THE GALE ENCYCLOPEDIA OF CHILDREN'S HEALTH: INFANCY THROUGH ADOLESCENCE
EYE AND SKIN INFECTIONS ARE GENERALLY TREATABLE WITH PROPER MEDICATION ALTHOUGH MOST CASES OF BRAIN INFECTION WITH ACANTHAMOEBA HAVE BEEN FATAL A FEW PATIENTS HAVE RECOVERED FROM THE INFECTION WITH EYE INFECTIONS MAY BE PREVENTED BY USING COMMER CIALLY PREPARED CONTACT LENS CLEANING SOLUTION RATHER THAN MAKING HOMEMADE SOLUTIONS THERE IS LITTLE THAT CAN BE DONE TO PREVENT SKIN AND BODY INFECTION INJURY FROM AN ACCIDENT IS ONE OF THE MAJOR REASONS FOR A CHILDHOOD EMERGENCY ROOM VISIT AND TRAUMA IS THE LEADING CAUSE OF DEATH IN CHILDREN OVER ONE YEAR OF AGE ACCORDING TO THE NATIONAL SAFETY COUNCIL AND THE NATIONAL CENTER FOR INJURY PREVENTION AND CONTROL EACH YEAR MORE THAN 28 000 DEATHS AND ALMOST SEVEN MILLION INJURIES OCCUR FROM ACCIDENTS IN THE HOME THIS MEANS THAT A DEATH OCCURS EVERY 19 MINUTES FROM A HOME ACCIDENT AND A DISABLING INJURY EVERY VE THE TYPES OF TRAUMA THAT CAUSE DEATH IN CHILDREN IN ORDER OF FREQUENCY ARE 1 MOTOR VEHICLE ACCIDENTS 2 DROWNING 3 BURNS 4 POISONINGS 5 REARMS 6 FALLS MEDICATION FOUND IN MANY OVER THE COUNTER PAIN RELIEVERS THAT IS EFFECTIVE FOR PAIN RELIEF BUT NOT FOR IN AMMATION IT IS OFTEN PRESCRIBED AS A FEVER REDUCER EASIER ON THE STOMACH THAN EITHER ASPIRIN OR IBUPROFEN IT DOES NOT SIGNI CANTLY PROLONG BLEEDING THEREFORE CHILDREN WHO ARE ABOUT TO HAVE A MEDICAL PROCEDURE THAT MAY CAUSE BLEEDING SUCH AS TOOTH EXTRACTIONS OR CHILDREN WHO HAVE FREQUENT NOSEBLEEDS OR OTHER BLEEDING PROBLEMS CAN SAFELY TAKE ACETAMINOPHEN FOR PAIN RELIEF ON THE OTHER HAND SOME PEDIATRICIANS WORRY THAT PARENTS ARE OVERMEDICATING THEIR CHILDREN AND RISKING AN OVERDOSE BY GIVING THEIR CHILDREN ACETA MINOPHEN WHENEVER THEY RUN A FEVER IN FACT EVEN FEVER OF 102 F MAY NOT BE DANGEROUS TO A SMALL CHILD SINCE FEVER IS A NORMAL RESPONSE TO AN INFEC TION AND NO CAUSE FOR ALARM A TYPICAL DOSE OF ACET AMINOPHEN FOR A CHILD IS 10 TO 15 MG PER KG TO A MAXIMUM OF 1 GRAM TWO 500 MG TABLETS WHILE MOST PARENTS BELIEVE THAT CHILDREN S ACETA MINOPHEN IS PERFECTLY SAFE BECAUSE IT IS A NONPRE SCRIPTION MEDICATION IT DOES POSE A SPECIAL RISK IN CHILDREN AN OVERDOSE OR EVEN A NORMAL DOSE COMBINED WITH OTHER MEDICATIONS OR WHEN A CHILD HAS NOT EATEN CAN OVERWHELM THE CHILD S LIVER IN EXTREME CASES THE LIVER MAY BE DAMAGED BEYOND AN OVERDOSE TYPICALLY CAUSES NAUSEA VOMITING AND LOSS OF APPETITE ALL OF WHICH USUALLY DISAPPEAR IN A DAY OR TWO HOWEVER IT IS DURING THIS TIME THAT