Scheduled care times are done to promote developmental care for your baby. We cluster activities to minimize disturbances while they rest; this is part of developmental care. You can make a request for a special time and we can try to accommodate it. Changes in care times are based on the individual needs of your baby.

Can I use my cell phone while visiting my baby?

Yes.

Why are there so many alarms? Why don’t the care team members respond to them quickly?

Nurses and allied health team members are aware when alarms beep. They also know when an alarm requires urgent attention or when it is safe to let it beep briefly while they deal with a more urgent issue.

Why is it important for us to wash our hands before visiting and after changing a diaper or using the bathroom?

It is important to wash hands during these times to prevent the spread of infection.

Who is my baby’s nurse and why isn’t she at my baby’s bedside all the time?

Your baby’s nurse should have his/her name on the white board next to your bedside. Your baby’s nurse will likely have other babies as part of their assignment for their shift. This means they are also doing work to help another baby.

Why does it take so long for someone to answer the phone when I call?

Staff are usually busy tending to the needs of babies and their families. Please be patient.

Will you notify me if my baby’s condition worsens?

Yes. Please make sure to give your nurse the best phone number where you can be reached. This will be placed in your baby’s medical chart.

Who can I talk to about problems I have with transportation, housing, etc.?

You can tell your nurse and she will let our social worker know.

Can I still visit if I’m sick?

No. Many babies in the NICU have weakened immune systems. If you are not sure if you should visit call the NICU and speak to your nurse.

Should I still pump my breast milk if I am on medication or if I am sick?

It is important to continue to pump milk despite being unwell or on medication.

Can my baby be moved to a hospital closer to my home?

Yes. Once your baby is stable, your baby can be moved to another hospital as long as they have a NICU that can accommodate your baby’s needs and have space available.

How will I know if my baby is doing well? When will a doctor or neonatal nurse practitioner call me?

We discuss each baby at morning rounds daily at 8 am. You are invited to participate. If you are unable to attend, you are welcome to call at any time and someone can provide you an update over the phone. Otherwise, you can speak with someone when you arrive.

Can I have a meeting with medical staff or nurses in private?

Yes.

What decisions can I make about my baby’s care?

You can make decisions about every aspect of your baby’s care.

How often can I or should I visit? How long can I or should I stay?

There are no restrictions. You can visit any time for as long as you feel comfortable. Closer to discharge we will ask you to be here more frequently to work on oral feeds with your baby and learn how to provide care.

What special needs will my baby most likely have when he or she goes home?

We will discuss any special requirements prior to your discharge. These needs are individual and based solely on your baby.

What kind of support is available for my family now and when my baby goes home and has special needs?

A care plan will be developed prior to your discharge home. We will discuss individual needs based on your baby’s condition. Our whole team is involved in determining the supports required and needed for your baby.

The following resources have been compiled as topics of interest most commonly identified by NICU parents. If you are looking for more information or other resources please speak to a NICU staff member.

General NICU resources

Welcome to the Club – The Canadian Premature Babies Foundation has created a PDF booklet for first-time NICU parents.

March of Dimes is an American based organization that has a number of resources and fact sheets for NICU parents to download.

Canadian Preemie Support Network is a closed, private group on Facebook with the aim of providing peer support to NICU parents. The group is moderated by the Canadian Premature Babies Foundation.

Support 4 NICU Parents is a web-based comprehensive resource for NICU family support.

Life with a Preterm Baby is a collaborative network between Mount Sinai and Sunnybrook Hospitals. The program serves as a support network following discharge as families’ transition from the NICU to their first months at home.

Multiple Births Canada has created this fact sheet on kangaroo care for preterm infants.

Financial support

Family caregiver benefit for children is an employment insurance benefit that some parents may be eligible for during their baby’s NICU stay.

Milestone certificates

The Canadian Premature Babies Foundation has created a series of printable certificates that parents can download to celebrate milestones (such as first feed, first bath, etc.) in the NICU.

Mental health

Mother Matters is an online support group run by Women’s College Hospital for mothers who are experiencing mood changes after the birth of a baby.

