When it comes to food, babies and young children can be picky eaters. It could be a forkful of broccoli that is met with resistance or a whole meal that they push away, yet parents often expect these reactions when introducing new foods.

But what do you do if mealtime is a constant source of agitation for your child? For example, they refuse to eat anything except for one particular item, such as french fries. Or you have noticed that they are taking forever to chew and swallow certain foods. These reactions may not be related to their personal preferences. They could be signs of a problem that needs to be addressed by a feeding specialist.

What is a feeding specialist?

A feeding specialist is a trained medical professional who works with you and your child to determine whether the food issues you have noticed are a phase that your child is expected to outgrow independently or if this is something that requires intervention.  Additionally, the specialist will help to pinpoint if feeding struggles are behavioral or if there is an underlying medical condition contributing to the challenges associated with eating or drinking.  A specialist’s examination will help get to the root of the problem and establish next steps for treatment when necessary.

Beth Kraus, MS, CCC-SLP, Speech Language Pathologist and Senior Clinical Specialist at the Department of Pediatric Otolaryngology at the New York Eye and Ear Infirmary of Mount Sinai.

“There are certain medical conditions that place kids at a higher risk for a feeding issue,” says Beth Kraus, MS, CCC-SLP, Speech Language Pathologist and Senior Clinical Specialist at the Department of Pediatric Otolaryngology at the New York Eye and Ear Infirmary of Mount Sinai.

“In some instances, a feeding problem is one of the first red flags, and we discover the underlying medical condition through thorough examination.”

When should I see a feeding specialist?

There are several signs that a child may be experiencing feeding issues that go beyond picky eating. These signs differ based on age and stage of development.

For babies who are still being breastfed or bottle fed, look for:

• Arching of the back or general stiffness during feeding
• Constant crying or fussing during or after feeding
• Problems staying awake during feeding
• Few or no wet diapers
• Difficulty latching on the breast or bottle, spilling milk/formula from the mouth
• Generally refusing the breast or bottle

“Stiffness, arching, or fussing during or after feeding generally are typically signs of discomfort and may indicate digestive concerns,” Ms. Kraus says. “However, lack of wet diapers or weight gain is a strong indicator that a child is not receiving enough calories to grow.”

For children who have transitioned to solid food, look for signs such as:

• Refusing or turning their head away when offered food
• Agitation at the sight of food
• Choking or gagging when eating or drinking
• Struggling or unwillingness to chew their food
• Taking a long time to eat a meal
• Avoiding all but one type of food
• Frequent vomiting
• Lack of weight gain
• Changes in vocal quality during or after mealtime, such as a wet or phlegmy voice
• Nasal stuffiness when eating
• Pronounced drooling or significant food or liquid dripping out of the mouth
• Frequent respiratory infections

What do I do if my child has signs of feeding issues?

In cases where there is a safety concern, such as coughing, choking, gagging, persistent vomiting, or ongoing weight loss, you should immediately contact your pediatrician for an initial assessment. This will help rule out acute illness as a possible cause before you are referred to a feeding specialist for work-up of a chronic feeding problem.

Prior to meeting with a feeding specialist, Ms. Kraus also recommends keeping a daily log of food intake and behaviors during snacks and meals to get a better sense of both the issues that your child is experiencing and their frequency. This will help to provide concrete details during your child’s evaluation.

“Often times, parents can identify that something isn’t quite right during mealtimes, but they have a hard time quantifying the frequency or identifying specifics of the problem when they are in the office with the specialist,” says Ms. Kraus. “Having some data collected beforehand will help the specialist complete a more comprehensive assessment right from the initial encounter.”

Uterine cancer occurs in the uterus when healthy cells change and grow out of control. There are two main types of uterine cancer: endometrial cancer and uterine sarcoma. Endometrial cancer develops in the lining of the uterus. It is one of the most common gynecologic cancers and the most common type of uterine cancer. Uterine sarcoma develops in the muscle of the uterus and is rare.

According to the Centers for Disease Control and Prevention, uterine cancer is more likely to occur in women who have already gone through menopause. About 66,000 new cases of uterine cancer are diagnosed each year, according to the American Cancer Society. This is the most common cancer of the female reproductive organs.

In this Q&A, Stephanie V. Blank, MD, Director of Gynecologic Oncology at Mount Sinai Health System, answers frequently asked questions about uterine cancer relating to risk factors, prevention, and treatment options.

What are the symptoms of uterine cancer?

Postmenopausal bleeding is the hallmark symptom of endometrial cancer. It is important to know that bleeding after menopause is never normal. Symptoms of endometrial cancer before menopause include heavy bleeding or bleeding between periods. Other common symptoms include pelvic pain or pressure, changes in urination, unusual vaginal discharge, or pain during intercourse. With uterine sarcomas, you may have unusual bleeding or you may have symptoms similar to fibroids, such as a mass or pressure in your pelvis.

Is there a relationship between hormonal imbalances and uterine cancer?

Endometrial cancers are associated with hormonal imbalances, specifically the most common type of endometrial cancers. They are caused by having more estrogen relative to progesterone.

Are there any other risk factors?

Some of the risk factors for endometrial cancer include:

• Obesity
• Never having had children
• Taking estrogen without enough progesterone, or taking unopposed estrogen, which is just estrogen alone
• Taking tamoxifen, which people take for breast cancer

Additionally, there are genes that predispose you to endometrial cancer. These are genes associated with Lynch syndrome mainly.

Can uterine cancer be prevented?

Uterine cancer can be prevented with birth control pills and by hysterectomy. IUDs with progesterone can also prevent cervical cancer.

What are the treatment options?

