What Causes Speech Delay in Children?

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.

Photo of Aldo Londino IIIAldo Londino, MD, is a pediatric otolaryngologist at the Division of Pediatric ENT, who treats patients at Mount Sinai Doctors East 85 Street (234 East 85th Street, Fourth Floor) and 2025 Richmond Road on Staten Island. Dr. Londino specializes in the diagnosis and treatment of the full gamut of ear, nose, and throat conditions in children and adolescents, including the most complex cases.

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Sports Players, Beware of Nasal Fractures

Injuries to the nose and face are common for both weekend warriors and children involved in sports. The bleeding and possible disfigurement associated with facial trauma can cause great anxiety for patients or the parents of injured children. Joshua Rosenberg, MD, Co-Chief of the Division of Facial Plastic and Reconstructive Surgery at Mount Sinai’s Department of Otolaryngology – Head and Neck Surgery, explains what happens during a nasal fracture and what you should do immediately following the injury.

How common are nasal injuries and fractures?

The nasal bones are the most common facial bones to be fractured, and nasal fractures are the third most commonly occurring fracture in the body. The injury is two to three times more common in males, most often occurring in patients between ages 15 and 40. The most common causes are accidents, physical altercations, and sports. Within sports, soccer accounts for the highest percentage, at 40 percent of all sports-related nasal injures. In younger children, sports-related injuries are the leading cause of broken noses, accounting for 65 percent of all nasal fractures.

What happens during a nasal fracture?

The nose is composed of paired nasal bones at the top and paired cartilaginous elements at the bottom. The nasal septum, which divides the nostrils, is also made up of both bone and cartilage. Nasal fractures typically involve injury to both the bony and cartilaginous elements. A deviated septum may also result from the injury.

At the time of the fracture, bleeding often occurs and can be impressive. It can usually be stopped by holding pressure (pinching the nose) or by nasal packing applied by a trained medical professional. Swelling of the nose soon follows, along with bruising, especially underneath the eyes.

How do I know if my nose is fractured?

A broken nose can be diagnosed during a clinical exam. However, most patients complaining of the injury are keenly aware of their broken nose symptoms, which include swelling, bruising around the nose and eyes, a change in the appearance of the nose, and increased difficulties with nasal breathing.

X-rays can be performed, but because the nose is primarily composed of cartilage, they often do not accurately detect nasal fractures. CT scans can be more useful, but are usually only needed to fully evaluate the face for any other broken bones or injuries. While many patients are unhappy with the appearance of their nose after it has been fractured, the difficulty in breathing that frequently results can be especially bothersome and will often drive them to seek medical attention from an ear, nose, and throat surgeon.

How are nasal fractures treated?

Patients have several treatment options to correct the form and function of their fractured nose. In the early period after an injury, the bones can sometimes be manually pushed back into place, either in the doctor’s office or the operating room. While this option can help patients avoid surgery, the nose’s appearance as well as the patient’s nasal breathing may not return to normal.

Once the bones have begun to heal, a rhinoplasty can be performed to restore the pre-fracture appearance and full nasal breathing. During this procedure, surgeons will re-fracture and reposition the nasal bones and cartilage. Surgeons can also correct a deviated septum which may have resulted from the injury (called ‘septorhinoplasty,’ as it involves the nasal septum).

The best treatment plan is one that takes into account the manner and pattern of injury, along with the patient’s expectations. When these are all appropriately managed, good results usually follow.

Joshua Rosenberg, MD, is an Assistant Professor, Otolaryngology at the Icahn School of Medicine at Mount Sinai. A diplomate of the American Board of Facial Plastic and Reconstructive Surgery and the American Board of Otolaryngology, Dr. Rosenberg is an expert in facial plastic and reconstructive surgery and microvascular reconstruction.

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Why Does My Skin Feel So Dry in the Winter?

As the temperatures drop, it’s important to use a moisturizer to keep skin healthy and vibrant throughout the winter months.  On a daily basis, we see advertisements touting the hydrating capability of various lotions and creams. The options can be confusing.  Angela J. Lamb, MD, Director of the Westside Mount Sinai Dermatology Faculty Practice, explains why moisturizing is key for skin health and what type of products are the most beneficial.

