Scott Webb (Host): All of us parents know that milestones like walking for our kids are important. And when our kiddos seem like they're struggling or maybe just behind a bit, perhaps pediatric rehabilitation might be the answer. I'm joined today by Drew Haverstock. He's a pediatric physical therapist practicing at Franciscan Health.

 This is the Franciscan Health Doc Pod. I'm Scott Webb. Drew, it's so nice to have you here today. We're going to talk about toddler development and when to seek therapy. And I was just sharing some stories of my own life, a daughter who was an army crawler and not a normal crawler, and that's a different podcast. But for us today, when we're talking about toddler development, what age of children are you referring to when you say toddler?

Drew Haverstock: In regards to the phrase toddler, in most cases, that starts around age one and runs up to around age three. These are the kids, and during this time, there's just an absolute ton of rapid growth and development. It's when they start walking, when they start exploring the world around them. And this stage focuses on increasing their independence both intellectually, socially, as well as emotionally during this period. It's easily one of the most important stages of development without question.

Host: Yeah. So important. And I know you had kids, I have kids. And those of us have kids listening to this, one of the things that we thought about, at least I did when my kids were younger, was these milestones. And so, let's talk about that a little bit, the types of milestones that toddlers should be achieving at certain ages.

Drew Haverstock: Perfect. So before they become toddlers, typically you're going to see your child sitting independently, starting to make great eye contact, start to mirror words that they hear, things of that nature. But by the time they hit age one and so forth, you're going to want to start seeing them start to walk alone and walk well; maybe start to run, and running is defined when both feet are off the ground at the same time. So, some kids may waddle really fast, but that's not truly a run. A run is when both of those feet are off the ground at the same time. These kids should also start being able to do things like pull toys along behind them. Maybe kick and throw a ball. They climb on and off furniture and also do pretty well at that local playground, and they should be able to navigate stairs with decreasing support. Jumping is also starting to emerge around this age. So from a gross motor standpoint, you really start to see a lot of those things stick out.

A few other things that start to come around is the imitation of other kiddos' behaviors. Developing kind of an awareness of themselves and understanding the difference between mine and hers or his. They should recognize themselves in a mirror and start to be able to discover hidden objects. So, the game that you play when they're itty bitty and you're like, "Where'd the ball go?" and you hold it behind their back, toddlers aren't having that. They're going to go around you. They're going to get the ball and show you who's boss. Because in the end, they're going to say, "That ball is mine" 100%.

Host: For sure.

Drew Haverstock: They certainly should be playing enthusiastically along other kids. And they should also start to do some of that pretend play stuff where they start to have dolls. And maybe start doing activities of daily living with them, whether it's combing their hair, getting them dressed, things like that. When they're playing with toys, they should probably start sorting by shape and color. They should be imitating scribbles that they see and vertical and horizontal lines. And also, they probably should start being able to stack those cubes to build a tower. Even it's just two or three pieces high, they should start being able to do that.

And more importantly, cognitively, they should start being able to follow more than just one-step instructions. They should start being able to follow two or three-step directions. And on the other side, when it comes to verbal expression, not just the cognitive reception of what's being asked of them. When it comes to verbal expression, they should be able to use four and five-word sentences now pretty consistently, even if it's "More milk please" or something along those lines. They should start being able to do that. And ultimately, they should be feeding themselves around this age. They still may need to have things cut for them, meat put into smaller pieces, and so forth. But ultimately, it should be a lot on them. At this age, the way I like to look at it is they are the world's greatest scientists. They are banging things to see if they're hard or soft. They're putting them in their mouth. To see if they're hot or they're cold or if they have a distinct taste to them. They are scientists to the nth degree, and it's really fun to watch from afar.

Host: It is so fun, just listening to you talk, just bringing a big smile to my face, just remembering back when my kids were little, and as you say, the great little scientists that they were. Wondering, when we talk to pediatricians, what types of questions should we be asking them regarding development? Are there signs? Yeah, I know you went through some of the stuff, the milestones, but are there signs or delays that would indicate that a child really might benefit from PT?