LIVER FAILURE MAY BE OCCURRING LIVER DAMAGE CAN BE REVERSED WITH INTRAVENOUS ADMINISTRATION OF AN ANTIDOTE IF GIVEN IN TIME ACHIEVEMENT TESTS ARE STAN DARDIZED MEASURES OF KNOWLEDGE INFORMATION OR PROCEDURAL LEARNING SUCH AS HOW TO DO SOME THING THIS TYPE OF ASSESSMENT IS USED TO MEASURE STUDENT LEARNING IN COMPARISON TO A NORM ACHIEVEMENT TESTS MAY ASSESS GENERAL ACADEMIC SKILL AREAS SUCH AS READING WRITING OR MATHEMAT ICS OR THEY MAY TEST FOR CONTENT KNOWLEDGE IN A SPECI C ACADEMIC SUBJECT SUCH AS BIOLOGY OR AMER ICAN HISTORY ACHIEVEMENT TESTS ARE USED BY SCHOOL SYSTEMS TO PROVIDE A STANDARD MEASURE OF INDIVID UAL STUDENT PERFORMANCE AND TO PROVIDE AN AGGRE GATED MEASURE OF PERFORMANCE THAT ENABLES SCHOOL SYSTEMS TO EVALUATE THEIR EFFECTIVENESS ACHIEVE MENT TESTS ARE ALSO USED AS PART OF THE DIAGNOSTIC ASSESSMENT OF INDIVIDUALS TO DETERMINE WHETHER THEY HAVE A LEARNING DISABILITY AND THEREFORE QUAL IFY FOR SPECIAL EDUCATION SERVICES THE MOST COMMON SKIN DISEASE IN THE UNITED STATES THIS VERY COMMON IN AMMATORY REACTION IN OIL PRODUCING FOLLICLES USUALLY APPEARS ON THE FACE SHOULDERS AND BACK WHILE MOST COM MON DURING THE TEENAGE YEARS IT MAY ALSO AFFECT NEWBORNS BECAUSE IT CAN LEAD TO PERMANENT SCAR RING ON THE FACE ACNE CAN HAVE PROFOUND AND LONG LASTING PSYCHOLOGICAL EFFECTS IN BOYS ACNE USUALLY BEGINS IN EARLY ADOLES CENCE TENDS TO BE MORE SEVERE THAN IN GIRLS AND IMPROVES IN THE EARLY TO MID TWENTIES IN GIRLS ACNE USUALLY BEGINS IN THE MID TEENS AND IS OFTEN LESS SEVERE IN SOME INDIVIDUALS THE PROBLEM CAN CONTINUE INTO ADULTHOOD ACNE IS NOT CAUSED BY DIET CHOCOLATE OR FATS DIRT OR SURFACE OIL NORMALLY OIL IS PRODUCED IN GLANDS IN THE SKIN TRAVELING UP TO THE HAIR FOLLICLES AND OW ING OUT ONTO THE SURFACE OF THE SKIN WHEN OIL GLANDS WITHIN THE HAIR FOLLICLES ARE STIMULATED AND BEGIN TO ENLARGE USUALLY AS A RESULT OF HORMONAL CHANGES AT PUBERTY THEY BEGIN TO PRODUCE MORE OIL ACNE BACTERIA PROPIONIBACTERIUM ACNES INSIDE THE FOLLICLES MULTIPLY AND PRODUCE FATTY ACIDS WHICH IRRITATE THE LINING OF THE PORES AT THE SAME TIME THE NUMBER OF THICKER CELLS IN THE LINING OF THE PORES INCREASES AND THEY CLUMP TOGETHER NARROW ING AND CLOGGING THE PORE OPENINGS WITH OIL SKIN CELLS AND DEBRIS AS THE PRESSURE BUILDS WITHIN THESE CLOGGED PORES THE CONSTANT PRODUCTION OF OIL TOGETHER WITH IRRITATION FROM BACTERIA RUPTURES THE PORE WALLS WHEN THE OIL PATHWAY GETS BLOCKED AND THE PLUG PUSHES UP TO THE SURFACE IT CAUSES A BLACKHEAD COMEDO WHEN THE