What causes dry skin?

Your skin is a barrier that protects our body from diseases and infections. Skin can become dry, scaly, or ashy due to cold temperatures, low humidity, wind, heating and air conditioning, as well as  washing with harsh soaps and not moisturizing. Contrary to popular belief, dry skin does not lack oil. In fact, skin becomes dry when it fails to retain water.

Dry, cracked skin may lead to an infection. It can also lead to an exacerbation of eczema—typically a winter skin condition that causes itching and rash.

What is the best way to keep my skin hydrated?

The best way to hydrate skin is to help it retain water. One way to do this is by avoiding long, hot showers as they will cause your skin to dry out. Try taking a brief shower with lukewarm water, avoid scrubbing your skin or using harsh soaps, and follow with a moisturizer.

Look for soaps that have moisturizing properties, like glycerin or almond oil, embedded. Avoid antibacterial soaps which can be very drying.

What is in a moisturizer?

People typically think that lotions or creams put moisture into the skin; however moisturizers actually work by coating the skin, thereby preventing water loss. Most moisturizers combine both occlusive and humectant agents.

Occlusive agents are heavy moisturizers that are oily. They prevent water loss from the skin by blocking or sealing the skin surface, thereby restoring moisture to it. The best occlusive moisturizer is petrolatum jelly which reduces water loss by 99 percent.  It contains no water and is best applied while the skin is still damp. Most patients do not like using solely petroleum as it is sticky and stains clothing. Other examples in this group include mineral oil, silicon, vegetable oils, and wax esters (like beeswax and vegetable waxes).

Humectant agents attract moisture. A popular ingredient for moisturizers is hyaluronic acid, which is also used in injectable fillers for wrinkles instead of the traditional collagen. Hyaluronic acid helps improve the appearance of the skin by causing the skin cells to swell and be less scaly. Other humectants include sodium lactate, urea, propylene glycol, glycerin, and some vitamins and proteins. Humectants work best at high humidity, greater than 70 percent.

What should you look for in a moisturizer?

Moisturizers that include glycerin or hyaluronic acid are great at trapping moisture in and preventing your skin from feeling dried out. Avoid purely oil based moisturizers. While they make your skin feel good at the time, they do not do a very good job of trapping in water. If you like using oils, I encourage you to layer a thicker moisturizer on top during the winter to prevent skin from feeling dry.

In addition to using an excellent moisturizer to hydrate your skin, humidifiers are a great defender against dryness. Humidifiers raise the moisture level in the environment and prevent evaporation of water from across the skin surface.  If neither a moisturizer nor a humidifier has helped your dry skin or you start to develop a rash with redness and itching, you may need to consult a dermatologist.

Photo of Angela LambAngela J. Lamb, MD, is the Director of the Westside Mount Sinai Dermatology Faculty Practice and Assistant Professor of Dermatology at the Icahn School of Medicine at Mount Sinai. Dr. Lamb welcomes patients of all ages and has great expertise in the treatment of acne, eczema, and skin cancer detection. She is intent on partnering with her patients to determine the best course of treatment and ongoing care. She wants her patients to be actively involved in their medical treatment and feels that education is the key to healthy skin.

What is the difference between cream and lotion?

Creams ­are thick mixtures of grease in water or other liquids. Patients tend to prefer creams over ointments, as they contain less grease.

Lotions are mixtures of oil and water, with water as the predominant ingredient. Most lotions are not the best moisturizers for people with dry skin conditions, mainly because the water in lotion evaporates quickly.

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How Much Protein Do You Really Need?

Protein makes its way in and out of the news often, from high-protein/low-carb diet fads to the addition of protein in food products like sports bars and ice cream. Consumers can be left wondering how much protein they truly need.

The 2015 Dietary Guidelines for Americans recommend eating a variety of protein-rich foods, including lean meats and poultry, seafood, eggs, beans, peas, nuts, seeds, and soy products. Some dairy products, such as Greek yogurt and cottage cheese, are also good sources of protein. Whole grains, whole-grain products, and vegetables all contain some protein.