Fathers Mental Health provides mental health assessment and treatment services through Mount Sinai Hospital and St. Joseph’s Health Centre for expecting, new, and fathers with young children. The website also has a number of parenting resources geared towards fathers.

Toronto Public Health offers free services for women experiencing depression or anxiety during pregnancy or after giving birth.

Women’s College Hospital’s Reproductive Life Stages (RLS) Program provides assessment and support to women experiencing new or recurrent mental health problems, such as anxiety or depression, during pregnancy or in the postpartum period.

Preparing for discharge home

The Canadian Premature Babies Foundation has created a tip sheet and downloadable letter to share with family and friends before your baby comes home.

Parenting resources at home

Healthy Babies Healthy Children (HBHC) is a free home-visiting program that supports you and your family with promoting your child’s growth and development and connecting you to resources and programs within your community.

EarlyON Child and Family Centres are free drop-in centres for children 0-6 and their caregivers. They offer a range of services such as groups and interactive activities and advice from professionals trained in early childhood development.

Bereavement

Pregnancy and Infant Loss Network offers volunteer peer-support on a one-to-one basis; through groups; over the phone; and online. They also host several remembrance events throughout the year.

Bereaved Families of Toronto offers support to grieving families through both open and closed groups.

Community resources after discharge

Healthy Babies Healthy Children is a free home-visiting program that supports you and your family with promoting your child’s growth and development and connecting you to resources and programs within your community.

EarlyON Child and Family Centres are free drop-in centres for children 0-6 and their caregivers. They offer a range of services such as groups and interactive activities and advice from professionals trained in early childhood development.

Telehealth Ontario Breastfeeding Hotline offers new and expectant moms 24/7 access to expert advice and support for breastfeeding. The service is free and confidential and can be accessed in more than 100 languages.

Toronto Public Health Breastfeeding Clinics offer individual consultations by health care professionals prenatally and after the baby is born. At the clinic, families can have their baby weighed and their breastfeeding concerns addressed.

The outreach clinics were established in order to meet the needs of under-serviced, high-risk and economically disadvantaged children who face barriers to accessing health care. The outreach program aims to alleviate barriers to accessing child and youth medical, developmental and mental health care through providing St. Michael’s outreach pediatric clinics embedded within nearly 10 inner city sites, including public schools, family medicine health teams, EarlyON child and family centres, and homeless shelters:

• Covenant House. Covenant House is Canada’s largest shelter for street-involved and homeless youth. Outreach services include the provision of mental health services including cognitive behavioural therapy, dialectical behavioural therapy, substance counseling, and trauma counseling.
• EarlyON Child and Family Centre (Parents for Better Beginnings). A community pre-school centre is a developmental hub for inner city pre-school children. It provides on-site developmental consultation for a variety of developmental and behavioural concerns with the opportunity to work closely with an early development team (developmental home visitors, early childhood educators, school readiness staff, drop-in pre-school/development program staff, social workers, behavior/infant mental health specialists and child and family advocates). This clinic is a unique model for developmental team care.
• Model School-Based Health Clinics. The Model Schools Pediatric Health Initiative is an alternative health care delivery model providing health care to children through school-based health centres. The program was founded in 2010 to help alleviate health care access barriers and disparities among Toronto’s most vulnerable inner city children. The program now focuses on developmental and mental health care. There are two SBHCs, one at Sprucecourt Public School and another at Nelson Mandela Park Public School. Each SBHC serves approximately 20 surrounding inner city schools.
• Robertson House. As a community partner of St. Michael’s, the goal of the neonatal nurse practitioner role at Robertson House shelter is to break down barriers to health care access for a vulnerable population of women and children in transitional housing. Often families are displaced from their primary caregiver and need referral to St. Michael’s Family Practice or pregnant mothers may require referral to Obstetrics. At other times, children may need more urgent follow-up during illness, or if there are developmental or failure to thrive concerns necessitating referral to pediatricians at St. Michael’s.
• St. Michael’s Hospital Family Health. Developmental pediatricians are embedded within St. Michael’s family medicine practices to facilitate developmental pediatric consultation and coordinated care. This is a unique collaborative medical model designed to provide family- and patient-centered care and to alleviate barriers to accessing developmental pediatric care. Locations:
  • Wellesley – St. James Town Health Centre
  • 80 Bond Health Centre
  • Sumac Creek Health Centre
• Yonge Street Mission. Evergreen is the medical services arm affiliated with the Yonge Street Mission and provides on-site medical, mental, dental, and allied health services to street-involved youth. Outreach through St. Michael’s includes the provision of primary medical care services with a focus on sexual and reproductive health.
• Youthdale Treatment Centre. Youthdale Treatment Centre is a mental health organization by the Ministry of Children and Youth Services and the Ministry of Health and Long-Term Care. Youthdale operates three psychiatric units, several group homes in Toronto’s Annex and Aurora, and outpatient mental health programming at Covenant House.