OPENING IS VERY TIGHTLY CLOSED THE MATERIAL BEHIND IT CAUSES A WHITEHEAD WHILE THERE ARE MANY FACTORS BEHIND THE IN AM MATORY CHANGES SEEN IN ACNE ONE OF THE MOST IMPORTANT IS THE DIFFERENT LEVELS OF BACTERIA FOUND ON THE SKIN WHILE ACNE IS NOT A BACTERIAL INFECTION EXPERTS BELIEVE THAT IN AMMATION RESULTS FROM THE BY PRODUCTS RELEASED BY THE BACTERIUM PROPIONIBAC TERIUM ACNES FOUND DEEP IN THE FOLLICLE EMOTIONAL STRESS COSMETICS GENETICS AND CER TAIN DRUGS SUCH AS BIRTH CONTROL PILLS MAY WORSEN THE CONDITION ESTROGEN HOWEVER WILL IMPROVE ACNE IS HEREDITARY AND THE TENDENCY TO DEVELOP IT RUNS IN FAMILIES IF BOTH PARENTS HAVE ACNE THEN THREE OUT OF FOUR OF THEIR CHILDREN WILL ALSO HAVE ACNE OIL IN COSMETICS ALSO CAN CONTRIBUTE TO ACNE WHICH IS WHY MAKEUP SHOULD BE WASHED OFF EACH THERE ARE EXCELLENT TYPES OF THERAPY FOR ALL KINDS OF ACNE INCLUDING TOPICAL TREATMENT ANTIBIOTICS AND HORMONAL MANIPULATION MOST TEENAGERS BENE T FROM A COMBINATION OF PEELING THE SKIN DESTROYING BACTERIA AND APPLYING PRODUCTS THAT AFFECT WHITE HEADS AND BLACKHEADS TREATMENTS SHOULD BEGIN WITH SOAP AND WATER CLEANSING EVERY NIGHT WITH A GOOD DIET AND REGU LAR EXERCISE FOR MILDER CASES MEDICATIONS CONTAIN ING BENZOYL PEROXIDE 5 PERCENT OR THOSE CONTAINING SULFUR OR A COMBINATION OF SULFUR AND RESORCINOL OR SALICYLIC ACID ARE EFFECTIVE SINCE OIL BUILDUP ATTRACTS BACTERIA AND THE BAC TERIA S FATTY ACIDS IRRITATE THE SKIN ONE OF THE BEST WAYS TO GHT ACNE IS TO KILL THE BACTERIA THOSE PRODUCTS THAT ARE EFFECTIVE IN TREATING ACNE ACTUALLY CUT DOWN THE OIL PRODUCTION OF THE GLANDS SLIGHTLY AND DESTROY BACTERIA IN THE FOLLICLE THE MOST POP ULAR ANTIBIOTICS IN THE TREATMENT OF ACNE ARE TETRA CYCLINE MINOCYCLINE AND ERYTHROMYCIN FOR MILDER CASES ANTIBIOTICS CAN BE USED DIRECTLY ON THE SKIN FOR MORE ADVANCED CASES THEY ARE TAKEN RETIN A A DRUG RELATED TO VITAMIN A IS AN EFFEC TIVE TREATMENT FOR WHITEHEADS AND BLACKHEADS IT IS OFTEN COMBINED WITH BENZOYL PEROXIDE OR ANTIBI OTICS THOSE WITH THE MOST SEVERE TYPES OF ACNE MAY BE GIVEN A STRONGER VITAMIN A RELATED DRUG CALLED ACCUTANE ISOTRETINOIN THIS DRUG HAS MORE SERIOUS SIDE EFFECTS INCLUDING BIRTH DEFECTS AND REQUIRES STRICT MEDICAL SUPERVISION IT S POSSIBLE THAT SOME CASES OF ACNE CAN BE CON TROLLED BY REGULATING THE ANDROGEN ESTROGEN HOR MONE BALANCE IN THOSE GIRLS WHO HAVE AN INCREASED ACTIVITY OF THE ENZYME THAT CONVERTS TESTOSTERONE A MALE HORMONE INTO A MORE POTENT FORM THAT AFFECTS THE OIL GLANDS SINCE ANDROGEN HAS