Talk With A Doc

Talk With A Doc: Lifecycle: Health For A Better World
Episode 04: Healthy Beginnings: Thriving Toddlers

Dr. ALex Hamling
That can be a challenge because every kid may perceive different emotions, may process different emotions very differently. I would say that kids definitely experience. They definitely experience love just as well too, so as a family unit or as a parent, you know, you may have times of stress. And it's OK to talk to your child and say Mommy's really sad, or daddy's really angry and I just need a minute to myself. And then I'm going to come out and we're going to, you know, read a book together.
Jennifer Semenza
Welcome to talk of the docs lifecycle help for a better world. This series aims to enhance your healthcare knowledge, empowering you to improve your health outcomes and quality of life for all your healthcare needs. Providence.org to find general practitioners and specialists in your area and the latest in health care news. In our last episode, we covered basic care for newborns, including the important milestones and warning signs of potential issues, and we also addressed healthcare issues for new moms like postpartum depression and anxiety. I'm your host, Jennifer Samenza, and today we're joined again by Doctor Alex Hamlin. We're going to be talking about children's development from ages two to six. Things like establishing healthy habits, tips for keeping kids healthy and when and what screenings and vaccinations you should consider for your toddlers and preschoolers. So let's get started. Back doctor Hamlin.
Dr. ALex Hamling
Hello. Thanks Jennifer. Thanks for having me back.
Jennifer Semenza
You bet children are just. I love to see their personalities developing and they're so eager to learn and I really want to begin our conversation today talking about the physical and cognitive development milestones for kids that are ages 2:00 to 6:00. So let's jump. In by the age of two, kids should be walking and are are probably. They probably have a small vocabulary. What are some of the other motor skills that kids should be hitting by this age?
Dr. ALex Hamling
Absolutely. Certainly this age is like a critical expanse age. This is the age where I think that most families. Look at their baby and say wow, my child is now becoming a person. They have a personality, they have desires, needs. Once they have mobility, they have excitement into the world of exploring and learning things. So as you alluded, yeah, most kids. Have a vocabulary that is. They're starting to put together 2 to 3 words for their sentences, so they're going to sound still kind of jumbled up. But as the parents, now, you're actually starting to understand exactly what those needs, desires and. Your child is probably very excited to try to be on a balanced bike or be on a tricycle. They still enjoy interacting with the world, using their hands, their fingers to manipulate things, to pick flowers. So it's a lot of explosion of growth, motor skills, fine motor skills, as well as that person. Connection. They're making much more personal connections with US parents with their siblings, with grandparents as well to being able to recognize them and express that love and joy in many different ways. It's kind of. Growth phrase for them across the board.
Jennifer Semenza
Absolutely. And if someone's child is lagging, what can they do or what should they do to help them develop those skills to keep them on that development track?
Dr. ALex Hamling
Yeah. So depending on what families are concerned about or what areas a child may be behind on, you can do some easy interventions at home. First of all, I always say, you know for a. Number. Speak to your child. In normal tones, normal volume using normal words that you would have housed and that may be in English or in other languages, and that's. The other thing. Is to read to your child. Them be exposed to. Have them have an understanding that words and contacts and stories exist. In our world. For kids who are under the age of. Again, this is a great step to call early intervention if you have a concern or worried the birth of three program is a wonderful stage of helping with families who. Had those concerns or worries of development before your child. Three, after your child turns 3, you generally have to go through your local school district, and it's a little harder to qualify a little different to qualify for. And needs. Again, these are great times where if you haven't had your 24 month visit or for some families needing a 30 month, a well child visit, these are perfect times. Bring. Concerns up with your pediatrician as well, too. And if you're kind of in between and you're just worried, just call your pediatricians office, schedule a visit, and they can help guide you as far as what some of those next steps may be. Whether additional screenings with audiology or speech therapy, occupational or physical therapy, may be beneficial for your child.
Jennifer Semenza
And we know that just all kids are. Are some kids eager to push themselves and kind of learn at a normal or accelerated pace while others are just more content and maybe not that interested? Pushing themselves.
