The Centers for Disease Control and Prevention recently recommended that children ages 5 through 11 receive a COVID-19 booster shot five months after completing the vaccine series.
In this Q&A, Kristin Oliver, MD, MHS, a pediatrician and preventive medicine physician at the Mount Sinai Health System, explains the benefits of the booster shot and urges parents to talk with their child’s health care provider if they have questions.
“We know information about COVID-19 and vaccination is constantly evolving,” says Dr. Oliver, who is also an Associate Professor of Pediatrics, and Environmental Medicine and Public Health, at the Icahn School of Medicine at Mount Sinai. “Reach out to your child’s pediatrician if you have any questions. We are happy to talk with you.”
What are the benefits of getting a COVID-19 booster shot?
While two doses of COVID-19 vaccine continue to give good protection to children against severe disease and hospitalization from COVID-19, protection from infection decreases at around five months after completing the series. A booster dose may increase protection against infection, emergency department and urgent care visits, and severe disease.
What side effects can we expect?
Side effects after a booster dose are similar to side effects after the second dose, with pain at the injection site most common, followed by tiredness and headache.
Is there any data on how effective the booster shot is?
In the study of 5- to 11-year-olds, the booster dose increased levels of antibodies to COVID-19 to higher than they were after the first two doses. While there is not enough data from that study yet to see the effectiveness against infection in this age group, there is good data that a booster dose in older age groups provides increased protection against infection and severe disease. We expect to see this same increase in protection for children ages 5 to 11.
If my child had COVID-19, do they still need to get a booster?
A recent COVID-19 infection does provide some protection in the short term, but that protection also decreases over time. Depending on your child’s risk factors and potential exposures, for children with a recent COVID-19 infection you may want to consider waiting three months before getting a booster dose. Waiting this amount of time may result in a better antibody response. You can speak with your child’s doctor about this choice.
Is there anything else parents should know about the booster shot and staying safe from COVID-19?
The most important thing you can do is get the first two doses of the vaccine if you haven’t yet. Hospitalization with COVID-19 is twice as high for children who are unvaccinated compared to children who received two doses of the vaccine, even during the recent Omicron surge.
A nationwide shortage of infant formula has caused anxiety for parents across the nation as local and national agencies and private industry work to improve supply.
“Understandably, this has been a scary and concerning time for parents,“ says Morgan Howard, RD, CDN, a certified clinically advanced nutrition coordinator for the neonatal intensive care unit at The Mount Sinai Hospital. She encourages parents to use their pediatrician as a resource, and offers some helpful answers to the questions they have now.
My local stores don’t have the baby formula I usually buy. What should I do?
In most cases, any standard infant formula should be safe and appropriate to feed your baby. There are some circumstances where a specialized or particular formula is needed—for example if your baby has a severe allergy or another medical condition. If this is the case, you should consult with your pediatrician before changing brands or formula types. But these are rare instances. Even if you are using a sensitive formula or a reflux formula, you should be able to switch to a standard formula that is available to you. It is okay to switch between brands. Most brands are very similar, and your child should tolerate differences between them. Store-brand formulas are also a perfectly safe option for your kids, and in fact, most store-brand infant formulas are the same, with only store-specific labels.
You want to look at a variety of local stores and smaller stores in your community for any availability. You can also use store websites to show you in-store availability before going to multiple stores. Be sure to reach out to your child’s health care providers if you are having trouble finding infant formula, as they may have other tips to help. They also may give you further information to help you find the best options for your child. If you use WIC to obtain your formula, please reach out to your WIC office, because they can also help with tips and formula availability.
Can I dilute the baby formula to make it last longer?
Diluting baby formula is not recommended. This is not safe, because it will water down the key nutrients in the formula that your child needs. Watering down formula can cause dangerous abnormalities in sodium or calcium levels in the blood. We also don’t recommend any homemade infant formulas, as these are going to be missing vital nutrients for your baby. We know that this is a challenging time to try to find infant formula, but sticking to the available options in your stores is going to be the best choice for your infant.
Is it okay to give my baby milk? If so, what kind?
