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Your Child

The Benefits of Being Bilingual

2.00 to read

Do children who speak more than one language score higher on cognitive tests? Yes, according to a new Canadian study. Researchers say that bilingual students develop a deeper understanding of the structure of language, an important skill in learning to read and write.

Cognitive tests study the mental processes that allow us to perform daily functions such as paying attention, solving problems, producing and understanding language appropriately and making decisions.

Does being bilingual make a child smarter? Not necessarily, but previous studies have shown that children who learn two languages from birth are able to concentrate on the meaning of words better than monolingual children and have an advantage in developing multi-tasking skills.

In the Canadian study, researchers compared 104 six-year olds to measure their cognitive development. Some children were English speaking only. Others were Chinese-English bilinguals, French-English bilinguals, and Spanish-English bilinguals.

The experiments investigated the effects of language similarity, cultural background and educational experience on verbal and non-verbal abilities.

The children did a battery of tests that measured verbal development and one non-verbal task that measured executive control, in this case, the ability to focus attention where necessary without being distracted and then shift attention when required. The bilingual children demonstrated a superior ability to switch tasks.

"The results endorse the conclusion that bilingualism itself is responsible for the increased levels of executive control previously reported," the study's authors wrote.

To acquire language, bilingualism where the languages are similar in origin may have slight advantages, the researchers found. For example, Spanish-English bilinguals outperformed Chinese-English bilinguals and monolinguals on a test of awareness of the sound structure of spoken English.

Dr. Ellen Bialystok, one of the world's foremost experts on bilingualism among children, led the group of researchers from York University in analyzing the effects of bilingualism. Summarizing the results, Dr. Bialystok commented, "Our research has shown that reading progress amongst all bilingual children is improved" over monolingual children. In a separate statement, she said, "I think there's a lot of worry out there about other languages conflicting with a child's ability to learn to read in English, but that's absolutely not the case. Parents should not hesitate to share their native tongue with their children—it's a gift."

Because bilingualism is often tied to other factors such as culture, socioeconomic status, immigration history and language, the researchers partly took those into account by enrolling participants who all attended public schools and came from similar socio-economic backgrounds.

During the study, the children learned to read in both languages at the same time. Dr. Bialystok and her team thought that the additional time spent learning two languages might give the children an advantage. But, results showed that the advantages garnered by the children were independent of the instruction time in the other language.

Researchers noted in the online issue of the journal Child Development that "People always ask if the languages themselves matter and now we can definitively say no," study co-author, Dr. Bialystok, said in a release.

Learning a second language teaches children more about their first language. They understand the intricacies of grammar and acquire an additional awareness of how language is used to express thoughts.

The Canadian study was published in the February 8th, online issue of the journal Child DevelopmentThe study was funded by the U.S. National Institutes of Health.

Sources: http://www.cbc.ca/news/health/story/2012/02/08/bilingual-children-brain....

http://www.early-advantage.com/articles/learningtoread.aspx

Your Baby

Homemade or Commercial Baby Food- Which is Best?

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A new study from the U.K. looked at homemade baby food versus commercial baby food bought in grocery stores. They both come up winners in some categories and losers in others.

The researchers wanted to assess how well homemade and commercially available readymade meals designed for infants and young children met age specific national dietary recommendations.

Once thought to be the ideal baby food, homemade meals turned out to be higher in calories and fat and more time-consuming to prepare, but less expensive and higher in nutrients and variety. Commercial baby food came in more convenient, lower in calories, total fats and salt but was more expensive and lacked variety. Sugar content was about the same in both foods.

Each option had upsides and downsides. For example, home-cooked food had higher nutritional content, but 50% of homemade meals also exceed calorie recommendations, and 37% exceeded the recommendations for calories from fat, reported a research team led by Sharon Carstairs, a PhD student at the University of Aberdeen in Scotland.

Only 7% of the commercial baby food evaluated exceeded calorie recommendations, and less than 1% exceeded recommendations for calories from fat, Carstairs and colleagues reported in Archives of Disease in Childhood.

Researchers compared the store-bought meals with 408 recipes for home-cooked infant meals obtained from best-selling published cookbooks. The investigators entered the recipe ingredients into dietary analysis software to calculate the nutritional composition of the recipes per 100 grams.