Dr. ALex Hamling
Let me say that all kids are excited to learn as long as parents are excited to be. Them. Encourage them. There's definitely a bell curve. As far as timing you. So there are some kids who may have more of the vocabulary side lessen the coordination side and vice versa. You have some kids who are the runners, jumpers, climbers. But tend. Be more quiet throughout the day, but still have that foundation of words still putting together 2 to 3 words for sentences. So I would say it's really challenging to compare your child with anybody elses on the playground, especially at that early age. But as children get older. Those norms tend to shrink, and most kids fall within kind of a tighter band of of what is normal for their development, normal for their school readiness as they're getting ready for kindergarten in first grade. In that age range.
Jennifer Semenza
So you just answered my next question about do kids who are a little bit slower eventually catch?
Dr. ALex Hamling
Absolutely, yeah. Ideally, yes, absolutely for some. Who are we? Are still concerned and worried. Again, this is that conversation with your provider, you know, would my child benefit from a hearing screen from additional speech therapy, from other services in the community? My daughter, my youngest daughter, needed speech therapy to work on her's's. And so now we have our. Our secret code where we say the skipper sales at sunset and then she replies back to me. Sadly, the ship shall still sink, and so that's what we know, that we're talking to each other.
Jennifer Semenza
Are there things that parents might do for slow learners? Actually hinder their development.
Dr. ALex Hamling
I think the biggest thing that families unintentionally do is in the back of their mind, say I'm not going to worry about it now or I have heard that XYZ boys speak later. Girls develop faster. And they almost. That self doubt back on themselves at a later time when they do bring it. To their pediatrician.
So I would say that if you're worried? Concerned. That's the time to call. To schedule. Appointment and it's not an emergency visit, but something you know. Within the next one to two months, a lot of. Again, writing out what your concerns and worries are. Kind of how things progress over even that short time frame and knowing that for a lot of language development, speaking, reading, spending time with your child often helps, even in that. Period of time.
Jennifer Semenza
Yeah, and let's chat about their cognitive skills too. Within this age bracket of two to six, what are the cognitive skills that kids should be able to do at this age and when?
Dr. ALex Hamling
Yeah. So a lot of this is kind of those fine motor skills being able to hold a crayon or pencil with their hand easily, you know, manipulating blocks by stacking them up. Several tall, being excited to push them down and do repetitive actions of building the back up again. Kids at this age are enjoying kind of those larger floor puzzles. I would say in the sense that they're visualizing the whole picture concept and what is this small piece and how does? Fit into it. I love those kind of 36 piece giant lunch. Atrocities. If you're in your home to lay those out, those are a great way to occupy your kid. Your kid get excited for something. Have them. On those fine motor skills and cognitive development of seeing the small pieces fit into the larger, larger piece.
Jennifer Semenza
And it's just fun to play with your kid with those things, too, I would imagine.
Dr. ALex Hamling
Absolutely. Whether they're dinosaurs or trains. You know. Cars around the world.

Jennifer Semenza
What should parents do to help stimulate their kids and really help develop those skills?
Dr. ALex Hamling
Yeah. So I think that having parents that are also curious parents that are involved, taking your child to the library, exposing your child to other kids as well on the playground, through play dates, through social interactions and modeling those good, healthy behaviors for most parents, that means getting. Off of your phone means looking your child in the eye when you're talking with them. Have appropriate behavior at the dinner table turning off electronics when you're having meals are all. Easy starts that you can start at home and then kind of role model again in society and. Our community.
Jennifer Semenza
We know not. Parents can go out and buy toys and games and electronic devices to. Their kids. What are some of the things that parents can do to stimulate that growth that doesn't require money?
