An ENT may know the reason for your child’s developmental delay

An otolaryngologist (ENT) treats more than your child’s ear infections, swimmer’s ear and tonsillitis. Their expertise encompasses a wide range of ailments, some of which may surprise you.

Take sleep disorders, for instance. Did you know that the reason your child may not be sleeping well is because they may have a physical condition that is causing an airway obstruction?

“You don’t think about kids having sleep issues,” said otolaryngologist Bradford S. Chervin, MD, who practices at Cape Cod Ear, Nose and Throat Specialists in Hyannis. “But what we know very, very clearly is that a lot of school performance, athletic performance, attention and behavior type issues, are a result of unrefreshing, un-restorative sleep. Twenty-five years ago, these kids would automatically be labeled ADHD and be told ‘you’re just a restless sleeper.”

Today, ENTs like Dr. Chervin do a complete work-up and a pediatric sleep test, if indicated, on a child with sleep issues. Often times, these children are found to have problems that can be treated, such as enlarged tonsils or adenoids, or obstructed airways due to obesity, he said.

“Sleep is organized, it has structure,” said Dr. Chervin. Children can wake up tired after 10 hours of sleep, come home from school and take a nap. This is not normal; the child’s sleep is being disrupted in some way during the night, he said.

The ENT may examine the child’s airway with a small camera. Often, the problem is enlarged tonsils or adenoids. “More and more, we do tonsillectomy for sleep and breathing issues, rather than for infections or abscesses,” Dr. Chervin said.

“The studies are pretty clear that you can get these kids back on track and they’re performing better in school, not wetting the bed anymore. And it transfers over to a happier household.”

Local Providers Can Help

Dr. Chervin joined the Hyannis practice earlier this year, after practicing in Fairfield and Southport, Connecticut for 26 years. He and his fellow ENTs at Cape Cod Ear, Nose and Throat Specialists: Courtney Miller, MD; David Wood, MD and Victor Mokarry, MD, treat children and adults.

After he arrived. Dr. Chervin said he found that many pediatric cases that could be handled just as well here on the Cape were being sent to Boston hospitals for care.

The local pediatricians and primary care practitioners are “very aware” of where their patients should be developmentally and will often refer anything of concern for further assessment, especially for hearing and speech problems, he said.

“We don’t want to overlook a child that has the potential for normal development and miss an underlying diagnosis,” he explained. “Another group who have known barriers from the get-go, are children with Down syndrome, cerebral palsy or a child with a cleft palate that predisposes them to fluid in the ears. We want to give those kids every opportunity to succeed.”

Routine pediatric ENT cases are something that any of the local otolaryngologists can expertly take care of, he said, which means less of a burden on parents and caregivers.

“If you look at common pediatric cases, they have a big impact on the family: repeated infections, medications, pediatric visits, time out of work. And if you add onto that a trip to Boston, it just becomes more complicated.”

Dr. Chervin discussed some of the other lesser-known reasons children are referred to ENTs, and why it is important that they be seen, diagnosed and treated.

Developmental Delays

“Human development and language skills, and interpersonal communication skills, which are beyond language, are very dependent upon the ability to hear and speak well,” he said. If children are hard of hearing, it interferes with their ability to do all these things.

“We assess children at birth for hearing loss and if they fail, they are referred for evaluation. So, from day one, we want to make sure that those language development skills are being monitored so the child can have normal development,” he said.

Sometimes the problem develops later.

“When we see a 2-year-old that’s not talking, doesn’t have words, doesn’t respond to external stimuli. When we see a child that’s having trouble expressing language skills, we have to work it up and ask: Is this is a hearing issue, a central processing issue, an issue of motor function where they literally can’t speak words with their tongue? There are so many layers.”

Dr. Chervin told of a former pediatric patient in his Connecticut practice who was 3 at the time and, after a hearing assessment, was found to be speech-delayed because of hearing loss. “It was just plain and simple chronic ear infections and problems associated with it. So, I put a pair of vent tubes in, which is the simplest thing to do,” he said.

One child who had tubes put in her ears woke the morning after surgery and asked her mother where their new pet bird was, having never before heard birds chirping outside her window.

“Those kinds of simple things are a home run” said Dr. Chervin.

GERD

Pediatric gastroesophageal reflux disease, or GERD, may need a multi-disciplinary approach, including with an ENT, to get to the bottom of the problem, Dr. Chervin explained. Chronic coughs, chronic sore throats and hoarseness in children may be from chronic acid reflux. This is different from the standard GERD a pediatrician would handle, he said, and can be found in children who use their voice a lot.

“We’re looking for nodules on the vocal cords, swelling of the throat. We find these nodules or polyps all the time,” he said. “In little kids, we call them ‘screamer’s nodules,’ and in adults we call them ‘singer’s nodules.’”

What Parents Need to Know

To prevent ear, nose and throat problems in their children, parents should consider the following things, according to Dr. Chervin:

• Noise Exposure – “The world is a noisy place,” he said, and parents should help protect their children’s ears. Ear buds and headphones connected to devices concentrate sound in the ears, which can lead to lasting damage, if it’s too loud, or worn for long periods of time. Wearing ear protectors of some kind is advisable around things like power mowers and leaf blowers, he said. To prevent hearing loss earlier, buy earplugs for your aspiring drummer or for a child who wants to do target practice at a firing range, he said. “Even something as simple as putting ear and eye protection on your kids when out in the yard working.”
• Ingestion and Aspiration – “Be proactive in having that anticipatory guidance,” he said. Tiny toy pieces, like Legos, batteries and arts and crafts items. “I always cringe when a preschool does macaroni necklaces; someone always sticks one up their nose.”

Referrals

Local pediatricians and family practice providers are skilled at identifying children who need more assessment, such as hearing tests, Dr. Chervin said.

“Fortunately, in our environment, we have excellent primary care providers, and they are well aware of the appropriate stages of development and whether that child is or is not on the mark,” he said. Referrals to ENTs who work with children can make all the difference in their outcomes, he added. Local audiologists, like Amy Levasseur, Au.D. in his practice, work with the ENTs to assess children and adults.

Schools are another good referral for patients to ENTs, he said, as are groups on Facebook, online community group chats, and even moms talking at the bus stop, who share experiences and refer others to him or other ENTs in the area.

“It’s fun to be a detective, which is what all of us do every day,” he said.