There are many treatment options for endometrial cancer. These include surgery, hormonal treatment, chemotherapy, immunotherapy, or other targeted treatments.  There has been much progress in this area. Everyone with cancer is different and requires a different treatment plan. At Mount Sinai, we have experienced specialists and a multidisciplinary team working together to provide the very best treatment plan and individualized care for our patients.

About one in four people in the United States has a condition in which some fat is found in their liver, according to the National Institutes of Health.

Many people assume problems with the liver are caused by too much drinking. In fact, this condition is not related to excessive alcohol consumption, which is why it has been called nonalcoholic fatty liver disease, which goes by the acronym NAFLD.

More recently, a global consensus of experts and patients proposed a more clear and non-stigmatizing term, metabolic dysfunction-associated steatotic liver disease, or MASLD. This name was selected because this condition is often associated with metabolic risk factors such as diabetes. As this name change adoption will take time, there will be a period where both names are used, including the acronym NAFLD/MASLD.

What’s most important for patients is that, while having excess fat in the liver may sound concerning, it is one of the most common causes of liver disease. In addition, not everyone with the condition needs treatment, and the condition is reversible with early diagnosis and treatment.

In this Q&A, Meena B. Bansal, MD, Professor of Medicine (Hepatology) at the Icahn School of Medicine at Mount Sinai, explains more about this disease—including possible treatments and when it could lead to complications. She is also Director of the Mount Sinai’s Center of Excellence for patients with this condition and Director of Translational Research, Division of Liver Diseases.

What is nonalcoholic fatty liver disease (NAFLD/MASLD)?

Many patients are told that they have fatty liver disease, either by their primary care doctor or by a radiologist who is doing an ultrasound. But not everyone with a little fat in their liver has NAFLD. People with NAFLD have fat in at least five percent of their hepatocytes, which are a type of liver cell. In some people, that fat stimulates inflammation and scarring of the liver.

Why is scarring important?

If the liver is injured, it responds by laying down scar, just as if you cut your hand you would develop a scar. If the injury is repetitive and continual, the liver continues to lay down scar. Scarring (also called fibrosis) accumulates over time and can cause cirrhosis. Fibrosis is the most important determinant of clinical outcomes in fatty liver disease. Some people develop a more advanced form of NAFLD, which is called nonalcoholic steatohepatitis (NASH), or in the new nomenclature (metabolic-dysfunction associated steatohepatitis (MASH).

How common is this condition? Who is most at risk?

The prevalence of NAFLD in the general population is about 25 percent. Fatty liver disease is very complex; there are a number of determinants, including genes, environment, diabetes, and obesity. If you have diabetes, are obese, have metabolic syndrome, or have HIV, you are at increased risk of developing NAFLD. You are also at increased risk if you have metabolic syndrome, which includes a number of conditions such as prediabetes, central adiposity (having a little excess weight around the waist), high triglycerides, low HDL (good cholesterol), or high blood pressure.

How can I get screened for this condition?

Your primary care doctor or any doctor can calculate a fib-4 score, which is based on four variables: age, platelet count, aspartate aminotransferase (AST), and alanine aminotransferase (ALT). AST and ALT are liver enzymes. Your doctor probably already has these four pieces of information, so you shouldn’t need any additional blood test to get your fib-4 score. The FIB-4 score is very good—but not perfect—at ruling out significant liver disease. If your score is low, you can feel relatively confident that you don’t have cirrhosis or advanced liver disease. If the score is very high, you should see a liver expert (hepatologist) for further evaluation. And if you’re somewhere in between, you need some additional assessment.

What additional assessment would be needed?

If you have an intermediate Fib-4 score, you can get a Vibration Controlled Transient Elastography (VCTE) or Fibroscan. This test measures the stiffness of your liver. Many hepatologists have this scanner in their offices; Mount Sinai has a number of the scanners at various satellite locations. The machine sends a pressure wave through your liver and measures how fast the wave propagates. If your liver is soft, the wave goes slowly. If your liver is stiff because of scarring and inflammation, it moves faster.

What is cirrhosis?

Cirrhosis is when you have so much scarring it forms round nodules in your liver. It’s a natural wound healing response that has just been pushed to the limit.

Is NAFLD/MASLD treatable?  

The good news is fatty liver is completely reversible. We can reverse it with weight loss, exercise, and lifestyle modifications. In addition, the scarring that NAFLD/MASLD causes is also reversible. The most important thing to know is how much fibrosis you have. Then you and your doctor can work on interventions and track your liver’s response to them. Even early cirrhosis is reversible. However, once you have had cirrhosis for a prolonged period, you may reach the point where it is not reversible. Our goal is to help you before you get to that point.

How can Mount Sinai help?

When someone is referred to us for fatty liver disease (NAFLD/MASLD), we first confirm the diagnosis. It’s very important to make sure there are no other ongoing liver diseases that would require a different treatment course. Next, we assess how much scarring your liver has. Once we’ve established that, we develop a treatment plan.

What does a treatment plan look like?

The best treatment for fatty liver disease is exercise and weight loss. Studies show that losing 10 percent of your body weight causes fibrosis regression or a decrease in scarring. We recommend a Mediterranean diet. This approach emphasizes eating plant-based foods and healthy fats. In addition, we recommend black coffee, which is protective for the liver—you can have a couple of cups a day. If you have significant scarring in the liver, we may want to see if you might be eligible for one of our many clinical trials. We usually have at least ten active clinical trials for patients with various levels of fatty liver disease or fibrosis. We will also monitor how your liver is doing over time. Is the scar accumulating at a rapid rate or is it mostly stabilized? Each patient is different and it is important to know your trajectory.