Dr. ALex Hamling
Yeah. So this is where I take. Real good advantage of our library systems. You know, I've taken both my daughters to many of the different infant reading times and toddler reading times and arts and crafts that exist in your local area. Pretty much all libraries have some access or sections of children's books, whether they're board books or easy reader books. And these are great that you can take your child there and make it an adventure. Let's find a book that has the color red on it. Find a book that has horses on it. And start their excitement for. Four books. Language libraries in our country are well funded in that sense that there are free and easy and available. Communities, a lot of local community centers may also offer kind of drop in play dates or open gym experiences for young ages for young kids as well too. So we've done many of those in the Seattle area as well and those again are great opportunities for your child to interact with other kids. For them to enjoy just running around, playing with basketballs or plastic toys that are available there and then, at least in Seattle, I think that you know, there's at least a City Park once every quarter mile. There's often a part that you can easily. Walk to that may have a swing or a slide that, again, are readily, easily available, that you can get your kids out and about enjoying the weather and nature that don't cost.
Jennifer Semenza
The libraries really are just a wealth of information. I I know that ours here where I live have things like games and other things for them to rent that. Even. So I love that you. That as a resource.
Dr. ALex Hamling
Yeah, before our interview here, I was just at our local library and picked up a bunch of board games for myself and my kids and two or three graphic novels that I'll read with them. So have a nice.
Jennifer Semenza
Yeah. My next question is kind of a tough one. There signs that a parent should be aware of. That a child might be being abused, either physically, mentally or emotionally. What should parents be on the lookout for?
Dr. ALex Hamling
Yeah, this is probably a very terrifying kind of experience that a parent may wonder about or have concerns about. You know, we talk about kind of physical abuse of young children. These may be bruises in odd areas, you know, as a pediatrician, I'm very knowledgeable about in the toddler Wadler area. Kids are going to trip, they're going to fall, they're going to bang their knee. I definitely expect to see bruises. On their shins, and I often comment during the exam that hey, this means you must be outside. Are some of your favorite sports? What games do you like to play? I get worried or concerned if I see bruises in odd areas on the face, on the trunk, you know, on the chest kind of areas that may have a odd shape to them. Those raised my red flag and I would say that for family members who have those. Concerns those may raise red flags. I think that that's a great time to call your pediatricians office to have that discussion of, you know, is this an emergency room visit for safety? This something I should come in for to evaluate if there are other organic natural causes or where we're concerned that may cause bruising unrelated to abuse. We talk about. Food scarcity or malnutrition in children's another form of abuse. So again, this is a perfect time where pediatricians, because of the frequency of well visits, we often monitor patients wait their trajectory whether on on. Growth curve. And so if I notice something that looks odd or different, we generally come up with a plan for a follow. Up a few weeks later to assess. Ask additional questions. Provide additional resources that families may be able to take advantage of in the community and resources from there.
Jennifer Semenza
That's great. Thank you so much for for handling that difficult conversation with us. This is talk of the doc lifecycle and I'm speaking with Doctor Alex, handling a pediatrician at Pacific Medical Center about caring for your preschoolers through the first couple years of life to help keep them healthy and happy. We know that there's a lot to the mental and behavioral health aspects of developing young minds, which is, you know, they're really impressionable and very susceptible to influence. Know you're not a child psychologist, but maybe you can help us understand some of. Basics. Where kids should be at this age.
Dr. ALex Hamling
Yeah. So a lot of times, kids at this age are exploring the outside world. They are making connections outside of their body. Are looking for. They're looking to parents for reassurance when there's new things new. Park or new people who may come to the house or things like that. Kids love to have fun with each other. They love to play creative games. Friends are very normal. They like experiences that bring them joy and and have that reflected back upon you as well. Too. So if you were commenting, oh, this is fun to go down the slide. I'm happy to push you on this. Your child is going to very much gravitate to something exciting like that. Want to share that experience with you? So it's a great opportunity for parents to be intimately involved through their development, to expand again, what is their creative part? They more into the gymnastics. Are they more into the arts and painting part? And so you just get that opportunity to learn more about your child as they're growing and developing.
Jennifer Semenza
And who they're becoming, I imagine. What are kids capable of understanding and handling on a mental and emotional level? This age.
