Evo Terra (Host): Awareness of behavioral health issues has grown a lot in the last few years, but did you know there are even behavioral health services for toddlers? Let's find out more with Dr. Colby Butzon, a psychologist with Le Bonheur Pediatrics. This is the Peds Pod by Le Bonheur Children's Hospital. I am Evo Terra. Dr. Butzon, thanks for joining me once again.

Colby Butzon, PhD: Thank you for having me back. It's a pleasure to be with you again.

Host: So what does behavioral health mean when we're talking about toddlers?

Colby Butzon, PhD: Yeah, it seems a little bit strange to think about because we think, well, what's a toddler going to be talk, talking to us about? And when we think about toddlers and even infants and we're thinking about behavioral health; we're really thinking about supporting their emotional development, their social development, and how we can best encourage the optimal development for them.

Kids come into this world with a lot of personality, and they're not blank slates. Anybody who's been around a little one knows that, that they come into to the world with their own rhythms and patterns and behaviors and reactions and all those things. And by supporting behavioral health, we're supporting their development and supporting that relationship that they have with the grownups in their lives and the families and systems around them.

Host: Yeah, you're right. And sometimes those personalities come outta left field, don't they? And we just, we have to deal with them, and we come to the way that a human brain works. Now, when we're thinking about toddler behavioral health, I'm assuming it's going to the needs that are vary drastically from older children or even teens, right?

Colby Butzon, PhD: Absolutely. Yeah. A toddler isn't going to come up and say, I'm really dealing with depression. If I heard a toddler say that, that would make me want to lean in and ask some more questions, but usually they don't tell us with their words. They tell us with their behaviors and their reactions to things.

And so parents and the caregivers who are taking care of the toddlers in their lives, can see changes that their children are exhibiting or they might notice that the way this kiddo is coming through the world is a little different from the way the other kiddos have, or the kiddos in their family or in their community.

And that is when we start to kind of pay attention and think about, do we need to offer some support? How can we help this child be happy and thriving? And how can we help their family also support them in the best way that we can. We have to use a lot of observation to pick up on that. So parents are great observers. They have a front row seat to those behaviors from their children, but, as well as the behavioral health consultants or psychologists, pediatricians who are working with families, all of us use our keen observation skills to pick up on things that might need a little bit more attention or support.

Host: I'm assuming that you see some common signs that every kid is different, every brain is different. I totally understand that. But there are some commonalities. I'm assuming that you are seeing. What should parents grandparents like me be on the lookout for?

Colby Butzon, PhD: Some key things to look out for are changes in patterns that a child has previously displayed. So if we see big changes in their sleep patterns or their eating patterns, those can be common things that let us know, Hmm, maybe I need to talk about this with somebody else and get some additional feedback.

Temper tantrums are super duper common in toddlers. And sometimes they can be tiny and sometimes they can just rock your world. So depending on how big or small the tantrums are, or if there are changes in a pattern of tantrums, that can be a sign to talk to somebody about it. Tantrums are super common, sleep difficulties, picky eating.

Those are all super common things that come up. And where we really want to pay attention is if it's causing a lot of distress to the toddler or to their family where it's disrupting their day, where it's throwing everything off. We're not really recovering from these tantrums and moving on to other things.

If we're seeing something like that, so changes in kind of those biological patterns of eating, sleeping, responding to changes in the environment, that could be a time when it's a good idea to talk to a psychologist or behavioral health consultant or your pediatrician.

Evo Terra (Host): And I'm thinking through going through the terrible twos. Not for myself. I don't recall that, but I certainly do with my son. And my granddaughter are terrible twos, terrible threes, terrible fours. No, I'm kidding. They're lovely people. A lot of the, you just described changing in the eating habits, temper tantrums that go from small to other, they sound like normal toddler behavior to me, but clearly, well, maybe not clearly, what should I be on the lookout for? What should anybody be on the lookout for to find out what's not the same as normal behavior that we might need some help with?

Colby Butzon, PhD: Well, I would say that family members usually have a pretty good gut instinct. They can roll with the changes and say, you know, golly, this temper tantrum is bigger than last week's was. But maybe that's because those molars are coming in, or maybe because we've been traveling and, so I don't think I need to go talk to somebody about it. I think this is just a temporary thing.

If those changes are not temporary, if they're persisting, or if that mom or dad or grandma or grandpa, gut feeling is, you know, there's just something that's a little different from with this kiddo, or this is a change from how they used to be. That can be a good sign to at least bring it up with your pediatrician. At your next visit when you're checking in and talking about how development is going, you might bring that up and say, is this something I need to be concerned about, or is this just typical? In our practice within Le Bonheur Pediatrics, we have a behavioral health consultant in each of our six locations.

