Pediatric otolaryngologists (ear, nose, and throat doctors) play a vital role in the evaluation and management of children with speech delay, a communication disorder characterized by late speech and language development. These specialists, working with audiologists, speech therapists, and teachers, are an important part of the team that many children with speech delay rely on to reach their potential. Aldo Londino, MD, a pediatric otolaryngologist at The Mount Sinai Hospital, explains speech delay, what parents should expect during a physician visit, and how the condition is treated.

How do I know if my child has a speech delay?

While common causes of the condition include oral-motor problems (difficulty controlling speech muscles), significant ear wax buildup, chronic ear infections, or fluid behind the ear drums, signs of speech delay are varied.

Contact your child’s physician if your child:

• By four months is not babbling with expression and copying sounds he or she hears
• By six months is not responding to his or her name and/or cannot string vowels together (“ah,” “eh,” “oh”)
• By 12 months is not able to say “Mama” and “Dada” and/or is not expressing gestures, such as pointing or shaking head “no”
• By 18 months has difficulties imitating sounds
• By two years cannot follow simple directions or use verbal language to communicate more than immediate needs

Early detection can be critical. There are various steps both parents and doctors can take to help at-risk children.  If you need additional help deciding when to ask your pediatrician or ear, nose, and throat specialist about possible speech delay, consult the well-organized and thorough reference of milestones during childhood compiled by the U.S. Centers for Disease Control and Prevention.

Keep in mind that many children are late bloomers. Not every child with a late start will go on to have a speech delay.  Albert Einstein, for instance, was initially considered delayed because he developed speech late in childhood.

What tests are important for evaluating speech delay in children?

All children with a suspected speech delay receive a formal hearing test in the office.  Though sometimes difficult to perform in a young child, this test is a complete evaluation of how your child hears and provides valuable information about the health and function of their ears.  We always review hearing test results with the parent in the office.  Additionally, as part of the evaluation for delayed speech, we always perform a thorough physical examination of your child, focused particularly on the ears and the oral cavity.  We also evaluate the tongue for a tongue-tie and ensure that the tongue has good mobility.

What should I expect during a visit for speech delay?

Your pediatric ear, nose, and throat doctor will ask several questions about you and your child. Records from birth and from your child’s pediatrician can inform the best diagnosis and treatment.  Be prepared to answer the following questions, among many others:

• Were there any hurdles or challenges during the pregnancy or delivery of your child?
• A hearing test is generally done while your baby is in the nursery soon after birth. Did your child pass this screening?
• Has your child suffered from recurrent ear infections? If so, how frequent and how severe?
• Has your child ever had ear surgery?
• Is there a history of hearing loss in your family? Please note younger family members with hearing aids or any possible hereditary hearing loss.
• Does your child respond to sounds/noises/conversation in his or her environment?
• When was the last time your child had a hearing test?
• How is your child doing in school or day care?

How is speech delay treated?

The effective treatment of speech delay very much relies on the underlying cause. Treating recurrent ear infections, for example, can help a child hear normally, and thereby enhance their ability to interact and learn from the words and sounds in their environment. Repairing a tongue-tie can help increase the mobility of the tongue and, with practice and help, have a big impact on pronunciation.

Regardless of the underlying cause, it is important that your child has a team dedicated to helping them reach their full potential.  Pediatricians, pediatric otolaryngologists, audiologists, speech therapists, and teachers all play a critical role in helping you and your child reach your goals. As a parent, always communicate with your child.  Your positive reinforcement of their expressive habits is a valuable tool. And, most importantly, if you have concerns about your child, ask your pediatrician about consultation with a pediatric ear, nose, and throat specialist.

Screens are everywhere, even in the waiting areas of pediatric practices. This makes it harder for parents to control the amount of time children spend engaging with digital media. While there are legitimate educational applications that involve handing your child, or putting your child in front of, a screen, limits are important. Micah Resnick, MD, a board certified pediatrician at Mount Sinai Queens, explains how, and why, parents should limit usage.

How much is too much screen time?