Dr. ALex Hamling
Yeah, that can be a challenge, cause every kid may perceive different emotions, may process different emotions very differently. I would say that kids definitely experience. They definitely experience love just as well too, so. As a family unit or as a parent, you know you may have times of stress. And it's OK to talk to your. Say your mommy's really sad or daddy's really angry and I just need a minute to myself and then I'm going to come out and we're going to, you know, read a book together. And I think most kids respond, really. To that, if you take a. And you clear language. With them and give them a time frame of what may need to come, and they're able to internalize that as it's not a motion directed directly onto them, but that they can reciprocate and have empathy of oh, mom and Dad are happy or sad or angry and just. A minute.
Jennifer Semenza
In this age range of two to six is this one you start to notice that a child might be on the autism spectrum. And if so, what signs should parents look for if they think their child might be on?
Dr. ALex Hamling
That spectrum we generally like to screen most kids starting about 18 months of age, so slightly before this time frame, but then again around 2 years of age and certainly anytime after. That parents have concerns or worried about autism. With autism, it tends to be, you know, compilation of different things, often primarily a language delay, often as social inability of looking outside of onesel. This tends to be a child who is very happy just playing by themselves, but gets very emotional with loud noises or gets interfered with that would otherwise be an exaggeration of those emotions. And so that's also a great time to call your pediatrician or family medicine doctor. And have a visit and kind of keeping track or log of certain behaviors that you're worried about of certain incidences that are repetitive. Of certain things that may be restrictive of your child, and these can be a wide variety of things of only wanting to wear the color blue and having a very hard time accepting a red pair of socks to wear or making sure that the peas and carrots Don. On your plate and. They do. You have a very tough time at dinner. Things that may seem very much out of. Ordinary or usual? Or great examples to keep track of. Your pediatrician availing that Doctor May also probe and ask you to think about, in addition to giving referrals or additional screenings that may be beneficial to kind of narrow down as this a normal behavior, a terrible twos or terrible threes behavior. Are we concerned for autism or other developmental delay?
Jennifer Semenza
Yeah, yeah. How important is that early diagnosis in the treatment of autism?
Dr. ALex Hamling
With. We know that early diagnosis is very important. It helps establish what families can expect. It helps establish. What resources parents can get access to at an early age, so whether that's speech therapy, occupational therapy, ABA therapy, the sooner we firm up the diagnosis and are confident that that's the area, then the easier it is to kind of get started on those resources.

Jennifer Semenza
Let's switch gears to diet nutrition. I know that balanced diet is really vital for a child's growth and development, but it's not always easy to get kids to. Healthy foods. How important is a healthy diet for their develop?
Dr. ALex Hamling
I think we were talking about healthy diets. You know, we look at the whole family because I'm pretty smart. I'm pretty sure that all the two and six year olds are not doing their own grocery shopping. Not doing their it's one of the moms. The grandparents? The caregiver. And So what I often say is that start there. Doesn't come into the grocery. It doesn't come into the house, and if you put fruits and vegetables in the grocery cart, they're much more likely to make it into your refrigerator. So being mindful when you're meal planning for the week, trying to focus on a variety of colors. So whether those are red and green and purple or orange that come from a variety of fruits and vegetables, whole fruits, whole vegetables generally have more nutrients. They provide additional minerals and vitamins that sometimes process foods are lost. Through that process there. But I would say focusing on those five servings of fruits and vegetables each and every day for yourself and for your child, focus on drinking plenty of water. 4 glasses a day ideally. And then cutting down on bad behaviors like screen time. So no more than one to two hours a day and getting outside, promoting good behaviors for you and your child to go on walks or bike rides or stroll rides. And ideally for most kids. Age, juice and soda and pop tend to be empty calories. So min. Those as best you can.
Jennifer Semenza
Yeah, great advice. All the key nutrients and vitamins for a young mind and body needs to develop.
Dr. ALex Hamling
So we talk about kind of vitamin A. We talk about vitamin D, vitamin E, vitamin C for good immunity as well. A lot of the B vitamin complexes as well and also having a balance of proteins in our body. Whether these come from meats or beans or other legumes in order to give us the building blocks for muscle, for bone, for our blood cells. So eating well balances more so than just taking a multivitamin and more so than just eating fruits and. But it's a compilation of all the nutrients that we put into our body in the appropriate amounts and utilizing that energy appropriately for good growth and development later on too.
