Dr. Michael Smith (Host): Welcome to Meaningful Medicine, a Novant Health podcast. I'm Dr. Mike, and today I'm joined by Dr. Hunter Slemp, a dedicated Pediatrician with Novant Health. We'll be delving into the intriguing topic of Little Minds, Big Leaps, understanding ages three to five, and we'll be exploring the rapid development during these formative years.

So let's start off real simple. You know, for kids between three and five, Dr. Slemp, right off the bat, what are some of the key milestones?

Dr. Hunter Slemp: I think it's one super interesting to take a step back and just think about milestones in general, because from like birth to three, we follow milestones so close like every two months we're checking in to make sure that they do this and this and this and this and this. And then from three to five, they take kind of these different leaps and the milestones are different. And partially that's because from birth to three, they're kind of laying these foundational skills like the you gotta sit, you gotta crawl, you gotta walk, and then you gotta learn to pick up things and how to hold them and all of that, the foundation skills that you need to then kind of take off, and it's from three to five that they really start to take off and we start to really get to see their personality.

And with that can come a range of milestones that kids will have. Right. So your 3-year-old, may love to be super physical and may master the bike a little bit quicker than somebody else's three, 4-year-old who prefers to draw. He may crush a picture of mommy that is more intricate and detailed than me.

I'm not a great drawer. But it really is the beginning of their personality and their interests that kind of drives us stopping thinking about things month to month and really kind of grouping this age three to five together and looking at milestones a little different. The other thing that kind of happens is there's a ton of cognitive development.

Their brains are really fun. They're curious and they're imaginative and they're teachable. They're painfully honest, right?

Host: Yes, yes, yes. We know that.

Dr. Hunter Slemp: The kiddo who tells the stranger on the bus, Hey, you have no hair, and embarrasses you. But you know, it's not always easy. There's still moments of tantrums and talking back, and that's partially because they're not like sponges anymore. They're really starting to reason through the world.

And with that comes more executive function on like frontal lobe. They're able to like not only plan things, but understand consequences and reward systems in a new way that really helps them develop differently.

Host: What about language and communication skills during this stage of development?

Dr. Hunter Slemp: Yeah. So, they're fun to talk to. A typical 3-year-old will tell you some funny things. Usually they're speaking in just like three or four word sentences and most of what they say is really clearly understandable. And as they get older, closer to four and five, everything that they say should be understandable and they go from those short three to four word sentences to more long sentences and more back and forth.

You know, you can prompt a five-year-old and say, Hey, tell me something about your day. And, you know, you might know a little bit about it and give them a little, yeah, tell me about this. And they'll be able to retell you that and go into greater detail. No longer do you get the, I don't know, or the silence that you get beforehand and for teenagers, it's quite different for that three to five years.

Host: One of the things I wanted to ask you about, I'm really curious, in your expert opinion here, is about playtime for kids in this age. How important is that and what type of play is best? Because we know things have changed a lot, right? With computers and videos, they can watch all this kind of stuff. How does place still play a role?

Dr. Hunter Slemp: Play is huge, play is huge for all of us. Adults need to play. I think we should institute recess at work.

Host: Dr. Slemp for governor.

Dr. Hunter Slemp: No, but play is, I mean, it's huge. It's where children learn to be creative. It's how they learn to interact with their environment. It's how they learn to interact with other individuals. The playground is where you learn to advocate for yourself. It's where you learn conflict resolution with your friends.

It's where you learn new physical skills that develop into competence and then that leads to you being confident in a new way. I mean, play is huge and we, we know that it's not just crucial for kiddos. It's crucial for us as parents too. Parents who can uniquely let children play and able to play with them, are able to connect with kids, see a different perspective, and really appreciate their children more fully.

Host: Yeah. What about the difference between structured play and just kind of unstructured play? Right? And I know sometimes it's good to play games with them, you know, that are appropriate for this age group, but what about just also letting them just play with stuff?

Dr. Hunter Slemp: Yeah, the unstructured play, just creating a space or time, handing them a couple objects, letting them pretend is so important to let their mind grow and expand their imagination take off. I joke and tell my wife, I've never had an original thought, and I think that's because I had three older brothers and like, I don't know how much, I got to pick and choose how I played with things.

Host: I relate to that. I was the youngest of five kids. I get it.

Dr. Hunter Slemp: Okay, so you get it? Yeah. You haven't had original thought either. I'm kidding. But you know, that imagination and that creativity can really come from just no structure, just play.

Host: I love that. So during this age between, three to five now, a lot of brain growth. We just mentioned communication skills are starting to develop, fine and motor skills in general. Fine motor skills versus gross motor skills. How are they evolving now? Because, I have some nieces and nephews in this age group and they're pretty funny to watch when they try to run.

Dr. Hunter Slemp: Yeah. I always like to break it apart, and it helps me to think about fine motors as the little muscles. How do you use your little muscles and gross motors, how do you use your big muscles? And, for fine motors skills, it's between three and five you're really, I think about the pencil and learning how to draw a simple shape.