2nd Floor 61 Queen St. East
416-867-3655
Fax: 416-867-3736
Monday to Friday, 8 am to 4 pm
Phones are answered Monday to Thursday from 8:30 am to 3:30 pm and on Friday from 9 am to 3:30 pm

All consultations are by referral only. A member of our clinic team will contact the patient within two weeks of receiving a referral.

• Pediatric Ambulatory intake referral form

Adolescent and Teen Clinic

The Adolescent and Teen Clinic provides comprehensive health-care services and prevention education regarding primary, sexual and reproductive health care tailored to the needs of young people. The clinic sees youth with a variety of medical and mental health conditions such as menstrual irregularities, teenage pregnancy, eating disorders, depression, anxiety and other chronic diseases. The clinic also provides care to special populations such as young families and lesbian, gay, bisexual, and transgender youth.

Antenatal Consultation Clinic

This clinic provides prenatal counseling for families whose babies are at risk of neonatal complications either because of various maternal issues (i.e. IDDM, lupus, renal dysfunction, heart problems, etc.), pregnancy-related issues (infections, HIV, gestational diabetes, PIH etc.), perinatal drug/illicit substance exposure and/or prenatally diagnosed fetal abnormalities (malformations, deformations, syndromes etc.). Using a multidisciplinary approach, the team at the clinic counsels families, and outlines and coordinates perinatal plans of care.

Baby Steps Clinic

The Baby Steps Clinic is a nutrition follow-up clinic for extremely low birthweight infants (less than 1,500 grams) who are at highest risk for nutritional deficiencies post-discharge. The team at this clinic follows infants to prevent feeding difficulties by supporting breastfeeding post-discharge from the Neonatal Intensive Care Unit (NICU) and through the development of individualized feeding strategies to reduce the onset of feeding issues and subsequent nutritional deficiencies. The team at the Baby Steps Clinic includes a registered dietitian, lactation consultant and neonatologist.

Cardiology Clinic

Children with congenital heart disease may be prenatally diagnosed at St. Michael’s Hospital, delivered here and undergo a cardiac assessment prior to hospital discharge, return for outpatient cardiology clinic visits, and potentially graduate to an adult cardiologist all in one setting. St. Michael’s offers a wide spectrum of pediatric cardiology services including:

• Fetal echocardiography for prenatal screening, diagnosis and counseling
• NICU and newborn inpatient consultation
• Outpatient Pediatric Cardiology Clinic with ECG, echocardiography and holter monitoring

Compass Clinic (formerly Newcomers to Canada Clinic)

The Compass Clinic is a multidisciplinary consultation clinic that provides trauma-informed, low-barrier and culturally-safe care to families with special health needs that require extra time, support and navigation. We support patients with complex medical and/or special needs who may be refugees, immigrants, or undocumented children who are new to Canada; Indigenous patients and families; and children and families who may not be newly arrived, but still require interpretation, extra time, immigration/settlement support, school advocacy, and/or resource/system navigation.

Dermatology Clinic

The pediatric dermatologist provides consultative services for children from newborns to adolescents up to 18 years old. The clinic focuses on all pediatric dermatologic problems, with a special interest in hemangiomas of infancy, atopic dermatitis and alopecia areata.