It is recommended that healthy adults consume 0.8 grams of protein per kilogram of body weight per day. Protein needs increase during periods of growth, pregnancy or lactation, infection, and injury such as trauma or surgery. Athletes in particular need more protein for muscle growth and repair. Depending on the type of training, needs range from 1.2 – 2 grams of protein per kilogram of body weight per day. Eating high-quality protein within two hours after exercise can help with this process.

Plant proteins are generally less digestible than animal proteins, which can be a concern for vegetarians. However, if vegetarians have a varied diet, that includes beans, legumes, nuts, seeds, whole grains, and colorful fruits and vegetables, they will likely get enough total protein

The recommended upper limit of protein intake is 30-35 percent of total calories in the diet; however, research is unclear as to how much protein should make up a single meal. Some research indicates that the body can only make use of a certain amount of protein at a time— about 20-30 grams—to build muscles. Other studies do not support a practical upper limit to protein intake at a meal. It appears the difference in these conclusions is due to what foods were eaten at meals, sources of protein, and desired outcome of protein intake. Specifically for muscle building, 30 grams at a time appears beneficial.

Note that exceedingly high-protein diets can harm overall health. Elevated protein levels can cause dehydration, kidney damage, and bone and calcium imbalance. It is recommended to limit red meat such as beef, pork, and lamb to 12-18 ounces (cooked) per week. Avoid processed meat such as bacon, sausage, ham, hot dogs, and other deli meats due to their link to stomach and colorectal cancers.

Overall, protein is an essential part of our diet, and choosing plant-based and/or lean animal proteins will help keep the body healthy. Protein-rich foods should be paired with a variety of fresh fruits and vegetables as well as a small portion of whole grains for optimal meal structure. It is best to spread protein intake throughout the day to ensure all meals are complete and balanced.

For a chart of healthy protein choices, click here.

Rebecca Guterman, MS, RD, CDN, is the Senior Dietitian at Mount Sinai’s Derald H. Ruttenberg Treatment Center which offers a wide range of outpatient services for all cancer diagnoses, with the exception of breast cancer.

What Does Protein Do?

Protein plays a role in many body functions. It helps cells communicate within our body, moves compounds through the blood, plays a role in energy metabolism, and helps with muscle contractions and building. Proteins such as collagen, elastin, and keratin are found in the bones, teeth, skin, tendons, cartilage, hair, and nails. Other proteins provide the body with protection against bacteria or viruses. Minerals such as copper, iron, and zinc are stored in body tissues bound to proteins.

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Why Diets Don’t Work and What to Do Instead

You might be thinking, why is a dietitian telling me not to diet? Don’t they put people on diets?

Well, it’s complicated. Let’s first define ‘diet’ in the context of this post. When I say diet, I am referring to an eating plan with rules focused on restricting foods, food groups, calories, etc. The diet’s primary measure of success is the manipulation of body size or maintenance of an ideal weight. Often these goals are set forth by a societal standard and not the individual person.

Diets also tend to moralize foods as good or bad, healthy or not healthy, clean or—for lack of a better word—dirty. The foods you eat on a diet and how much you eat are usually determined by external rules set forth by an individual or the diet itself, and not internal cues like hunger, fullness, and cravings.

Popular examples include the paleo diet, which heavily restricts highly processed foods along with grains, legumes, and dairy products; the ketogenic diet, a low-carbohydrate and high-fat diet that virtually eliminates fruit and root vegetables; or structured eating plans where you are counting points or calories throughout the day.

Nearly everyone has tried to diet and most have ended up feeling like a failure in one way or another. But it is not the individual who has failed; it’s the diet, because diets don’t work.

In the long term, diets are not sustainable. There is not a single randomized-controlled trial that can show sustained weight loss after two years on any diet. Within five years, 95 percent of dieters will regain all weight lost. Often, the regain will leave folks heavier than they were before the diet, because dieting can adversely affect your hormones and slow your metabolism.

It is absolutely possible to feel good and live a healthy lifestyle without dieting. Instead of the latest fad diet or obsessing over a food tracking app, try the following:

Forget the black and white thinking.

Labeling foods as good or bad makes it really difficult to listen to hunger, fullness cues, and cravings.  Think of all foods as one big, neutral shade of gray. There is a place for every food in a balanced, varied diet. Remove the stigma placed on certain foods and the pedestal we put on other foods. That’s right, have your cake and eat your kale too.