During this time of need, the American Academy of Pediatrics is allowing for children six months and older to have some whole cow’s milk, only for a brief period of time, if formula isn’t available. The recommendation is to have no more than 24 ounces of your child’s feeds coming from whole cow’s milk, and not using any low-fat milk or skim milk. It is important to stick to whole cow’s milk, because, of the cow’s milk options, this will best meet your child’s needs. This should be for as brief a period as possible, because it isn’t typically recommended for this age group, but a few days should be okay for your child. Cow’s milk is low in iron, when compared to infant formula, so it is important to follow up with your pediatrician if this is something that you are doing, since additional supplements, especially iron, may be needed. If your child is eating solid foods, try to give some iron-fortified solid foods, like cereals or other iron-containing sources
What about donated breast milk?
Some families may also consider using donated breast milk. If you are considering this, the safest option is to obtain the milk from a certified milk bank, as this milk is pasteurized, tested, and known to be safe for your child.
How did this baby formula shortage happen, and what is being done?
The shortage has occurred for a few reasons, including supply-chain issues related to COVID-19, changing demands for formula, and, unfortunately, a recent recall of infant formula from a large formula manufacturer, which has significantly affected the amount of formula available for families to purchase. The government and formula companies are working together closely to try and resolve this issue. They are flying in formulas from overseas. The government is helping companies do whatever they can to increase formula production to try and provide more formula for your children. One large facility that was closed is now shortly going to be reopened, which should help increase the supply in the next six to eight weeks, first starting with specialty and allergy formulas for children who can’t otherwise tolerate standard formulas. Then the next step will be to increase the amount of standard formulas being produced so there should be more available for your infants.
Is there anything else parents need to know about the shortage?
We understand that this is a concerning time for parents. You should use your pediatrician as a resource. Many pediatric practices and local communities have made efforts to secure formula that may be available by donation. Any time you are getting formula from somewhere other than a retail store, it is important to make sure that you’re taking unopened, unused formulas that are not expired and also not part of the recall. The makers of infant formula offer support sites and hotlines that may be helpful to parents. And more information is available from the American Academy of Pediatrics, the U.S. Department of Health and Human Services, and New York State.
Some stress is part of everyone’s life. But there are times when the daily demands of the job or school, the complications of home life, the pressure of living in the New York metropolitan area, and the state of the world, especially with the ongoing pandemic, can combine to leave you feeling physically and emotionally overwhelmed. In these moments, you may notice your heart rate rising or your breathing becoming heavier, or find you are lacking energy or a sense of enthusiasm or confidence.
You know you need to do something. But what?
Jacqueline Hargrove, PhD
In this Q&A, Jacqueline Hargrove, PhD, a licensed clinical psychologist and Assistant Professor of Psychiatry at the Icahn School of Medicine at Mount Sinai, says you can start by separating “stressors,” those things like work, planning a wedding, or having a child, from stress, which is your body’s response to these stressors. Once you do that, she offers five tips on how to improve your mindset and increase your flexibility so you can begin to improve how you manage stress and get unstuck from cycles of chronic stress even while the stressors of life persist.
Get physical
The best way to deal with the stress is to do things that are physical. That helps breakdown those hormones that increase our heart rate and our breathing and get us ready for action. This can be a whole host of different things. Anything that literally just gets your heart rate going, or breathing deeply is fair game. Physical activity helps your body reach a calmer state. A lot of folks may not like going to the gym or going for a run. So you can do a Zumba class at home, or yoga. Or just focus on deep breathing or breathing exercises.
Alternatively, you can connect with other people and soak up some physical affection. If you’ve ever come home from work and been greeted warmly by your partner, or even a pet, you know how that can be comforting and stress reducing. Even laughing and crying can be helpful, as many may know from having a good cry or experiencing a deep belly laugh. Afterwards, you feel better, because it’s a physical process and helps us actually release some of that stress and tension that can stay stuck in our bodies.