BEEN IMPLICATED IN THE INCREASED SECRETION OF OIL THAT STARTS A BLEMISH ANDROGEN BLOCKERS THAT REDUCE THE SIZE OF OIL GLANDS MAY HELP GIRLS WHOSE ACNE IS ASSO CIATED WITH OTHER CHANGES SUCH AS EXCESSIVE HAIR GROWTH OR BALDING THESE DRUGS COULD BE IN THE FORM OF HIGH ESTROGEN BIRTH CONTROL PILLS STEROIDS ARE VERY EFFECTIVE FOR IN AMMATORY OR CYSTIC ACNE WHEN INJECTED INTO A LESION THIS CAN HEAL THE CYST IN ABOUT 24 HOURS ACNE IS NOT UNUSUAL AMONG NEW BORNS IT IS TRIGGERED BY HORMONES PASSED FROM THE MOTHER BEFORE BIRTH THE HORMONES CAUSE THE GLANDS IN THE SKIN TO PRODUCE OIL IF THESE GLANDS BECOME BLOCKED AND IN AMED WHITEHEADS AND PIMPLES MAY DEVELOP ON THE NEWBORN S FACE NEWBORN ACNE USUALLY CLEARS UP ON ITS OWN IN THREE OR FOUR MONTHS IF IT IS TROUBLESOME OR PER SISTENT A PEDIATRICIAN MAY PRESCRIBE A TOPICAL MED ICATION CONTRARY TO POPULAR BELIEF INFANT ACNE IS NOT ASSOCIATED WITH THE DEVELOPMENT OF ACNE IN ADOLESCENCE RARELY HOWEVER INFANTILE ACNE BECOMES SEVERE AND PERSISTS FOR MONTHS OR EVEN A FEW YEARS THIS IS USUALLY ASSOCIATED WITH A FAMILY HISTORY OF ACNE USUALLY IN THE FATHER AND IS OFTEN FOLLOWED BY SEVERE ACNE IN ADOLESCENCE A DOCTOR SHOULD EVALUATE THE SKIN CONDITION SO AS TO RULE OUT BOTH SEBORRHEA DERMATITIS AND MILIARIA ACQUIRED IMMUNODEFICIENCY SYNDROME AN ANTIVIRAL DRUG INTRO DUCED IN 1982 THAT IS USED TO TREAT VIRUSES CAUSING CHICKEN POX SHINGLES OR HERPES SIMPLEX INFECTION IT IS OF CIALLY APPROVED FOR THE ACUTE MANAGEMENT OF CHICKEN POX IN CHILDREN FOR WHICH IT CAN SLIGHTLY DECREASE THE SEVERITY AND DURATION OF THE INFECTION TO BE EFFECTIVE THERAPY MUST BE STARTED WITHIN HOURS OF THE ONSET OF THE RASH ITS EFFECT ON THE SUB SEQUENT DEVELOPMENT OF SHINGLES IS NOT KNOWN WHEN ACYCLOVIR IS GIVEN IN TIME IT DECREASES ITCHING THE NUMBER OF LESIONS AND THE TIME UNTIL CRUSTING BY THE THIRD DAY ALL TREATED CHILDREN COMPARED TO 75 PERCENT OF UNTREATED CHILDREN HAVE NO FEVER ACYCLOVIR DOES NOT WORK IF GIVEN AFTER THE RST 24 HOURS PAST THE START OF THE RASH ALTHOUGH ACYCLOVIR CAN DECREASE THE DURATION AND SEVERITY OF VARICELLA IT SHOULD NOT BE GIVEN ROU TINELY TO CHILDREN WHO ARE OTHERWISE HEALTHY ACY CLOVIR IS NOT INDICATED IN YOUNGSTERS UNDER AGE TWO CURRENTLY NO DATA INDICATE THAT TREATING CHICKEN POX WITH ACYCLOVIR HASTENS THE RETURN OF CHILDREN TO SCHOOL OR PARENTS TO WORK THE RATE OF DEVELOP MENT OF COMPLICATIONS HAS NOT BEEN DIMINISHED BY ACYCLOVIR HAS ALSO BEEN USED TO PREVENT THE DEVELOPMENT OF CHICKEN POX IN FAMILIES