A chief limitation of the study was that it only analyzed the recipes for homemade meals and did not take into account how these meals might be prepared in "real life."

"Parents may use cookbooks prescriptively or only as guidance, and thus the nutritional content of home-cooked recipes can vary greatly, and this can be augmented further by natural variations in the nutritional composition of raw ingredients," Carstairs and colleagues noted.

In addition, "the authors may have overestimated the values for salt within home-cooked recipes as it was often cited as optional; these results should thus be considered with caution."

The study reassures parents that it is okay to give homemade food to babies being weaned from breast milk or formula, Lauri Wright, PhD, of the University of South Florida College of Public Health and a spokesperson for the Academy of Nutrition and Dietetics, told MedPage Today.

"This is an important study, because in the United States parents think they have to do the commercial foods. Parents are afraid their child will miss out on nutrients if they don't give the specialized baby food."

The greater variety offered by homemade food may result in healthier taste preferences later in life, Wright added. "We used to think that taste preference developed at age 4 or 5, but we now know that taste preferences develop with the introduction of these first solid foods."

The bottom line from this study is that both types of baby food are acceptable; each comes with its own pros and cons. Just like with any other meal, how your homemade baby food is prepared is the key to whether it’s going to be healthy or not for baby. Understanding the guidelines for nourishing infant food and knowing the nutritional values of the foods you use, can help you prepare a wholesome meal for baby. Commercial baby foods also offer convenience and lower calories and fats. A mix of both will probably suit most families very well.

Story source: Medpage Today staff, http://www.medpagetoday.com/pediatrics/generalpediatrics/59228

 

 

Your Baby

Eating Chocolate While Pregnant May Improve Mom and Baby’s Health!

1:45

 Put another check in the win column for a reason to eat chocolate - as though anyone really needs one!

 A new study suggests that moms-to-be that eat a small piece of chocolate every day may improve their baby’s cardiovascular health and reduce the risk for preeclampsia.

 Researchers found that their findings held up regardless of whether the chocolate consumed contained high or low amounts of flavonoids, a group of phytochemicals that have antioxidant abilities. Various studies have also suggested that flavonoids may offer heart health benefits.

 As with most studies, the research did not prove that eating chocolate during pregnancy caused better circulatory health in pregnant women and their babies, only that there was an association.

 "Our observations suggest that a regular small consumption of dark chocolate -- whether or not the level of flavanol is high -- from the first trimester of pregnancy, could lead to an improvement of placental function," said study author Dr. Emmanuel Bujold. He is a professor of obstetrics and gynecology at Universite Laval in Quebec City, Canada.

 Bujold's team decided to see whether differences in flavanol content had any effect on the pregnancies of nearly 130 women.

 All of the women in the study were at the 11- to 14-week mark of their pregnancy, and carrying one child.

 All were instructed to consume 30 grams of chocolate (a little more than one ounce) each day over a 12-week period. That's equivalent to about one small square of chocolate per day, Bujold said.

 Half of the women consumed high-flavanol chocolate, while the other half was given low-flavanol chocolate. All were then tracked until their delivery date.

 Regardless of which type of chocolate was consumed, the women faced the same risk for both preeclampsia and routine high blood pressure. Placental weight and birth weight was also the same in both groups, the investigators found.

 Similarly, fetal and placental blood circulation levels, as well as in-utero blood velocity, did not appear to be affected by shifting flavanol levels.

 However, simply consuming a small amount of chocolate -- no matter what the flavanol content -- was associated with notable improvements in all blood circulation and velocity measures compared to the general population, the researchers said.

 Bujold said this suggests that there's something about chocolate, apart from flavanol levels, that may exert a positive influence on the course of pregnancy. Finding out exactly what that is "could lead to improvement of women's and children's health, along with a significant reduction of treatment cost," he said.

 While that’s good news for chocolate lovers, Bujold cautions that pregnant women keep the portion small and calorie intake low.

 So, a bit of chocolate daily while pregnant is not going to hurt you, in fact it just may give you and your baby’s health a little boost.

 The findings were scheduled for presentation at the Society for Maternal-Fetal Medicine's annual meeting, in Atlanta. The data and conclusions should be viewed as preliminary until published in a peer-reviewed journal.