Figure out what you can control and what you can’t
A lot of the stressors are out of our control. So it’s important to understand if something that is stressing you out is something you have some control over, and can problem solve, or not. If there is something, even a small thing, that you can do and is in your control that will help reduce or eliminate the stressor then absolutely do it. However, if it’s something that’s more chronic or something that you don’t necessarily have control over, try to see what meaning you can gain from the experience. Many of life’s most important transitions, such as that first job or first child, come with stress. But often it is the positive meaning we tend to associate with these events that can help us mitigate the stress associated with them. However, let’s say you may be facing a situation at work that’s challenging. Or in a relationship where you feel your needs aren’t being met. Sometimes just shifting our expectations can actually reduce stress because then we aren’t fighting with what we are expecting of other people or things we can’t control. Overall, it’s important to remember that stress, not chronic stress, is a part of life and learning to roll with and make meaning of these challenges is part of the journey.
Take stock of your environment and surroundings. It’s not necessarily all on you
Try to contextualize your stress. What I mean by that is, sometimes we can think we have a personal failing because we’re so stressed out. But if we just take a minute to step back, we realize there’s so much going on in our lives. Being in a global pandemic right now is stressful, being a parent right now is an added level of stress. Navigating your life as a person of color or an immigrant or a member of the LGBTQ community has its own stress due to discrimination or systemic barriers that are unjustly imposed on these communities. There are so many ways in which our identities can contribute to the stress that we experience. In this way, it can help to acknowledge how our identities and the environment we are in play a role in the day-to-day stress we experience. This can help us not be so self critical and can also help us identify ways to manage that stress and find empowering ways to deal with the stressors.
Redefine productivity
In the United States, there is a common narrative that centers around always needing to be productive, and that is a culture that is ripe for stress. Productivity can simply mean intentionally working toward a meaningful goal. So let’s say your goal is mental health and well-being, then rest can be a really productive thing that you’re doing in line with that goal. Making time for yourself can therefore be productive. Also, capitalize on idle time. This can include choosing to not do anything during those five minutes in between meetings. Or if you take public transit during your commute, maybe intentionally getting off one stop earlier and extending your walk home. Finding time when you don’t need to be engaging with your day-to-day stressors can be really important.
Learn to say no
Learn to say no to things and learn to set boundaries. A lot of our stress can come from sometimes feeling like we have to say yes, or put more and more on our plate, when it actually isn’t in our own best interest. So if you’re saying yes to things, and you have the ability to say no, you can ask yourself: Is this benefitting me? Does engaging in this activity help me feel energized and excited? Or does it end up making me feel depleted and resentful? Take time to listen to your body, set some boundaries, and find some time to relax and restore.
Skin cancer occurs when there is damage to cells that make up the outer layer of your skin, which causes these abnormal cells to grow in an uncontrolled way.
Skin cancer is the most common form of cancer—there are more cases of skin cancer than all other cancers combined. More than 5 million people in the United States are diagnosed with skin cancers each year. One in five people in the United States will develop a skin cancer by the age of 70. Most of these cancers are caught before they spread, and they are treated with surgical removal in the doctor’s office.
About 200,000 people are diagnosed each year with melanoma, a type of skin cancer that develops when melanocytes (the cells that give the skin its tan or brown color) start to grow out of control. Melanoma is a more dangerous form of skin cancer because it can spread to other parts of your body.
In this Q&A, Jesse M. Lewin, MD, FACMS, Assistant Professor of Dermatology, Icahn School of Medicine at Mount Sinai, explains how skin cancer is best treated with early detection and treatment, and offers some tips for reducing your risks. Dr. Lewin is also Chief of Mohs Micrographic and Dermatologic Surgery at the Kimberly and Eric J. Waldman Department of Dermatology.
“Unlike with many other cancers, patients and doctors have an advantage over skin cancer, in that we can see it with the naked eye,” says Dr. Lewin. “We don’t need invasive tests to look for these types of cancers; we just need to partner with our patients and be on the look-out for new and changing lesions, which are the earliest sign of skin cancer. The other advantage is our ability to reduce the risk of skin cancer by protecting ourselves from the sun.”
Who can get melanoma?
Melanoma affects more men than women. People of any skin color can get skin cancer, however those with lighter skin are at greater overall risk. Those at higher risk for developing melanoma include:
People with more than 50 moles or with atypical moles, which are often larger and have more ragged or blurred borders that are not easy to see
People who are sensitive to the sun, which includes those who sunburn easily, or have natural blonde or red hair
People with a personal or family history of melanoma
Click here to meet our team of experts specializing in skin cancer and melanoma care
Is the risk different for people with darker skin tones?