Drew Haverstock: Yeah. There's a bunch. And the thing that I always want to start this part of the conversation with is that every parent has what I call spider sense, right? Everyone knows Peter Parker from the comic books has that spider sense where he knows something's really not right and dangerous coming.

Host: Something's wrong. Yeah.

Drew Haverstock: Exactly. Parents have that. And I always tell them, when they do feel that tingle in the back of their neck, they should be following up with the physician immediately. They should push, not wait, because early intervention is the key. Just like with adults after your grandparents, or maybe your aunt or uncle has a stroke, they always talk about the first six months after a stroke is the most important period of time because that's when they're going to have the greatest period of acquisition. For children, this toddler stage up through age five, depending on the articles and journals you're reading, may be up to age seven, but that zero to five is when you have the biggest period of acquisition in a developing child's life. And that is why when you go see the physician, they're like, "Eh, let's just wait and find out," that's not always the best answer. And I know a lot of physicians mean well, because they don't want to press an alarm where there need be none. But when in doubt, there's a way to go about it and have your child evaluated. And there's nothing that warms my heart more than when a parent has that spider sense tingling and they come to our clinic and we're able to do an evaluation on their gross motor skills or maybe their fine motor skills with their occupational therapy needs, maybe speech, either receptive or expressive.

And we go through the process and we're able to come back to them at the end of that evaluation and say, "I've got some good news and some good news. Which do you want first?" And they laugh for a moment because they're like," Wait, where's the bad news part?" And it's great to let them know that there is none. Yes, your child's not perfect. And yes, there's some syllabus-y issues or what have you. But in the end, your kid's developing like a typical child. And while I understand and saw some of the things you're concerned about, overall, they should be good. And because you've had people who are specialists who spend their entire lives only focusing on these specific aspects, getting your kid in for that evaluation early is the best possible thing you can do.

Now, circling back, when you're talking about what questions, you should always be talking to your doctor about what are the developmental milestones for my child at this age? Should they be running? Should they be throwing? Should they be catching? You want to know, "Okay, if they should be doing this, are there any things I can do specifically to help keep them on track?"

One of the other things that people should also want to know is if my kid doesn't reach the milestone, the one you're saying, "Eh, maybe not worry right now," what are some things I can do immediately to help move the needle for my child going forward? If the physician is a little stumped or not really sure, by all means, ask the question about getting that therapeutic evaluation, whether it's physical, occupational, or speech therapy, and allow the professionals to do their job. Because again, there's nothing better than seeing that parent that's a bundle of nerves and being able to come back to them and say, "Nope, everything's good." and the smile that hits their face, it's that just wash of relief that just goes over their back and feels so good. It warms my heart. I love saying it that way.

Host: Yeah. And you specialize in this. This is what you do. I was reading in your bio, just learning about you before we got on the line here today, and this is your passion, this is your heart, right?

Drew Haverstock: It really is. And to be very clear, I do look at this a bit differently. Scott, I am what I call a triple agent, not just a double agent. So, I am a therapist that works in the system. I am a business person who does the contract work with Franciscan to handle their pediatric outpatient needs.

But the reason I look at myself a bit differently is I'm also a parent with a kid in the system. My oldest son, who is now going to be 23 soon was what's called apraxic. And he had a metric ton of speech and occupational therapy services through age 7. And what's so interesting is my wife is a speech therapist, and I myself am a pediatric PT, but my son's issues were fine motor and sensory, which is occupational therapy, and he was a speech child, but my wife at the time only worked with adults. So while both of us were therapists, neither one of us were truly the ones properly suited to help my son overcome these obstacles in his way. And so, I had to take off my owner hat, I had to take off my therapist hat, and I had to just sit back and be a dad.

Host: Be dad, yeah.

Drew Haverstock: And one of the things that I do is I talk really fast. It's taking every bone in my body right now to speak deliberately to you rather than go at my 500 mile an hour speed that I typically maintain. But what I learned through this process when I just sat back and listened and was a dad. When that speech therapist that was a pediatric specialist came to our house and explained my rapid talking was actually a detriment to my son, because he was trying to keep up with me. And it was actually causing him to stutter. And once I learned to slow the pace of my speech down, my son's stuttering slowly went away. And now, you never know it. Now, this kid who had so much difficulty early on in school, Tommy now wants to be a high school history teacher. And he's actually on his last rotations as we speak heading over to England shortly actually to do his last rotation so he can get that degree and graduate in December. So, very proud of that kid who had all that therapy and now is on the other side of it.