Jennifer Semenza
I have a one year old grandson and I am just astounded by some of the things that he enjoys eating because his parents actually really try a variety of foods and textures. Just so impressed with how they're handling things, but is there a reason that some kids don't like to eat? Those healthy foods have their taste buds, just not fully developed.
Dr. ALex Hamling
I would say that most foods are different, whether it's a flavour, a texture, a saltiness, a sourness, a sweetness, and that's just new for your child. And so I. Say that at least offer those same food products. 10 to 15 times before you absolutely throw up your hands and say great, my kid does. Like asparagus. Because you never know. And what I often tell my daughters is today's the day to test and see if your mushroom taste buds have come in. Because maybe you. Them today. And so when you do that enough times, yes, your kids catch on to what you're pulling, but it also means that they've been exposed to a nice wide variety of different foods that you're preparing that you know that are healthy and that are part of your families, norm. Of eating.
Jennifer Semenza
Well, I. Absolutely commend with your daughter because my mushroom taste buds can still not develop. So I understand that about her. This is talk of the. Elizabethan at Swedish First Hill in Seattle. Doctor Mead will provide valuable insights into common health care issues encountered by adolescents and discuss effective strategies for managing these challenges. As we begin to wind down this episode, I really want to talk a. About. There's a lot of controversy still over vaccines just for the record, do vaccines cause autism?
Dr. ALex Hamling
A great question. For the record, no vaccines do not cause autism.
Jennifer Semenza
Great. Thank. What vaccines should? Of this age, get and when.
Dr. ALex Hamling
There's a multitude of different vaccines that we recommend kind of throughout the spectrum, you know, certainly any vaccines that a child has missed from their earlier time frame, we want to get. Caught. On at this age. We're also recommending kind of the seasonal vaccine, so this includes at this time flu and covad. I run our travel medicine clinic through PAC Med and see many pediatric. Who are going all over the? And so we have a a wider variety of vaccines to offer those families for health and protection. You know, whether that's for typhoid or Japanese encephalitis. And so talking with your pediatrician about what your plans are, if you're going to leave the country or. Been hesitant on certain vaccines or if families have moved around and may have missed a few of those well visits they. Be behind on vaccines as well. So I would say that I try to make every visit in my practice a vaccine visit if. Child's due for one.
Jennifer Semenza
What are the downside if kids end up missing vaccines?
Dr. ALex Hamling
They are more at risk. Acquiring those diseases for suffering from some of the consequences of those diseases. Again, vaccines were developed in order to protect against things that were deadly, could cause dismemberment or death of a of a person or child. And so the vaccines have been regularly studied, you know, well researched, distributed in large populations known to be safe and known to be effective. So ioffer. I do it because I I like the child. I want to see them around longer and I want to keep them protected and I don't want them to suffer from any of the minor viruses or major viruses or major or minor consequences of any of these diseases.
Jennifer Semenza
Are there any downsides for kids in getting these vaccines?
Dr. ALex Hamling
I say the biggest downside, like any vaccine, is probably the hope, the injection, the site that may become red, may become swollen, may become slightly tender. But I think that's very much of A minor inconvenience versus acquiring. Diseases like diphtheria or pertussis that can lead to severe consequences or hospitalizations.
Jennifer Semenza
And those are some of the more extreme illnesses, but can to have you know, real common health issues as well, like colds, flu and the air infections. What are some of the most common illnesses that kids face, and should they be treated the same way as treat an adult?
Dr. ALex Hamling
Great. I would say that what we know is that there's different bacteria that affect different kids of different. And so that's part of our training as physicians is recognizing that the bacterial viruses that affect young infants. Different than the viruses and bacteria that affect early school or later school or adults, and some of that is what they've been exposed to, what vaccines they've received, what the natural immunity they may have acquired over that time frame as well. There are a lot of medications that we can use to treat certain bacteria�s and certain viruses. With most pediatric patients, it's similar medications, just the dose amount is different based on a child's weight and their size. But I wouldn't say that. 100% equivalent. The time. So again, that's where our training as pediatricians and family medicine doctors really comes into play. If knowing how to test for some of these diseases and viruses, what medications to provide and the accurate dose and timing of them as well.