Developmental Pediatrics Services and Clinics

Developmental assessments consider the medical, neurological, genetic and psychosocial aspects of children’s and adolescents’ development and behaviour for conditions such as developmental delays, attention difficulties or genetic disorders. Following the assessment, the developmental team member(s) discusses the developmental assessment with the parent(s)/caregiver(s) and provides recommendations and resources. The clinic works closely with parents, teachers and community agencies to ensure that each child’s strengths and needs are recognized and appropriate developmental services and supports are set in place. The Child Development Clinics are located at St. Michael’s as well as at various inner city developmental outreach program sites, including two Toronto District School Board model school clinics, an EarlyON Child and Family Centre and St. Michael’s family health teams.

Fetal Alcohol Spectrum Disorder Diagnostic Clinic

This clinic uses a multidisciplinary approach to provide diagnostic services, a personalized plan of care for patients, and co-ordination of community referrals as needed. The clinic assesses children under 18 within Toronto region with suspected Fetal Alcohol Spectrum Disorder (FASD). In order to be considered for assessment, children must have confirmed prenatal alcohol exposure (PAE) or all three sentinel facial features related to FASD.

If you have any questions about this clinic, please email FASDclinic@unityhealth.to

Flu/RSV Clinic

Annual flu shots are available for clinic patients during the flu season. Premature babies who qualify for an appointment in our RSV clinic during winter months receive a Synagis injection. For more information, please contact the pediatric clinic at 416-867-3655.

General Pediatric Consultation Clinic

The General Pediatric Consultation Clinic sees patients referred for diagnosis, evaluation and management of problems ranging from asthma to zinc deficiency. This clinic has a special interest in the inner city population including developmental delay, child behavioural issues, new immigrants and socially disadvantaged families. Children from birth up to 16 years of age are seen in the clinic, and particular emphasis is placed on children with chronic disabilities or diseases that require evaluation, monitoring, treatment and ongoing advocacy.

Hematology

The clinic provides consultative services in benign general hematology to children from newborn to age 18. Common reasons for referral may include anemia, thrombocytopenia, neutropenia, abnormal bleeding, and counseling around hereditary hematological disease, among other benign hematological issues. The hematologist provides antenatal consultation to pregnant women with congenital or acquired hematological disorders themselves whose newborns may be at risk for related hematological issues or complications.

Mental Health Clinic

The Pediatric Mental Health Clinic is a child and adolescent psychiatry outpatient clinic. Within the Unity Health Mental Health and Addictions Department, the Pediatric Mental Health Clinic provides consultations and follow-ups for clients referred from many internal routes within the hospital for pediatric psychiatry needs. The team at the Pediatric Mental Health Clinic hopes to provide more robust and interdisciplinary support to patients and their families by strengthening the link between the network’s pediatric and mental health departments.

• Pediatric Mental Health referral form

Neonatal Follow-up Clinic

As a regional perinatal centre and a Level 2 NICU provider, St. Michael’s provides continued care after discharge from hospital through the ongoing assessment of growth and development during the first two years of life. Infants who are born at St. Michael’s and/or transferred from tertiary care centres for Level 2 care at St. Michael’s and who meet the regional follow-up criteria including alcohol and drug-exposed infants, infants at high risk for developmental disability and infants exposed to a high-risk pregnancy are eligible to be seen at this clinic.

REACH School Network

The REACH School Network (also known as The Model Schools Pediatric Health Initiative) is a unique health care delivery model using school-based health centres to reach at-risk children. The program was founded in 2010 to help alleviate health care access barriers and disparities among Toronto’s most vulnerable inner city children. The program now focuses on developmental and mental health care. There are two SBHCs, one at Sprucecourt Public School and another at Nelson Mandela Park Public School together serving 50 surrounding at risk schools. reachschoolnetwork.ca

Rheumatology Clinic

The Pediatric Rheumatology Clinic provides consultation, assessment, and treatments for common musculoskeletal/rheumatic conditions. The Pediatric Rheumatology Clinic sees patients living with a variety of pediatric rheumatology conditions including:

• Juvenile idiopathic arthritis
• Joint pain
• Uveitis
• Juvenile fibromyalgia
• Raynaud’s phenomenon
• Unexplained recurrent fevers
• Lupus
• Neonatal lupus
• Recurrent oral ulcers
• Adolescent to young adult transition services for juvenile idiopathic arthritis

Specialized Nutritional Clinic

The Specialized Nutritional Clinic uses a multidisciplinary approach including specialized pediatricians and a dietitian. The clinic focuses on complex nutritional issues including failure to thrive, behavioural feeding problems, feeding tube evaluation and assessment of micronutrient deficiencies. At this clinic, particular emphasis is placed on infants and children with complex nutritional issues requiring ongoing evaluation, monitoring and treatment.