 Source:  Alan Mozes, http://consumer.healthday.com/vitamins-and-nutrition-information-27/food-and-nutrition-news-316/small-square-of-chocolate-each-day-during-pregnancy-may-help-mom-and-baby-707736.html

Your Child

Child’s Chronic Cough Could Mean Something More Serious

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Children that continue to cough for weeks after an acute respiratory illness should be seen by their pediatrician and examined for the possibility of an underlying lung disease, according to a new study.

That’s one of the lessons from a Queensland, Australia, study of 839 children presenting to Emergency Room Departments with an acute respiratory illness.

The researchers found that 20 percent of the children still had a persistent cough when followed up 4 weeks later.

When those children were examined, 47 percent were diagnosed with protracted bacterial bronchitis.

When reviewed by a pulmonologist, 31% of the children with chronic cough were found to have an undiagnosed chronic lung disease, such as asthma, obstructive sleep apnea and bronchiectasis, a condition where the walls of the airway thicken as a result of chronic inflammation or infection.

The finding of high rates of chronic cough with an underlying disease shows the importance of making sure a child is examined early or has a follow up appointment if he or she continues coughing after a respiratory illness.

Lead author, Dr. Kerry-Ann O’Grady (PhD), an epidemiologist at the Centre for Children’s Health Research in Brisbane, said it was notable that one-third of the children with chronic cough, in the study, had wet cough — a key symptom of persistent lower airway bacterial infection.

If not treated promptly, the underlying conditions revealed in the reviews could lead to irreversible lung damage, she said.

“If you can knock it off and pick it up early in kids, then you’re likely to lead to long-term better health outcome.”

Story source: https://www.pharmacynews.com.au/News/Latest-news/Why-you-should-never-ignore-kids-with-chronic-coug

Your Child

2 Doses of Chickenpox Vaccine Almost 100 Percent Effective

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Chickenpox is one of the most common childhood illnesses. It is a viral infection caused by the Varicella zoster virus and produces a painful, itchy rash with small, fluid-filled blisters.

It occurs most often in early spring and late winter and is highly contagious. Typically, chickenpox occurs in kids between 6 and 10 years of age.

A new study shows that among schoolchildren, two doses of the chickenpox vaccine is more effective than one.

Giving the first dose at age 1 and the second dose at ages 4 to 6 is nearly 100 percent effective in preventing the once common childhood disease, researchers have found.

"A second dose of varicella [chickenpox] vaccine provides school-aged children with better protection against the chickenpox virus, compared to one dose alone or no vaccination," said lead researcher Dana Perella, of the Philadelphia Department of Public Health.

Two doses of the vaccine protected against the moderate to severe chickenpox infections that can lead to complications and hospitalizations, she said.

Before routine chickenpox vaccination began in 1995, virtually all children were infected at some point, sometimes with serious complications. About 11,000 children were hospitalized each year for chickenpox, and 100 died annually from the disease, according to the CDC.

One-dose vaccination greatly reduced incidence of chickenpox, but outbreaks continued to be reported in schools where many kids had been vaccinated. That led the CDC in 2006 to recommend a second vaccine dose.

To evaluate effectiveness of the double- dose regimen, Perella and colleagues collected data on 125 children with chickenpox in Philadelphia and northern Los Angeles and compared them with 408 kids who had not had the disease.

They found that two doses of the vaccine was slightly more than 97 percent effective in protecting kids from chickenpox.

"With improved protection provided by two-dose varicella vaccination compared with one-dose only, continued decreases in the occurrence of chickenpox, including more severe infections and hospitalizations, are expected as more children routinely receive dose two between the ages of 4 and 6 years," Perella said.

For children with weakened immune systems that cannot take the vaccine, having their classmates and playmates protected by the vaccine helps protect them against the viral infection.

School vaccine requirements should include two-dose varicella vaccination, Perella said.

"In addition, 'catch-up' varicella vaccination is also important," she said. This applies to anyone over 6 who haven’t had a second vaccine dose, especially if they could be exposed to chickenpox or shingles - a painful condition in older people caused by reactivation of the chickenpox virus, she said.

Most healthy children who get chickenpox do not have serious complications from the illness. But there are cases when chickenpox has caused hospitalization, serious complications and even death.

A child may be at greater risk for complications if he or she:

·      Has a weakened immune system

·      Is under 1 year of age

·      Suffers from eczema

·      Takes a medication called salicylate

·      Was born prematurely

The report was published online March 14 and will appear in the April print issue of the journal Pediatrics.