Instead of focusing on weight or body size, focus on how you feel.

What health-promoting behaviors will help you feel good? Make a list of these items: things like eating more vegetables, going for evening walks, taking an exercise class that you enjoy, or cooking dinner for your family. Identify the behaviors that make you feel good but that you may not be doing enough of, and vice versa. These behaviors and the frequency with which we practice them make a difference in long term health, not micromanaging our diets or weight.

Seek out help from a registered dietitian with non-diet, weight neutral philosophies.

Our relationships with food are complicated. It can be extremely hard to break up with dieting and the diet mindset. These specialized dietitians can help guide you on a path of diet freedom and a more positive relationship with food, and help you identify the health-promoting behaviors that can fit within your lifestyle.

Kelly Hogan, MS, RD, CDNKelly Hogan, MS, RD, CDN, is a registered dietitian who focuses on breast cancer nutrition for the Dubin Breast Center of The Tisch Cancer Institute. Ms. Hogan creates patient education and wellness programs and provides individual counseling in the areas of wellness, weight management, and symptom/side effect management.

While diets do not promote prolonged weight loss, they often lead to the following:

Increased cravings

Restricting certain foods and food groups often makes us want them more than ever.

Higher risk of bingeing

The restrictive nature of diets can also cause an increase in bingeing, the body’s physiological response to energy deficiency and starvation.

Nutrient deficiencies

Over long periods of time, eliminating certain foods or food groups can lead to deficiencies in fiber, calcium, and other vitamins and minerals.

A negative relationship with food

In some cases, the hyper-focus on food can lead to disordered eating, which profoundly impacts quality of life.

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How to Pick an Urgent Care Center

There are many urgent care centers throughout New York, and they are not all the same. Mount Sinai’s approach to urgent care is unique. Joseph Feldman, MD, FACEP, Mount Sinai Urgent Care Medical Director, explains why that’s important for you.

What can I expect when I walk into a Mount Sinai urgent care center?

When you visit Mount Sinai Urgent Care you become part of the Mount Sinai family.  Our centers are an integral part of the Mount Sinai Health System, known for quality care and cutting-edge research.

What are the qualifications of the doctors?

You will be treated by board certified Emergency Medicine and Family Medicine physicians along with skilled nurse practitioners and physician assistants. All physicians have faculty appointments to the Icahn School of Medicine at Mount Sinai and often train residents and medical students in the latest urgent care practices.

Why is a connection to a medical school important?

Mount Sinai doctors and researchers are developing strategies that will help patients avoid unnecessary visits to the hospital emergency department (ED). ED visits for conditions that are not true emergencies can be expensive and detrimental to your health. Our urgent care centers play an important role in providing you the right care and have shorter wait times

 Can I really just walk in?

We welcome walk-ins. If you have an urgent medical need that is not a life-threatening emergency, just come into any of our locations throughout Manhattan and Brooklyn. You can also reserve a spot with our online scheduling system. We see patients of all ages, from infants to geriatrics, and we take all insurance plans including Fidelis and HealthFirst.

 What if I need further care?

We have priority access to primary care and specialty physicians of the Mount Sinai Health System, ensuring you can get easy referrals if you need additional care. Some of our urgent care centers even have multi-specialty practices within the same facility. Our urgent care centers are connected to the rest of the Mount Sinai Health System through electronic medical records, making it easy for physicians to communicate about your care.

What exactly do you treat at Mount Sinai Urgent Care?

We treat almost any immediate medical issue that’s not a life-threatening emergency, from sprains and broken bones to wounds and rashes. If you’re feeling symptoms of common illnesses like strep throat, flu, urinary tract infections, or sexually transmitted infections, we can confirm a diagnosis with a test and provide the medication you need. We offer a full array of vaccines and PPD testing for tuberculosis. We can also conduct physicals for school, work, workman’s compensation, and no-fault evaluations.

What kinds of diagnostic tools and imaging are available?

We do a full range of blood work and perform electrocardiograms. Our certified radiology technicians also provide full X-ray services. Some locations offer more advanced imaging, including CT scans and ultrasounds.

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