But coming back to it, If your kid doesn't reach that milestone, definitely seek the professionals. Come and set an appointment with us at the Franciscan Pediatric Therapy Center. And we'd love to get you guys in to see about what we can do to ease and calm those nerves.

Host: Yeah. Calm the nerves. Yeah, and along those lines, Drew, let's talk about that. What's the first PT session like for a toddler? What can parents and caregivers expect?

Drew Haverstock: A great question. The first thing I like to do is I always call it taking the car out for a spin. You don't know what the car can do, so you want to see how it handles, you want to see the acceleration. The same thing is with a kid. And everything that we do, especially at this age, is play-based. So, we have to establish a rapport with the child. We have to be able to come up with a way to connect and engage with them. I'm six-feet tall and 215 pounds and I'm bald. So, a lot of kids when they see me, I'm not necessarily the most inviting guy. But once I'm able to connect with them because I make a silly noise or I sing a song or I do something to make them say, "Hey, this guy's not so crazy," all of a sudden, then I can start playing with them. And what I love doing is when I'm doing something as simple as just rolling a ball back and forth with a child. Some parents have wondered, "Drew, what the heck are you doing?" And I love explaining to them, "Oh, you just think I'm just rolling a ball back and forth with your kid." And their response is, "Yeah, Drew, that's exactly what you're doing."

Host: That's what it looks like. Sure.

Drew Haverstock: exactly. But my PT mind is not so much. Right now, the first thing I'm looking for since we're sitting down is does he have the core strength to hold himself upright? And if the ball goes outside his base of support, does he have the ability to reach outside that base and then return to center, okay? So, I'm looking at his core strength. Second, is he letting that ball just hit him in the body before he goes to get it? Or is he tracking it with his eyes and anticipating its arrival and corralling the ball as it comes to him, right? That's the next step. Beyond that, or is the child grabbing it, picking up and just launching it back to me? That's the following steps. So, each of these is just a little baby step, one above the next to see where he is in his processing and his gross motor control. This play-based nature of what we do is so much fun because when you explain it and break it down to parents like that, they're like, "Oh my God. I never thought of that." And my response is, "I know I'm the one that went and did all the crazy classes and spent all that money to become the professional at this." But there really is so much to it. And in what everyone can talk about from a first session is, yes, you should show up 15 minutes early to fill out that paperwork. And yes, we're going to play 20 questions with you because while we have a lot of information within the EPIC system about the child's medical condition or what have you, it's always good to hear a parent tell their story. And you get so much more than what you would on a piece of paper when you let a parent talk about how they had this birth that went nothing like they expected.

Oftentimes, you're as a husband and a wife, you're pregnant and you've got this vision about where things are going to go. And I always call it the picture that you hang up on the wall of your mind. And if you're a mom, it may be, "Hey, I want to get on the train and go downtown with my daughter to the American Girl Doll store and pick out a matching dress for her and her doll and just have some fun with that." And if you're a dad, I know my thing, just as simple as it was, I just wanted to go out in the backyard and play catch with Tommy. These are the things that you dream of. And then, something awry, and it's nobody's fault often, but something awry occurs during delivery or what have you, and you hear words like stat and you hear buzzers going off, and you're thinking, "Okay, which name are we going to choose?" And five seconds later, the delivery you were going to have is now a C-section because they've got to get the baby out quickly. And then they sweep the baby away. And they come back with all these words and talk about things like intraventricular hemorrhages or whatever it may be. And that picture on the wall of your mind tilts sideways and falls to the ground because that vision is now gone. And god has a different plan for you at that moment. And how are you going to react?

So during our evaluations, when we're getting that story, oftentimes you can see the parent's head down their shoulders forward and they're just a little despondent because all they've heard about is what their child won't be able to do or can't do or the medical procedures that they're going to need in the future. And the way I like to approach it is simply this. I say mom or dad. I can't predict the future. But what I can tell you statistically, if you look at all the medical journals and read those periodicals, if we don't start doing something right now, again, I can't say if your kid's going to sit or walk or run, but I can tell you if we don't start right now, the chance of that occurring is down by the floor. So if it's good with you, I see a number of things we can work on, and I think we need to start today. Are you ready?