Jennifer Semenza
And I know that there seems. Be a never ending supply of kids getting ear. Is there anything we can do to prevent those and when should a parent take their child to see the pediatrician for an infection?
Dr. ALex Hamling
So we're actually seen with like the advent of the pneumococcal vaccine that steadily kind of increased the number of serotypes from 7 to 13 to 15 to 20 now and beyond that we are seeing that particular bacteria causing less and less ear infections. Most ear infections, then will cap in in a child before the age of. That's very common, very normal for all children. Have some sort of an ear infection. Most infections may go away on their own if they tend to be mild. If they tend to be just one sided. Rather than I would say that families who are worried about their child with a high fever, with severe pain on both sides going on for longer than two to three days is a perfect time to call your pediatrician or family medicine doctor for an evaluation. They can do a good exam of the Middle year, vitals and temperature. And assessment. Then decide if a medication is the right answer or not.

Jennifer Semenza
And what about allergies? You. 'Cause your child to develop allergies by giving them certain foods like peanut butter too early.
Dr. ALex Hamling
This again, is one of these big pendulums that has swung the other. What we've studied and what we know from a lot of the research now is that us telling families to wait to two to three years before introducing nuts, peanuts, fish eggs may have actually been detrimental to causing more allergies. So now we're actually recommending. Introduction so closer to six months of age with these highly genetic. So whether that's egg whites or egg yolks or creamy peanut butter, small bits of fish. What we're seeing is that that's causing less and less allergies as children get older, so I always encourage, you know, they don't need to be your child's first food at six months, but maybe in the first few months or the next time that you're having that as. You offer a small taste, a small bite.
Jennifer Semenza
Great. And lastly about asthma, how do you recognize if your child might have asthma?
Dr. ALex Hamling
As it tends to be an over reactive airway, and inflammation process tends to be a trigger from a wide variety of things. For some kids it can be allergy related. Allergies, environmental allergies, pollen, allerg. Other kids, it's exercise induced. And what we're seeing with that is that kids tend to have a tough time breathing. Number one as everything is kind of clamped down and as far as their airway system, you may hear some audible wheezing or gasping from your child. They may look in distress, so these are great early signs that you may need. Call. 11 depending on kind of your experience with asthma and your child or present to your pediatrician's office or emergency room, depending on kind of how your child is is. At that time. But often it's a good. It's a good examination and then whether a medication is helpful or not is helping to determine, is this an asthma and what medication should we use, whether a daily medication or an as needed medication?
Jennifer Semenza
Great. We've covered a lot of ground here today, but I know we didn't have time to talk about everything. Is there anything you think is essential? Didn't cover. You want to make sure we touch on today.
Dr. ALex Hamling
I think again, in this age group here, you know, the more you can practice that your kids need laps and not apps, the better that they're going to be with society. Be interested in playing with other kids, being more engaged with their preschool and kindergarten first grade time.
Jennifer Semenza
Wonderful Doctor Hamlin, thanks so much. Has been another great conversation.

Dr. ALex Hamling
My pleasure.
Jennifer Semenza
Thank you for joining us on talk with the docs lifecycle help for a better world. We hope this information on toddlerhood and early adolescence has been valuable. This joyful time can be challenging and we aim to support you in your parenting journey to get continued information on other important healthcare topics, please subscribe to talk with the doc on your favorite podcast platform. You can connect with us on Facebook, TikTok and X at Providence and on Instagram and LinkedIn. Under Providence Health systems. For additional information about this and other health related topics, please check out the Providence blog at blog.providence.org. To learn more about our missions, programs and services, go to providence.org. Download the Providence app to access all this information and more. And remember the information provided during this program is for educational purposes only. You should always. Your healthcare provider, if you have any questions regarding a medical condition or treatment. Thanks for listening.
Here's what's coming up on our next episode. TBD