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Melanie Cole (Host):  There’s no handbook for your child’s health. But we do have a podcast, featuring world class clinical and research physicians covering everything from your child’s allergies to zinc levels. This is Kids Health Cast by Weill Cornell Medicine. I’m Melanie Cole and our topic today is preventive health for toddlers. Joining me is Dr. Cory Kercher. She’s an Assistant Professor of Pediatrics at Weill Cornell Medicine and an Assistant Attending Pediatrician at New York Presbyterian Weill Cornell Medical Center. Dr. Kercher, it’s such a pleasure to have you with us and as we’ve talked in a previous podcast about infants; we’re talking about toddlers now. So, let’s just start with monitoring their growth. How do you do that as a toddler? What are we looking for?

Cory Kercher, MD (Guest):  So, it goes along similar to when babies are infants, what we’re doing at every well visit is checking how they are growing. The frequency of the well visits is spaced such that we won’t miss any big changes that we need to see in terms of their growth. So, at each visit, we check their weight and their height. And when they are under two years old; we also are measuring their head circumference. And really what we’re looking for is the trend. We don’t care about the actual raw number or the percentile. We love to give them to parents and parents love to hear them because it’s exciting to hear. But we don’t worry so much about that actual number. What we want to see is that they are trending in the right direction. Where they were before, are they still there, did they go up too much, go up too little, really on the same lines.

So, we don’t care if you are at the 50^th percentile, the 100^th percentile or the fifth percentile as long as that’s where you’ve been and that you are staying in the same trajectory.

Host:  Well thanks for clarifying that for parents. It’s so important. And autism screening. When does that take place and what’s involved?

Dr. Kercher:  So, that’s obviously a big topic that parents are concerned about even from birth. We are checking on a baby’s development from the time that they are born and at every well visit. The earliest time we can do any concrete standardized testing is at the 18 month visit. So, there’s a questionnaire that we give parents called the M-Chat that is a screening tool that we use at both 18 months and two years. And that give us really a standardized measure of are there any red flags or things that indicate that we should have heightened awareness or be concerned for autism in that child. However, at every visit, we’re screening for not only their motor skill development but their language and their social development which is what is crucially important when we are looking at autism.

So, we are doing the tools, the concrete tools at 18 month and two year visit, but at every visit we really are making sure that the child is developing appropriately.

Host:  Well so as long as you’re bringing up developmental milestones; are there anything you can tell us that our kids should have, and I understand all kids are different. But are there certain things they should have accomplished by the time that they are toddlers? Some parents are going to worry but as we’ve said, not all children are the same but are there some red flags we’re looking for?

Dr. Kercher:  So, the most important thing is that a child is making progress in all their milestones. I would say in the toddler years, so starting at 12 months; the most concerning area of development for parents is how their speech is developing. And that is also the most variable. So, some babies are not saying very much at all until they’re two years old. Some are speaking in prose when they are 15 months old. But what is most important is that the baby or the child is making progress. So, the big things that we’re looking for for speech for example is when you are 15 months old, that you have good receptive language or understanding simple commands. It doesn’t really matter how much your baby is actually saying at that age as long as they are understanding you.

Then at 18 months, we’d like them to have some words. And then at two; more words. And just along that line making progress. So, even though your friend’s child has 30 words at 15 months; if your child is not speaking; that’s okay as long as they are understanding you and then your child should be making progress along the way. For speech, that is the most important thing but it’s also probably the biggest worry for most parents if their child isn’t speaking at an early age and under two it is across the board in terms of how kids develop in speech.

Walking is another one that people are very concerned about. Some children walk at age 12 months, but truth be told; you can have until 18 months to reach that milestone. So, that’s six months is a huge amount of time where some babies are walking, and some aren’t. And after 18 months, really for the most part, babies are walking but again; if they aren’t at that point as long as they are getting to it, they are now pulling themselves up to stand, they are trying to cruise and move around furniture. They are going to walk soon but they haven’t quite gotten it yet; that’s okay. We want to see progress.

Host:  Well as one of those parents that was worried about all of those things, thank you for that answer; tell us a little bit about the timing vaccines are given with toddlers. Tell us a just a little bit about the schedule.