Parenting is not easy. Sometimes a screen is the most efficient solution for occupying your child while you attend to the needs of other family members, or even your own needs. Despite the ease and importance of using digital media, the American Academy of Pediatrics (AAP) recommends the following:

• No screen time before 18 months old except for video chatting
• Strictly limited screen time for toddlers 18 to 24 months old
• One hour a day of “co-viewing” for children two to five years old
• Consistent limits on screen time for children six years and older

Those are pretty serious restrictions, and with good reason.  Too much screen time can result in lack of sleep, aggression, obesity, and loss of social skills.  No one wants that, especially during your child’s crucial development stage.

So, what are parents to do?

An excellent starting point to help limit screen time is the creation of a family media plan.  HealthyChildren.org, a parenting advice website from the AAP, provides helpful tools like a media plan template and a media plan calculator here. Using the media plan calculator, you are given an age-appropriate checklist advising how to help create screen-free zones, screen-free times, and device curfews, and how to balance online and offline time for your child.   There are also important sections on how your child can be a good “digital citizen.”  Speak with your child about cyberbullying, the dangers of sending or receiving explicit images via text, and the importance of following online guidelines.

Encourage tactile activities. 

While digital media is ubiquitous, it is not essential. An early childhood filled with books and educational toys will pay off well into adolescence.  Play with your children, read to them, and teach them about colors and numbers and how to play musical instruments.  These tactile interactions will promote the most intellectual and emotional development.

No one likes injections. In just the first year of a healthy baby’s life, 12 shots will be administered. More injections will follow through adolescence, making needles an uncomfortable but necessary fact of life. Micah Resnick, MD, a board certified pediatrician at Mount Sinai Doctors Queens, explains how to minimize the stress and pain surrounding these injections, which help you and your child stay healthy.

Only a handful of my friends get their annual flu vaccines, the rest skip out because of their needle phobia, so it is no surprise that infants and children are fearful of injections and blood draws. How can we, as parents and as physicians, help alleviate the fear? I never lie to parents when they ask me if infants can feel pain. Yes, they can. However, for babies and children of all ages, it is important that parents stay calm, smile, and use encouraging words. Your child, especially toddlers and older children, will take cues from you.

For babies, physical contact is very important. Hold your baby close in an upright position. You may want to breastfeed before, during, and after the immunization to calm your baby down. There are over-the-counter topical anesthetic creams that may minimize the pain, but these can take 30 to 60 minutes from application to start working.

Toddlers require more active intervention. Tell your toddler about the injection ahead of time. You know your child best—some young children respond well to being told just before, while other children may do better with several short discussions in the days leading up to the doctor visit. In either case, try to distract your child at the time of the injection by blowing on a pinwheel or even blowing something imaginary out of your hand. Don’t tell them it will only hurt a little, or it will be over soon. This will only remind them of the discomfort.

School-aged children are typically more reasonable. Honesty is the best policy here. The goal is to set a realistic expectation. Explain to your child that injections are necessary. Let them know that the little pinch from the needle keeps them from getting sick.  For the injection, your best bet is to distract your child: you can play music or talk about a book you both like. In my office, I have colorful posters of animals and trees on the wall. I often point to those animals or ask a child to list the different ones on the wall he or she recognizes.

Talk with your child about the experience afterward. Acknowledge the pain. Give praise for doing a good job, or even just for a “best effort.” Ice cream or another enjoyable treat may also be in order.

What do you do with an absolutely inconsolable toddler or child?  Number one, don’t drag it out. Take a short time to reason with your child, and if it is a no go, hold your child while the injection is given. It is only very rare cases, when the fear turns into a phobia, that the services of a psychologist may be necessary. Remember, we are hoping that your child sees injections as an unpleasant fact of life. Stay positive, stay supportive.

Family meals are a great occasion to enjoy time together. These shared meals can result in feeling closer, and more nutritious meals are an essential ingredient for a happy, healthy family life. Micah Resnick, MD, a board certified pediatrician at Mount Sinai Queens, explains how parents can use shared meals to establish a commitment to lifelong nutrition in children.