Host: Let's get rolling, yeah.

Drew Haverstock: I'll see that head come up, shoulders go back, and if they could, I guarantee you they'd like rip open their shirt and have that big red S on their and cape would be flowing. And they're like, "Now I know what to do. Now again I have purpose. I've been on this ship not knowing where it was going to go, but this Drew guy, this bald guy has said, 'Hey, We do this and we're going to help your kid.' And since this is my kid, this is my job now," and seeing them just light up and realize, "Okay, here's what we're going to do. Here's the plan. Here's my exercises. Here's my home programming." And again, the speech therapist and the occupational therapist can do the same thing. But ultimately, they then can just take pride knowing that if the answer is, "Yes, your child does need therapy, here's how we're going to get them from point A to point B to point C," and hopefully to discharge. So, that's what we're trying to do.

So, this session there's some paperwork, there's some direct testing, there's some indirect testing, there's a lot of listening. And there's a lot of very calculated professional observation. Because again, it's the first session, and I can't just immediately ask the kid to do jump down, turn around, grab a basketball, and shoot a three-pointer, right? I don't know what the kid can do yet. So, you have to be very guarded to not press my, for lack of a better term, bubbly personality sometimes can scare or alienate a child. So, I've had to learn to keep myself in check, just like the speed of my voice, and slowly let it come out once the child warms to me. And truthfully, the parents as well, because oftentimes they'll see a therapist and have an idea about what this is going to go like, and then need to be able to do the same that I was describing. Listen, learn, and then apply it to their child. So, it truly is a collaborative process and it starts with that first session.

Host: Definitely. It's been a lot of fun today, Drew. My face hurts from smiling so much. Just the fond memories of childhood and listening to how passionate you are about your work. Just more of a pragmatic sort of business sort of question, do folks need a pediatrician referral to make a PT appointment for a child? I know we did for our daughter, but she's 16 and maybe that's different. Just want to check with you.

Drew Haverstock: Yeah, there have been some changes in law, but ultimately best practice and what we practice at the Franciscan Pediatric Therapy Center is we do need to get a referral from a pediatrician for all of our patients. So while your PPO may say, for example, you don't need a referral--

Scott Webb: Go anywhere you want. Just do whatever you want.

Drew Haverstock: Exactly. In the end, the hospital probably wants to be paid for what we're doing. So, they do accept pretty much every major medical plan, as well as most of the Medicaid vehicles in the state, which gives us the biggest welcome mat you could possibly have at the front door, which is why I love working with them. They've been fabulous partners in that regard. And the thing where I knew we had a good partner when we started this years ago was one of the things that we always stress is the idea that our job is to unlock life's potential. That goes for the kids, but it also goes for the parents, right? Again, they have new purpose when they see it. It goes for my therapist, because this is their chance to leave a mark in this world that goes beyond them. They're helping a child have a better life through every step they take. The clinic coordinators that are scheduling these kids are helping these kids get the services that they need. So coming back, yes, you need this referral to get this done. And through that referral, then we can truly unlock all that potential. And that's what, again, gets me out of bed every day.

Host: Right. Yeah, this has been great. All of us parents, as you say, you have this sort of picture in your mind of how perfect everything's going to be and how perfect your children are going to be. And of course, they are in a way, but they may need some help. They may need physical therapy, occupational therapy, speech therapy, whatever it might be to help them get there where they need to go, where they want to go. And obviously, this really sounds almost like a partnership really with parents, caregivers with you, just developing a plan, sticking to the plan, and everybody pulling on the same end, so to speak. So, I just really appreciate this today. So much fun. Thank you so much.

Drew Haverstock: It's been wonderful. Thanks so much, Scott.

Host: And for more information about Pediatric Physical Therapy Services, visit franciscanhealth,org and search Pediatric Rehabilitation. And if you found this podcast helpful, please share it on your social channels and be sure to check out the full podcast library for additional topics of interest. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.