Melanoma in patients with darker skin tones is often diagnosed in its later stages, when it’s more difficult to treat. One reason is that people with darker skin types are more prone to developing skin cancer on nonexposed skin with less pigment, and these are places that people tend not think about as they are not exposed to the sun. Up to 75 percent of tumors occur on the palms, soles, in the mouth, and under the nails.
What are the early signs of melanoma?
Some of the early signs include changes in the size, shape, or color of an existing mole or a new brown or black lesion with irregular borders, multiple colors, and asymmetry. Between 20 and 30 percent of melanomas occur in existing moles, while 70 to 80 percent are found on apparently normal skin.
Most melanoma cells still make melanin (brown pigment), so melanomas are usually brown or black. But some melanomas do not make melanin and can appear pink, tan, or even white. This variety highlights the importance of seeing your dermatologist for periodic skin cancer screening exams.
Melanomas can develop anywhere on your skin, but they are more likely to start on the chest and back in men, and on the legs in women. The neck and face are other common sites. In about half of cases, patients discover these melanomas themselves. The best way to detect melanoma is to look for a change in the size, shape or color of an existing mole or other skin lesion.
How can I avoid getting melanoma?
There are some risk factors that you cannot change like your skin type, age, and family history. But there are ways to lower your risk of skin cancer.
The majority of skin cancers are caused by ultraviolet (UV) radiation from the sun and tanning beds, so the most important thing you can do to reduce your risk of developing skin cancer is take steps to protect yourself from these exposures.
Studies show that having five or more sunburns doubles your risk for melanoma. This is why it is particularly important to educate and protect children and adolescents from the sun. People who first use a tanning bed before age 35 increase their risk for melanoma by 75 percent.
Here are some tips:
Use sunscreen with a Sun Protection Factor (SPF) of 30 or above. A nickel-sized dollop of sunscreen is enough for your face. One ounce of sunscreen can cover your whole body but needs to be reapplied every two hours. One study found that regular daily use of an SPF 15 or higher sunscreen reduces the risk of developing melanoma by 50 percent. Your face is especially vulnerable to sun damage as it is exposed to the sun year-round.
You are vulnerable to sunlight all year round, not just when at the beach. So consider using a moisturizer with sunscreen every day all year.
When outside, wear protective clothing, a wide brimmed hat, and UV-blocking sunglasses. Seek shade. If possible, avoid the sun during peak sun hours (10 am to 4 pm).
Avoid tanning beds.
What Treatments are Available for Skin Cancer?
Mohs surgery is a precise surgical technique used to remove skin cancers, including those found in areas that are important to your appearance and your daily life, such as your eyes, nose, lips, ears, fingers, and toes, as well as for some skin cancers on other areas of your body. This procedure can be used to treat a wide array of skin cancers, including melanoma and nonmelanoma skin cancer.
For this procedure, we give local anesthesia to numb the skin, and then remove the skin cancer with a margin of normal skin. The skin is then turned into slides so we can look under the microscope and see if we have fully removed the tumor. If there is still skin cancer left, we go back and remove more and look at another round of slides. Once the skin cancer is fully removed, we fix the wound by stitching it in such a way to offer the patient an optimal functional and cosmetic outcome.
For early melanomas, removing the skin cancer with a margin of normal skin is all that is required. Mohs surgery with immunohistochemical staining for early melanomas, particularly those located on functionally and cosmetically sensitive areas, is also offered at select academic centers including Mount Sinai. For melanomas that are deeper, lymph node testing and imaging, such as a CT (computerized tomography) or PET (positron emission tomography), may be indicated.
One in eight people in the United States over age 12 has hearing loss in both ears, according to the National Institute on Deafness and other Communication Disorders, and many younger people are now experiencing problems.
At the same time, only one in five who would benefit from a hearing aid actually uses one. And people with hearing loss wait an average of seven years before seeking help, according to the Hearing Loss Association of America.
“Individuals of all ages could benefit from testing, hearing aids, medication, and other treatments,” says Bess Nagler, AuD, CCC-A, clinical manager of audiology at the Center for Hearing and Balance at Mount Sinai. “Often it is a family member who encourages the person with hearing loss to finally come in for an evaluation.”