I encourage families to cook together, eat together, and talk together. This can happen at any meal – breakfast, lunch, or dinner – so try to find the meal that will allow the most time and relaxation.

What are the nutritional benefits to family meals?  In June 2011, a study published in the medical journal Pediatrics found that sharing three or more family mealtimes per week resulted in a 12 percent reduction in the odds of being overweight; a 20 percent decrease in eating unhealthy foods; a 35 percent decrease in disordered eating; and an increase of 24 percent in the odds for eating healthy foods.

Family meal times are a great place to start your kids on a lifelong commitment to nutrition and a healthy relationship to food.  Involve your children in age-appropriate meal planning and shopping. If dinner is your family meal, be sure to plan for healthy snacks beforehand so that your children are appropriately hungry at the start of mealtime, but not too crabby to participate in the fun. For picky eaters, mealtime offers an opportunity to try one or two new foods a week.  Do not force your children to eat new foods; however, gentle consistent encouragement will go a long way toward a bite of broccoli or pineapple.

Meals are also an excellent time to hear about your children’s daily experiences.  Ask about school, friendships, what is going well, and where they may need help.

Children learn a great deal from their parents about socialization and how to communicate. Meals are definitely a time for parents to model good habits like table manners and listening skills. Encourage your children to practice these skills which will provide enduring benefits. I recommend that parents model a “no screens rule” during family meals – TV off, phones away.

Consider your children’s ages to ensure successful mealtimes.  Younger children shouldn’t be challenged to sit through long meals.

Quality is just as important as quantity.   Set a realistic goal for your family – plan for three times a week to start and see if you can increase that number over time.

The American Academy of Pediatrics (AAP) recommends approximately 10 well-baby and well-child visits in just the first two years. These routine checkups are very important in assessing your child’s development. Micah Resnick, MD, a board certified pediatrician at Mount Sinai Doctors Queens, explains why.

Well visits are used to make sure your baby is thriving, check the child’s progress against broad established milestones, and provide routine immunizations. You can take a look at the Developmental Milestones Checklist created by the U.S. Centers for Disease Control and Prevention. Additionally, the AAP has a recommended vaccination schedule for those 18 years and younger.

During well visits, your baby will be checked from head to toe. Your child will be weighed and measured, including the head circumference.   Pediatricians will examine the baby’s heart, lungs, skin, abdomen, and more.  The first year is such an important time, filled with rapid, and often delightful, changes. While I always want to assure parents that all is well, these visits give pediatricians a better chance to discover issues early.

At each visit, your pediatrician will learn more about your baby’s temperament and development.   Does your baby make eye contact, smile, and laugh?  Is your child able to support his or her head?  During early development, I always recommend that parents talk with and read to their baby frequently.  Remember, it is never too early to start reading books with your child. Please try to limit screen time before the age of two.

I also take this opportunity to check in on parents. How are you and your partner getting along together? Have you been getting out together without your child? What do you do when problems really get to you? I talk to parents about their interactions with their child, asking questions like: Do you feel attached to your child? Does your child appear attached to you? I try to take the time to question the parents further about their home life. I like to ask about what a typical day looks like. How is the multitude of tasks required to raise a child shared. If things aren’t going so well at home, if parents have more concerns, or we just need more time to talk, I often ask parents to follow up with me in a week or two for more discussion. I am a pediatrician because I love to advocate for children, but I also enjoy taking care of families.

As your child gets older, she will take a more active role in the visit.  Pediatricians will ask your child questions and try to engage her in healthy habits including engagement in exercise and good nutrition and sleep habits.  For your adolescent child, annual exams present an excellent opportunity to discuss behavioral and socio-emotional concerns, plan for the future, and complete a physical exam to ensure that puberty and growth are progressing appropriately.

I believe in empowering all parents and children. I want my patients to help me improve the quality of care provided by thinking about the visit ahead of time and writing down any questions and concerns.  I do my best to answer patient questions and provide resources to help families stay healthy.

Please remember that this information is not a substitute for direct medical advice.