So when a parent brings up that concern with the pediatrician, the pediatrician can have that family meet with us often on the same day, and we can dig in a little deeper to see what's going on and offer some support for the family. We might give some suggestions and strategies for things to try, and maybe watch and wait to see if those behaviors do kind of resolve or improve, or if not, then we can help take next steps for, getting a little bit more in depth with the support that we offer, or even referring out if some additional services are necessary.

Host: Well, let's talk about those further services, which might be necessary or more involvement. What does a behavioral health session look like when you're talking about a toddler? They're not going to lay down on a couch. They're not going to sit or answer questions about their mother. So what's going on?

Colby Butzon, PhD: Yeah, we're not getting all Freudian with these toddlers for sure. A session with a toddler and a behavioral health consultant involves the child and their grownups. So that's one first thing that makes this kind of work exciting for me, but can be a, an additional wrinkle, which is that all these little people come in with a system around them.

So they come in, in the context of a family, their parent or their aunt or uncle or grandma or grandpa or a foster care situation. So we're always working with the child and their grown up together. We usually get the bulk of the information in the from the grownup in the room.

So we ask about typical development, history, things like that. And then we again, use those strong observational skills. We observe the child with their grownup. We might interact with the child as well, depending on how comfortable they are with us as a stranger. We might play with them. We might sing songs or do different games or things like that.

So there's a, the talking and the information gathering really comes from the grownup, but we're getting a lot of rich information just by observing the child and how they are interacting with us, how they're interacting with their grownup as well.

Host: Yeah, it sounds like the, you require the parents or the caregivers to really stay deeply or even start deeply involved and stay all the way through the process. Outside of the individual sessions, how do parents or caregivers stay involved?

Colby Butzon, PhD: So we work with parents with learning skills that they can try at home. So we talk with parents about things for changing the, whatever the issue is, whether it is the toileting or the sleep or the temper tantrums, or maybe if it's a developmental concern and we need to get some sort of developmental therapies or things like that.

We help the parent learn and strategize some things that they can try at home. We talk about what resources they have at home and what like time they have available and all of that. We don't want to give somebody this long list of things to do if they've got a million things already on their list of things to do at home.

So we want to tailor all of those supports and interventions to what the family is able to do and learn from the parent what life looks like at home so that we can best support them with strategies that they will actually be able to implement in a reasonable way.

Host: I want to ask you for a moment about therapies and services that are available for toddlers there at Le Bonheur Pediatrics.

Colby Butzon, PhD: We do a lot of parent training, and we also have parent-child interaction therapy or PCIT that we're able to do in the primary care setting as well. We provide a lot of psychoeducation, which means basically talking to families about what is going on, what our concerns are, or what their concerns are, and kind of explaining what a diagnosis is or what the next steps are going to be.

Sometimes kids who are having developmental concerns, like if there might be a concern about a speech or language delay, or maybe an autism spectrum disorder or something like that; we help support them with connecting the family with a specialist to assess that, whether it's a speech therapist, a developmental behavioral pediatrician, a psychologist, and then we walk the family through what they can expect in that setting, and then what's going to happen afterwards too.

We want to be sure that the family is supported all the way through. That any questions they have are answered. And that we're able to help them understand what's going on so that nobody's going into this trusting their child with somebody who's a stranger.

Host: You know, I speak with a lot of physicians, and two of every one of them will say this, earlier you can intervene in something, the better the possible outcome is happening for some sort of medical condition. I'm assuming that's holds true also in a child's development or mental health?

Colby Butzon, PhD: Absolutely it does. Early intervention is crucial. Anytime we can help address an issue as soon as possible and get on a different trajectory, that's going to lead to better outcomes. It's going to help a child be able to benefit from the, their environment around them, whether that's preschool or school or just interacting with other children at daycare or at home or at the park.

So early intervention really is key. Here in Tennessee we have the Tennessee Early Intervention System, or TEIS, who provides services to kids from birth to age three. Sometimes the child might not need TEIS services, but they might need some behavioral support. And that's what we can offer through, the behavioral health consultants in Le Bonheur Pediatrics.

Host: That's great. One more question about pediatricians and then I want to get into talking about what parents can do and some great tips from you there. So, pediatricians, I mean, they see these kids not nearly as often as the parents see the children, but does do they play a role in helping to identify and possibly even refer toddlers for behavioral health services?

Colby Butzon, PhD: Pediatricians are crucial members of the multidisciplinary team. You are exactly right that the parents are the expert on their children, but the pediatricians are the expert on child medical treatment, medical needs, and development. So the pediatrician, when you're going in for your checkups, the pediatrician is checking in on how is development going?