Story sources: Steven Reinberg, http://www.webmd.com/children/news/20160314/two-dose-chickenpox-shot-gets-the-job-done-study-shows

http://www.parents.com/health/vaccines/chicken-pox/chickenpox-facts/

Your Baby

Does Your Unborn Baby Hear You?

2.00 to read

More than twenty years ago I remember reading that fetuses can learn to recognize their mothers and father’s voices and then respond to those voices as newborns. I thought… well maybe… but it seemed to me that voices from outside of the womb would sound muffled from inside. Of course, I don’t remember my in utero experience so I don’t really know how words sound.

Over the years though, scientists have continued to examine how and what babies learn before they are born.

A recent study by researchers at the University of Helsinki in Finland have determined that fetuses not only hear and recognize voices but they can become familiar with different words and different pitches used when saying those words.

The study involved 33 moms-to-be, and examined their babies after birth. While pregnant, 17 mothers listened at a loud volume to a CD with (2), four-minute sequences of the made-up words “tatata” or “tatota.” The words were said with several different pitches. The moms-to-be listened to the recordings beginning at 29 weeks of pregnancy -about 7 months along- until birth. They heard them around 50 to 71 times.

Following birth, researchers tested the babies for normal hearing and then performed an electroencephalograph (EEG) brain scan to see if the newborns would respond to the made-up words and different pitches. And sure enough, the brain scans showed increased activity from the babies who had been listening to the CD in utero when the words were played to them after birth. Not only did they respond to the words, but also seemed to recognize the different pitches used when they heard them.  

The babies born to the mothers who had not listened to the CDs while pregnant showed little reaction to the words or pitches.

 “We have known that fetuses can learn certain sounds from their environment during pregnancy,” Eino Partanen, a doctoral student and lead author on the paper, said via email.

“We can now very easily assess the effects of fetal learning on a very detailed level—like in our study, [we] look at the learning effects to very small changes in the middle of a word.”

Some experts believe the finding shows that not only can a third-trimester fetus hear and recognize voices; he or she can also detect subtle changes and process complex information.

“Interestingly, this prenatal exposure also helped the newborns to detect changes which they were not exposed to: the infants who have received additional prenatal stimulation could also detect loudness changes in pseudo words but the unexposed infants could not,” Partanen says.

“However, both groups did have responses to vowel changes (which are very common in Finnish, and which newborns have been many time previously been shown to be capable of).”

You may be wondering why is it even important that scientists know if fetuses can recognize voices or words.  Partanen says because sounds heard in utero may shape the developing human brain in ways that affect speech and language development after birth.

“The better we know how the fetus’ brain works, the more we’ll know about early development of language,” Partanen says. “If we know better how language develops very early, we may one day be able to develop very early interventions [for babies with abnormal development].” 

An abstract for the Finnish study is published on the Proceedings of the National Academy of Sciences website.

Does talking and singing to your baby before it’s born actually stimulate his or her brain activity and increase language learning? Some experts say definitely yes, others say it has no impact. But really, most moms and dads enjoy baby bump bonding whether it’s productive or not. And who knows, maybe your pre-born hears you loud and clear. 

Source: Meghan Holohan, http://www.nbcnews.com/health/unborn-babies-are-hearing-you-loud-clear-8C11005474

Your Child

More PE in School Linked to Higher Math Scores

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Students in the Washington D.C. school system who spent more time doing physical activity also increased their standardized math scores significantly, according to a new study American University study.

A law passed in 2010, requires D.C. students to adhere to certain requirements regarding nutrition and physical activity at school to receive federal funding. They are also obligated to report how they implement these programs.

“This finding demonstrates that students’ academic performance improves when there’s a balance between time spent on physical education and time spent on learning,” said Stacey Snelling, dean of American University’s School of Education.

The study divided the city’s elementary schools into four groups based on how much physical education they offered: the lower 25 percent, lower-middle 25 percent, upper-middle 25 percent and upper 25 percent.

The researchers then took the average DC CAS math proficiency score, from the 2012-2013 school year, for each of these four groups and found that schools offering more physical activity posted higher math scores.

The upper 25 percent had an average of 151 minutes of physical education and saw an average math proficiency rate of 56.66. The lower 25 percent had an average of 29 minutes of physical education per week and an average math proficiency rate of 47.53. Some of the findings also were published in the academic journal Appetite. 