Dr. Kercher:  So, the well visits are spaced not only for making sure that we meet the growth and developmental milestones but also that the vaccines are able to be given on time. So, each of the well visits are scheduled for the important vaccines. So, typically that’s at 12 months, 15 months, 18 months, and then two years. The primary series of vaccines is usually done by the 18 month visit. So, we have a few at 12 months, 15 months and one at 18 months and then we’re done for a couple of years actually except for the flu shot every winter. And so, following those well visits will keep you on track with your vaccines, your developmental screening and your growth screening.

Host:  And with all of those screenings which are medically based and so important; as kids become toddlers, Dr. Kercher, you know this, parents are terrified of behavior and discipline. Can our pediatrician help us and how would they know if some of that behavior is normal or the terrible twos or all these things that we’ve heard about and give us one of your pieces of best advice for helping our toddlers to behave.

Dr. Kercher:  So, behavior is a big point of conversation in the toddler well visits especially between ages two and three. They are not only terrible twos but then you get threenagers which are a whole other beast in and of themselves. We all have our sweet little babies and then all of the sudden; it’s like you are living with a maniac when they turn two. And that’s really stressful for parents. So, pediatricians are really here to help guide you on which of these behaviors is typical and when have we gotten out of the range of typical for behaviors. So, when we see the temper tantrums at age two and the lying on the floor, banging the floor and banging their head; we can be reassuring and saying that that’s normal. The best advice I tend to give parents is to actively try to ignore and not engage in the more dramatic behaviors meaning the temper tantrums. Child want attention and sometimes it’s that they don’t know how to express what they want and that’s why these tantrums and behaviors will happen.

Once you know that your child is developing normally and everything is appropriate; then you can be comfortable teaching your child that it’s not an effective way to communicate their wants and needs and that they are going to have to learn how to do that better and so, not engaging in the behavior which stresses anyone who has children that has done it, if you try to engage or try and solve the problem, offer them things, try and talk to them about it; it just escalates it. And so, having them try and work it out on their own and coming back to you once they’ve been able to calm is really effective in them learning how to more effectively communicate their wants and needs. But again, that’s after having made sure with your pediatrician that your child is developing typically and there’s no other concerns that you wouldn’t want to necessarily intervene that way.

Host:  It’s so important, really for parents and the other important thing for parents is safety. I mean that’s really our job is to keep them safe. So, how can our pediatrician help with injury prevention and what tips do you tell parents about making sure their home is safe?

Dr. Kercher:  Absolutely. So, knowing what is coming in terms of your child’s development is crucially important to also knowing how to keep them safe. Meaning, as they are getting bigger and moving around more and more adventurous; we have to know what the risks are because they change. So, as soon as a baby starts pulling up to stand which happens around nine months of age or in the toddler years; we should be preparing our home for them. The most important things that people will overlook is making sure all furniture especially big furniture is anchored to the wall, dressers, TVs, wine racks, things like that. Thing you would not even think of, think are too heavy for babies to – or children to pull over. They are all over the place. They pull out the drawers, they pull out the cabinets and then they step inside. So, we want to make sure everything is anchored to the wall so that when they start climbing on the furniture it can’t tip over.

Outlets, we talk about putting plug covers on them, outlet covers on them. Corners and edges. Kitchens can be dangerous areas for children. Making sure you can wall it off and not have them go in there or if they can, making sure the oven and the stove are safe, removing the handles if you need to. If you live in a house that has a pool; making sure that the pool is fenced in and there’s no access to it at all. And really just taking a look around and making sure you are aware of any potential risks even if your child hasn’t done it yet, things that they could possibly get into.

Host:  It is such great advice and if you had one final thought for parents of toddlers, what would you like them to know?

Dr. Kercher:  Patience. Honestly. As toddlers are so much fun but they are a challenge that’s a lot of work. They send us through the ringer a little bit. But being very, very patient and understanding that we only have this time for a brief time, and it will pass; will just help get you through.

Host:  Well it certainly does and thank you so much Dr. Cory Kercher for your great information and to our listeners. That’s concludes today’s episode of Kids Health Cast. Please remember to subscribe, rate and review this podcast and all the other Weill Cornell Medicine podcasts. For more health tips and updates, please follow us on your social channels. I’m Melanie Cole