How is your child learning and growing? The American Academy of Pediatrics recommends several screeners that our pediatricians do within Le Bonheur Pediatrics. They check in on how is the child's motor development going? So walking, moving blocks from hand to hand, jumping, things like that. So when you go to your checkup and the pediatrician's having your child jump, it's not just to entertain them.

That's an added benefit. It's also to check on their motor development. But then they're also getting feedback from parents about language development, communication, personal social development, all of those sorts of things. And when the pediatrician has a concern, they can refer the child either to a psychologist or a behavioral health consultant, or we might refer them to a developmental behavioral pediatrician within Le Bonheur.

But anytime there's a concern, that pediatrician has a front row seat to the child's development. Pediatricians have a really lovely relationship with families. They've seen your babies since they were newborns, and so they are going to notice when something is maybe a little different or not quite where they want it to be, and they can address it early so that we can get the benefit of that early intervention.

Host: Two more questions about parenting and then I will let you get back with your busy day. Any advice for parents who are feeling nervous or unsure about seeking help for their toddler?

Colby Butzon, PhD: I would just encourage parents to listen to their gut and also listen to their pediatrician. Your pediatrician is someone you trust with your child's care, and that is a huge trust, and that is a very important relationship to have. So if your pediatrician is encouraging you to get support, I would listen to that person and hopefully through listening to this podcast, maybe parents have dispelled some fears or misconceptions about what this might look like.

And a visit with a psychologist or a developmental pediatrician or a behavioral health consultant with your toddler is really going to be child focused. We're not going to be big scary folks coming in with a big light on our head or things like that. We're pretty nice people and we want it to be a fun experience for the child and for the parent.

And we also are in the business of helping parents. We're not going to be blaming parents or trying to make people feel guilty or anything like that. We really want to support the family and the child together. So regardless of who is bringing that child in, it's clear that that person loves and cares for that child and wants what's best for them, and we want to walk with them in that process.

Host: And yes we do. We love these children. We want to care for them and we want to see them be as good as they can be. So, general question for parents and caregivers. What can we do to support our toddlers' I guess emotional health and make sure that they continue to be healthy and hale people as they continue to develop.

Colby Butzon, PhD: The really great news is that most people already know what to do even if you've not been around many children, sort of those thoughts about, okay, I should probably play with them and maybe talk to them and be sure they have all these needs met. Those, that's the key. So kids really need a safe, stable, nurturing environment and a predictable relationship with at least one grownup in their life.

So that might be mom or dad, that might be aunt or uncle or grandma or grandpa, or a foster parent, or just any person who is safe, stable, consistent. That's what a kiddo needs. They need to have their basic needs met. They need to have good food to eat. It doesn't have to be gourmet because they might not eat that, but they need to have food to eat, a place to sleep, their basic needs met. It's super important to talk to your children from the time they are newborns. Talk to those babies, and you don't have to talk to them like they're a baby. Sometimes that's awkward for adults, so you can talk to them just like you're talking to your neighbor down the street.

Hearing that language really helps their brains learn language. So even if they're not talking back, they're still benefiting from all of that talking as well. Positive, safe touch. So like hugging and cuddling and tickling. That's really good for baby development, toddler development, reading books.

We love to read books to kiddos and, Dolly Parton and the Imagination Library have a great books from birth program where families can get a book every month of their child's life from birth to age five. So that's a great way to get those books if you don't have those handy. Kids don't need a whole bunch of toys.

Toys are great, but you don't have to break the bank getting a bunch of toys. And I would encourage folks to put the screens away, both the baby screen, the toddler screen, and your grownup screen, and interact with your kiddo. There's a lot of really cool apps and videos these days and, but that is no substitute for that interaction with a loving adult.

So if your kiddo likes Ms. Rachel or those other folks on the internet, you can watch that with them. I would encourage you to watch it, watch those programs with the child, learn those songs, learn those games, and then you can interact with your child with that. You can then respond to your child when they say that word that they've never said before. Ms. Rachel on the video can't do that, but you can. So I would encourage families to just interact with their kiddos, talk to them, read to them, sing to them, play with them, and know that you're doing a great job. Kids are a lot of work, and those terrible twos, those three major years, it can feel like you're holding on for deal life.

But know that you're not going through it alone. And if you need support, that's what people like me are here to do.

Host: Dr. Butzon, always a pleasure. Thanks for the great information today.

Colby Butzon, PhD: Thank you so much.

Host: Once again, that was Dr. Colby Butzon a psychologist with Le Bonheur Pediatrics. For more information, please visit LeBonheurpediatrics.com. And if you found this episode helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. I'm Evo Terra, and this has been The Peds Pod by Le Bonheur Children's Hospital.

Thanks for listening.