Researchers graded each school on how it implemented various aspects of the legislation — including building school gardens, serving healthy lunches and offering ample physical education time — on a 33-point scale. They found that, despite socioeconomic differences, there were no significant variations in how schools performed on the 33-point-scale across the District’s eight wards.

There were certain limitations pointed out in the findings. Researchers said that the data is based on schools’ self-reporting – which can leave room for errors. Several schools have also closed and opened during the five –year study, yielding inconsistent data.

D. C. Council member Mary M. Cheh (D-Ward 3), who authored the original 2010 legislation, applauded the report’s findings, adding that although schools effectively provided more nutritious lunches, there is still more room for more physical ­activity.

“When children are fed and they are not hopping all around because their hungry, they’re better learners, and that’s translated throughout,” Cheh. “I was impressed with the findings.”

More schools across the country are taking a second look at adding back PE to students’ school week. Many schools have cancelled PE classes in order to use that time to prepare students for testing. As study after study comes in pointing out the benefits, including higher test scores, of children engaging in some sort of physical activity during the school day, school administrations are beginning take notice.

Source: Perry Stein, https://www.washingtonpost.com/news/education/wp/2016/02/09/is-more-physical-education-at-school-linked-to-higher-student-math-scores/

 

Your Baby

Should Newborns Sleep in Yours or Their Own Room?

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It’s an age-old question, should your newborn sleep in his or her own bed in the parents’ bedroom for a while or start their sleeping habits in their own room?

A new study suggests infants benefit from sleeping in their own room, but the American Academy of Pediatrics (AAP) says the dangers may offset the benefit.

Recent research from a hospital in Philadelphia says babies go to sleep earlier, take less time to fall asleep, get more total sleep over the course of 24 hours, and spend more time asleep at night when they don’t share a bedroom with their parents. Parents also report that they get more rest as well.

“There are a number of possible reasons that babies sleep better in their own room,” said lead study author Jodi Mindell, associate director of the Sleep Center at the Children’s Hospital of Philadelphia. 

“One main reason is that they are more likely to self-soothe to sleep,” Mindell said by email.

During the study, researchers found that parents who put babies to sleep in a separate room were less likely to feed infants to help them fall asleep at bedtime or when they awoke during the night.

When babies had their own rooms, parents also perceived bedtime to be less difficult.

The study focused on infants 6 to 12 months old. Researchers examined data from a questionnaire completed by parents of 6,236 infants in the U.S. and 3,798 babies in an international sample from Australia, Brazil, Canada, Great Britain and New Zealand. All participants were users of a publicly available smartphone app for baby sleep. The researchers noted that because of the use of the smartphone app, results might not be the same for a larger population of households.

The AAP recommends that newborns sleep in their own bed in their parents’ bedroom till the infant is at least 6 months of age to minimize the risk of sleep-related death. Ideally, babies should stay in their parents’ rooms at night for a full year, AAP advised 

The reason for the AAP recommendation is because babies sleeping in the same room as parents, but not the same bed, may have a lower risk of sudden infant death syndrome (SIDS).

The safest spot for infant sleep is on a firm surface such as a crib or bassinet without any soft bedding, bumpers or pillows, the guidelines stressed. 

“Pediatric providers have been struggling with what to tell parents since the release of the AAP recommendations,” Mindell said. “Once a baby is past the risk of SIDS, by 6 months of age, parents need to decide what works best for them and their family, which enables everyone in the family to get the sleep they need.”

SIDS deaths occur most often from birth to six months but can also happen in older babies that were the focus on the study, said Dr. Lori Feldman-Winter, a coauthor of the AAP guidelines and pediatrics researcher at Cooper Medical School of Rowan University in Camden, New Jersey. 

“If the only goal is to increase sleep, then the results may be compelling,” Feldman-Winter said in an email to Reuters Health. “However, since we don’t know the causes of SIDS and evidence supports room sharing as a method to decrease SIDS, giving up some sleep may be worth it.”

The study was published online in the journal Sleep Medicine.

Story source: https://www.reuters.com/article/us-sleep-infants-location/parents-find-older-babies-sleep-better-in-their-own-room-idUSKCN1BC5QI

 

Your Child

New Guidelines for Tonsillectomies

Most children who get repeated throat infections probably don’t need surgery to remove their tonsils and would improve in time with careful monitoring, according to new clinical guidelines on tonsillectomies in children.