The Neonatal Circumcision Clinic provides weekly outpatient surgical newborn circumcisions to newborns less than four weeks old. The clinic serves both families whose boys were born at St. Michael’s as well as those delivered elsewhere in the Greater Toronto Area and whose families have chosen to undergo this elective procedure. The team at the clinic provides families with counseling about the procedure if desired, information as well as post-care education prior to discharge home. This is a pay-for-service procedure. Please call the Pediatric Clinic to book an appointment, 416-867-3655.

• Circumcision at St. Michael’s Hospital
• What to do after your baby is circumcised

The Department of Pediatrics at St. Michael’s is committed to innovative clinical research and educational projects which focus on urban children’s health. Using a developmental lens, our research spans the continuum of child health and development from the neonatal period, through childhood and youth development. The Department of Pediatrics of St. Michael’s is an integral part of the Department of Pediatrics at The University of Toronto and has developed focused research in a number of areas including neonatology, TARGet Kids!, the Model Schools Pediatrics Health Program and adolescent health and well-being.

In order to accomplish our research goals, the department has developed a model to ensure stability of research infrastructure, which is a collaborative program to financially support the research coordinators within the department. A joint agreement between St. Michael’s, the University of Toronto and The Department of Pediatrics Practice Plan will share the salaries and support infrastructure needed for the research coordinators to ensure individuals are hired (full-time) to focus on both development and completion of research projects. The model that the department has developed, along with the strong academic mission of the department, has led to continued research success.

• More about research at Unity Health Toronto

St. Michael’s Hospital is an academic teaching hospital fully affiliated with the University of Toronto and a full member of the Toronto Academic Health Science Network. The Department of Pediatrics at St. Michael’s Hospital provides outstanding education to medical students in both the classroom and clinical setting in undergraduate medical education as a member of the FitzGerald academy at the University of Toronto. Teachers and educators in our department have been instrumental in developing innovative programs in the Faculty of Medicine at the University of Toronto such as the Longitudinal Integrated Clerkship which enables students to participate in the comprehensive care of patients over time, develop continued learning relationships with dedicated preceptors, and navigate complex health systems to advocate for patients and families. Nursing students, international medical student observers, and elective medical students from across the country join us each year to learn from our health care team.

The Department of Pediatrics at St. Michael’s Hospital provides core and advanced postgraduate medical training for residents and clinical fellows in Pediatrics, Family Medicine, and Obstetrics and Gynecology programs at the University of Toronto. Residents and clinical fellows are an integral part of the health care team in providing excellent medical care in an academic hospital and gain valuable experience under dedicated clinical supervisors to become skilled physicians in their field. The Pediatric Ambulatory Clinic provides opportunity to participate in general pediatric consultative services, primary care for children with complex medical issues, developmental and school problem assessments, antenatal consultations, neonatal followup, specialized nutrition services, newcomer to Canada assessments and care, and subspecialty consultation clinics in adolescent medicine, child development, mental health, cardiology, dermatology, hematology and rheumatology clinics. Learners may also participate in inner city pediatric outreach clinics at multiple downtown sites, including schools, family medicine health teams, EarlyON child and family centres, and shelters.  Neonatology and care of the newborn rotations take place in the 20-bed advanced Level 2 Neonatal Intensive Care Unit (NICU) with more than 550 newborn admissions per year from within the hospital and transferred in from across the province, attendance at some of the 3,000 deliveries at St. Michael’s Hospital each year, and the inpatient postpartum ward. There are weekly educational academic rounds, patient care conferences, competency-based teaching from award-winning educators, and regular simulation training.

For more information please contact Christina La Torre, Pediatric Medical Education Coordinator at christina.latorre@unityhealth.to.