So it might start out as like a little circle and the picture of mommy with maybe just a head, perhaps a torso. And then by five, that picture of mommy's starting to look pretty good. Starting to have arms and legs. They can draw kind of more complex shapes then too, like squares or crosses or triangles, and can do more practical things, right? So I go back to the foundations there, let's use it so they can start to help dressing and undressing. So a typical five-year-old can kind of get themselves ready for the day, hopefully, which is super helpful for parents. Sometimes their choice of outfits may not be our choices, but, when you think about gross motor skills, you think about those big muscles. Usually by three you've got a decent sense of balance and can kind of climb on and off a couch. You might be wobbly at times, but as you get older, four and five year olds, you should be able to like skip and jump on one foot and have pretty good control of your body on the playground. And you'll still have injuries and falls and accidents. But in general, you've kind of got control of your body.

Host: So at this age group, comparing it to the first three years of life where the milestones are, I think are much more consistent weight, height, all that kind of stuff, are the milestones here; you, might have a 3-year-old neighbor who's kid is running pretty good, but your three year old's still a little wobbly, but eventually they're going to get there.

So there's more flexibility in when they achieve some of this stuff?

Dr. Hunter Slemp: Yeah, in a lot of ways, I mean, we still have these kind of general guidelines, but yeah, there's a little bit more flexibility. I mean, you go back in time and you, you see these more structured, routine, milestones that you typically see. But between three and five, there can be a little bit of variance, and that's okay.

Host: So preschool, early learning environments, how important are those things to this age group?

Dr. Hunter Slemp: Yeah, they're huge. So, they can be real lifesaver, from a just a social emotional development standpoint. Children between three and five, really start to be able to empathize and see others' perspectives and that can lead to sharing and seeing a friend who's sad and kind of intervening and it's often in like a preschool setting that they get the direct interaction with other kiddos that can kind of develop more of that empathy and imagination.

Imaginative play, kind of what we alluded to earlier. For children who have developmental differences or developmental delays, preschool is huge. Through the preschool program starting at three, you can get help with speech therapy and physical therapy and occupational therapy. For children with autism, you can get ABA therapy really, crucial things to help your child kind of develop, and, overcome some of the things that they're going through. And all of that can be found at the preschool.

Host: Let's shift the discussion a little bit more towards nutrition and sleep. How impactful are those, in helping developmental outcomes in this three to 5-year-old range?

Dr. Hunter Slemp: Well, they're important, my imagery that I try to use in clinic is, well, Dr. Mike, what happens if you put diesel in your car?

Host: It wouldn't like it.

Dr. Hunter Slemp: No. Right. You ain't getting anywhere. So yeah, I mean,

Host: Yeah.

Dr. Hunter Slemp: Same thing here. You gotta put the right fuel in your body. So children need balanced nutrition. thTy need a plate that's colorful, right, different colors, and, proper water intake, and we need to be cautious of how much added sugar we're giving them.

These things can really change our energy level, our ability to kind of focus and our brain's ability to function at, at peak. And same for sleep. If you've ever been without sleep, it's hard to think. No. And so to think that our kids would be any different and could run an all nighter and then know to listen to us is like, nah, that ain't going to happen.

Host: Yeah, the nutrition part is, I think real difficult, right? A lot of kids, we want them to start, enjoying like you said, that colorful plate, different vegetables, different fruits, different types of proteins. That can be difficult though, right for parents?

Dr. Hunter Slemp: My encouragement, I try as a parent. I try to give food, different vegetables, cooked in different ways as often as I can and just put it in front of him.

And if he takes a bite, I celebrate. And if he eats his mac and cheese, I go on and I'm just doing the best I can to hopefully get some nutrition in his body. And I think that's my encouragement for parents is, drive yourself crazy if you think about day to day or even meal to meal. But if you can think about it over two weeks, you'll often realize like, oh yeah, last week you crushed some green beans. You know?

Host: I like that. I think that's a good approach, right? So that as a parent, you're not stressing out so much, which doesn't help your sleep, right.

 So, when should parents though, you know, given this age group, become concerned, talk to their doctor, if their child isn't doing some of these things, they're four now and they're still not running well, or they're still not drawing the, like, when do we become concerned about this stuff?

Dr. Hunter Slemp: Well, you know, I think we as, as pediatricians try to always do surveillance and screening where we're asking these questions and we're having these conversations. So yeah, my encouragement is you are your kid's best advocate and so if you were ever worried about something, you should bring it up to your pediatrician and have a conversation and hopefully they'll be able to either give you some peace of mind, some helpful tips to overcome or the right resources to address the issue if that's the case.

Host: Very good advice. Just to wrap up, is there one last word you want to give the audience about developmental milestones in this three to five year age range?

Dr. Hunter Slemp: Well, I think have fun. And just try to enjoy the time you got. I think, structure and routine are so critical. I know we didn't really talk about that. But we all need structure and routine. You know, if we can keep a good structure and a good routine, they're able to really thrive. They can trust us. They feel safe. They feel secure. We know they learn better.

Host: Sounds great. Thank you for coming on. This was fantastic information I think is going to be very helpful to a lot of parents out there, with toddlers around three to five. For more information, you can visit novanthealth.org. Don't forget to explore more health and wellness insights at healthyheadlines.org.

And don't forget to share the podcast on your social channels and check out other podcasts that we have in our library for some engaging topics. This has been Meaningful Medicine. Thanks for listening.