The new guidelines also suggest, however, that removal of the tonsils, or tonsillectomy, may improve problems tied to poor sleep, including bed-wetting, slow growth, hyperactive behavior, and poor school performance. In fact, sleep-disordered breathing -- a set or problems that range from snoring to obstructive sleep apnea - is now the most common reason for tonsil removal in kids younger than 15. “We used to think that only if you were an air traffic controller did it matter if you slept well or not, and now we know that’s not the case,” says Amelia F. Drake, MD, chief of the division of pediatric otolaryngology at the University of North Carolina School of Medicine in Chapel Hill. More than half a million tonsillectomies are performed each year on children in the U.S., making it the second most common surgery in this age group, just behind procedures to place tubes in the ears to relieve recurrent ear infections. Despite the fact that it is a mainstay of American medicine, experts have long disagreed about how useful or appropriate tonsillectomies may be. The new guidelines, published Monday by the American Academy of Otolaryngology - Head and Neck Surgery, are the first set of official recommendations on tonsillectomy published in the U.S. The guidelines aim to give doctors and parents more information about when tonsillectomy may be warranted and to help minimize the risks and pain of this procedure in young patients. “I thought they were very comprehensive,” says Drake, who reviewed the new recommendations but was not involved in drafting them. “This is an area where improvements and refinements can have a huge impact. This is medicine at its core.” New Criteria for Removing Tonsils The guidelines update a set of clinical indicators for tonsillectomies published in 2000 by the American Academy of Otolaryngology, which suggested that doctors could consider taking out the tonsils if a child had at least three cases of swollen and infected tonsils in a year. The new guideline, however, says that kids should have at least seven episodes of throat infection, such as tonsillitis or strep throat in a year, or at least five episodes each year for two years, or three episodes annually for three years, before they become candidates for surgery, and that those infections should be documented by a doctor, rather than just reported by parents. The idea, experts said, was to reserve surgery only for the most severely affected, because the surgery can rarely have serious complications including infections and serious bleeding. “Children who have fewer episodes really aren’t going to see a lot of benefit,” says Jack L. Paradise, MD, professor emeritus of pediatrics at the University of Pittsburgh School of Medicine. “There aren’t many kids, overall, who meet those stringent criteria,” Paradise says. What’s more, Paradise, and other experts stress, that even children who satisfy the guidelines shouldn’t get an automatic green light for surgery. “I’m not sure, if I had a child that met all the criteria, that I’d automatically subject the child to the consequences of that,” Paradise says, “Post-operatively, it’s a very painful procedure.” The tonsils are cone-shaped lumps of tissue embedded in the throat, and they are believed to play a role in how the body responds to infections, though experts aren’t exactly sure how. But in the early part of the 20th century, the tonsils were blamed as the “focus of infection” in the body, and doctors began taking them out as a way to promote good health. The operation became so common for example, that entire classrooms of youngsters would get their tonsils taken out at school. But by the 1970s, many experts were questioning how effective and appropriate it was to subject kids to a painful operation that could have rare but serious complications; all for what new research suggested were minimal improvements in the risk of sore throats. At the same time, however, doctors were starting to become more aware of the myriad problems tied to sleep disordered breathing in children, a spectrum of problems that can range from snoring to obstructive sleep apnea. And more tonsils began to be taken out as a way to open up the airway and improve sleep. Improvement in Care for Kids Having Surgery Several of the guidelines suggest ways doctors and parents can improve the care of children having tonsillectomies. One of the strongest recommendations is against the use of antibiotics just before or just after surgery. “They are commonly given, and there’s no evidence that antibiotics offer any benefit,” says study researcher Reginald F. Baugh, MD, professor and chief of otolaryngology at the University of Toledo Medical Center in Ohio. “You run the risk of allergic reactions and there are the harms of over-prescribing.” In drafting the statement that advises doctors to counsel parents about the importance of pain management in kids after surgery, Baugh says the panel that reviewed the evidence behind the guidelines was alarmed to learn that many parents don’t give medications to control pain after the procedure. “That was one thing we really learned, about the importance of telling parents about the need to give pain meds in these kids,” Baugh says.

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