Bess Nagler, AuD, CCC-A
The number of people who have difficulty hearing is expected to rise dramatically in the coming decades. Age-related hearing loss usually begins around age 60. However, Dr. Nagler notes that many patients seeking evaluations are in their 40s and 50s.
“We are seeing a younger demographic coming into the office for a hearing exam. The emphasis today on sound quality with respect to music and Bluetooth streaming has underscored this trend,” explains Dr. Nagler. “At Mount Sinai Doctors Faculty Practice, we are also seeing an increased awareness about the importance of testing.”
Types of Hearing Loss
Complications with the physical structure of the ear, the nerves, or the connection between the inner ear and the brain are often the genesis of hearing loss. The three categories are:
Conductive hearing loss occurs when a problem in the outer or middle ear prevents sound from reaching the inner ear. Some causes include ear wax, middle ear fluid from a cold or allergies, acute or chronic ear infection, foreign body, or a perforation in the eardrum. Medication or surgery can often help this type of hearing loss.
Sensorineural hearing loss occurs due to a problem with the inner ear or the nerve pathway to the brain. Inner ear hair cell damage that occurs as we age is the most common cause. Some other causes include genetic conditions, loud noise exposure, ototoxic medications, tumor on the acoustic nerve, or illnesses. Hearing aids can often help this type of hearing loss.
Mixed hearing loss is a combination of both conductive and sensorineural hearing loss.
A common pattern of hearing loss is hearing in the normal range in the lower frequencies, but fading out to a more significant hearing loss in the higher frequencies. “In these cases, you can hear people talking but are unable distinguish every sound or word,” says Dr. Nagler. For example, high frequency sounds include consonants such as the s, f, th, and k. These sounds give speech clarity. When you miss these sounds, you need to rely on context or lip-reading (difficult with a mask!) to fill in what is being said, which can be exhausting over time, and difficult when people are wearing a mask. “Individuals often withdraw from the conversation completely, which can be very frustrating for them and their families,” Dr. Nagler says
How Hearing is Evaluated
Having your hearing tested is simple. First, the audiologist will look inside the ears to see if there is wax, fluid, or infection. Then, an objective middle ear function test is performed, measuring energy transmission through the middle ear. Finally, the audiologist will ask you to identify a variety of sounds and pitches in both ears. You will also be asked to repeat a series of words to evaluate what is known as your speech perception. The results are then reviewed and, when needed, referrals are made to an ear, nose, and throat physician.
Ten Signs You Need a Hearing Test
You ask people to repeat themselves. Conversations feel like a struggle—both in person and on the phone.
You hear ringing in your ears. Known as tinnitus, these noises are described as a buzzing, roaring, clicking, or hissing in one or both ears. The sensation may come and go or occur all the time. You may also have episodes of dizziness or vertigo.
The volume is constantly turned up. You need to crank the TV to be able to hear dialogue or music comfortably, or you rely heavily on subtitles. Family and friends tell you the volume is “too loud.”
It sounds like everyone around you is mumbling. You are always telling people to speak more clearly. This is more noticeable in individuals with high-pitched voices.
Understanding speech in background noise is more difficult. Filtering out external sounds in a busy environment like a restaurant or a party is challenging.
You have trouble following multiple voices. While in a meeting or at the dinner table, it is difficult to differentiate who is talking and when. You frequently need to ask the people around you to take turns speaking.
You leave social situations feeling exhausted. You are straining just to hear. You feel fatigued and need to exert extra effort to hear at public events. Your body feels strained and your neck or back may feel tight from twisting and tensing.
Everyday sounds are missed. You do not hear the doorbell, alarm clock, or phone ringing. Your loved ones express concerns about safely carrying out everyday tasks.
You feel isolated or depressed. A strain has developed on your relationships with family and friends. You feel as though they are frustrated with you. It feels easier to avoid social gatherings or situations where there is a lot of noise.
Family members keep telling you that you need a hearing test. Many people with hearing loss do not realize they are missing out on sounds or conversation. The people who live with you or interact with you every day are your best resource. Listen to their advice.
Advancements in Hearing Aids
More than 28 million adults in the U.S. could benefit from hearing aids. However, less than one in three adults, age 70 or older, wear them. There is still a misconception that hearing aids are bulky, squeaky, and cause sound to be distorted. However, hearing aid technology has improved dramatically over the past two decades and continues to advance every year.
A wide variety of hearing aid styles, ranging from invisible to larger behind-the-ear devices, are available today. Most hearing aids are capable of connecting to Bluetooth, have rechargeable batteries, and can work in tandem with each other to provide the best sound in any given environment. Many have different settings that you can control with a smartphone. For example, if you are in a noisy restaurant, you can choose a program that suppresses background noise.
“Hearing aids can dramatically improve the quality of life for people with hearing loss,” says Dr. Nagler. “It is worthwhile to get a baseline exam, especially if you or your loved ones are noticing any hearing difficulty in your daily life.”
A concussion is type of brain injury usually caused by a blow to the head. Most of the time, the effects are minor and short term. But that’s not always the case. Immediate medical care may be necessary to prevent long-lasting neurological symptoms such as problems with concentration and memory.
Jenna Tosto Mancuso, PT, DPT, NCS, clinical specialist in neurologic physical therapy and physical therapist at the Abilities Research Center at The Mount Sinai Hospital, explains what a concussion does to the brain and what to do if you or someone you know may have sustained the injury.
What happens to the brain during a concussion?
Concussions are different than other head or brain injuries because there isn’t just one injured spot—the injury damages the whole brain. Concussions are often caused by a jolt to the head, which can cause the brain to bounce around in the skull, either back and forth or side to side. This rapid movement, and then the stopping, is what usually causes the injury. It also leads to changes in the chemical messengers—called neurotransmitters— which affects the communication pathways in the brain, leading to a variety of symptoms.
How might someone get a concussion?
Concussions usually result from rapid movement or changes in head and neck positioning. For instance, if you are playing a contact sport—like football—and get tackled, this can cause a concussion. It can also happen in soccer if you are hit in the head with the ball. But not all concussions happen while playing sports.
Does a concussion cause you to lose consciousness?
When we think about concussions, we often assume that the person loses consciousness, but that’s usually not the case. While you may lose consciousness briefly, it rarely lasts very long. Years ago, we might not have taken a blow to the head seriously if someone didn’t lose consciousness. We might have called it a stinger or a head hit. But researchers have realized that if you have sustained a head injury, it’s not a good idea to just walk it off and get back on the field.
What are the symptoms of a concussion?
Most symptoms of concussions appear pretty quickly. A headache, nausea, or blurry/ double vision are very common. Often, a concussed person may appear disoriented, confused, or not like themselves. They may lose their sense of balance or move oddly. They may seem unaware of their surroundings or lose track of time. If the concussion was sustained during a sporting event, a good way to find out is to ask, “What quarter are we in?” or “Which was the last team to make a play?”
What should I do if I think I have a concussion?
Immediately go to the emergency department. The medical teams there are trained and experienced in evaluating concussion symptoms and ruling out any other diagnoses. They will provide the best and most appropriate care. It’s also important to follow up with care after the head injury. For instance, if your child sustained a concussion, check in with their pediatrician to make sure there isn’t anything serious going on and to make sure your child recovers as quickly as possible.
What happens if you can’t get to the emergency department immediately?
Research shows that those who sustain a concussion do best if they get rehabilitation as soon as possible. If concussion symptoms aren’t addressed early, within two to three weeks, you may develop what we call post-concussive syndrome. These longer-term symptoms can become more serious concerns such as problems with memory, concentration, and impulse control.
What type of health care professionals can diagnose and treat a concussion?
Research and care of concussions has improved over the last 20 years. More health systems are developing comprehensive concussion care teams, which include specialists in rehabilitation medicine/physiatry, sports medicine, and neurology. Some teams also have physical therapists, occupational therapists, and speech and language pathologists and therapists. If you are experiencing changes in vision—such as double vision—the team might also include a neuro-ophthalmologist, which is a specialty that combines expertise with vision and neurology. The concussion care team might also refer you to a vision therapist, which is a subspecialty of occupational and physical therapy. If there might be an injury to the spine, the team might include an orthopedist. To best treat a concussion, we need a multi-disciplinary team to create a comprehensive plan of care for recovery.
In this Q&A, 