IN WHICH ONE CHILD HAS DEVELOPED A RASH BEFORE OTHERS IN ONE STUDY ACYCLOVIR GIVEN TO EXPOSED CHILDREN SEVEN TO NINE DAYS AFTER EXPOSURE FOR SEVEN DAYS PROTECTED 84 PERCENT OF CHILDREN WHO DID NOT DEVELOP OVERT SYMPTOMS THE AMERICAN ACADEMY OF PEDIATRICS RECOM MENDS AGAINST THE ROUTINE USE OF ACYCLOVIR IN CASES OF UNCOMPLICATED CHICKEN POX IN OTHERWISE HEALTHY CHILDREN THE AAP DOES RECOMMEND ACY CLOVIR FOR SUSCEPTIBLE TEENAGERS WHO ARE NOT PREG NANT OR FOR THOSE CHILDREN OVER 12 MONTHS OF AGE WHO ARE RECEIVING LONG TERM SALICYLATE THERAPY BECAUSE OF THE RISK OF REYE S SYNDROME IN THOSE WITH CHRONIC PULMONARY OR SKIN PROBLEMS AND IN THOSE RECEIVING AEROSOLIZED CORTICOSTEROIDS HOW EVER THE BENE TS OF THERAPY IN THESE GROUPS HAS NOT BEEN PROVEN ADVERSE EFFECTS FROM ACYCLOVIR ARE UNCOMMON TAKEN BY MOUTH THE DRUG MAY RARELY CAUSE STOM ACH PROBLEMS HEADACHE DIZZINESS OR NAUSEA AND VOMITING THE OINTMENT MAY CAUSE SKIN IRRITATION OR RASH VERY RARELY ACYCLOVIR INJECTIONS MAY LEAD TO KIDNEY DAMAGE SEE ATTENTION DEFICIT HYPERACTIVITY DIS A STIMULANT MEDICATION PRESCRIBED FOR ATTENTION DEFICIT HYPERACTIVITY DISORDER ADHD THAT IS A COMBINATION OF DEXTRAMPHETAMINE AND AMPHETAMINE ADDERALL CAN BE USED IN CHILDREN OVER THE AGE OF THREE THE DRUG CAN IMPROVE ATTENTION SPAN AND DECREASE DISTRACTIBILITY AND MAY DECREASE IMPULSIV ITY STUBBORNNESS AND AGGRESSION THE DRUG ONLY NEEDS TO BE TAKEN ONCE OR TWICE A DAY WHILE THE EFFECTS MAY BE NOTED IMMEDIATELY IT MAY TAKE UP TO SIX WEEKS TO ACHIEVE ITS FULL BENE T ADDERALL IS USUALLY PRESCRIBED AS PART OF A TREAT MENT PLAN THAT INCLUDES EDUCATIONAL AND PSYCHOSO CIAL TREATMENT IT IS SOMETIMES PRESCRIBED IN CASES IN WHICH RITALIN OR OTHER STIMULANT MEDICATIONS HAVE BEEN INEFFECTIVE BECAUSE IT HAS A FAIRLY SLOW ONSET OF ACTION THERE MAY BE LESS CHANCE OF ADDER ALL CAUSING OR WORSENING TICS ADDERALL HAD EARLIER BEEN APPROVED AND MAR KETED BY ANOTHER COMPANY UNDER A DIFFERENT NAME OBETROL AS A WEIGHT CONTROL MEDICATION THE MANUFACTURER WAS TAKEN OVER BY ANOTHER COMPANY WHICH RENAMED THE PRODUCT ADDERALL IN 1994 THE DRUG WAS APPROVED FOR THE TREATMENT OF ADHD AND REINTRODUCED IN 1996 AS ADDERALL MOST COMMON SIDE EFFECTS INCLUDE APPETITE AND WEIGHT LOSS INSOMNIA AND HEADACHE LESS FRE QUENTLY A PATIENT MAY EXPERIENCE DRY MOUTH AND NAUSEA RARE SIDE EFFECTS INCLUDE DIZZINESS IRRITABIL ITY STOMACH PAIN INCREASED HEART RATE OR HALLUCI NATIONS AS WITH MOST STIMULANTS INDICATED FOR ADHD THERE IS A POSSIBILITY OF GROWTH SUPPRESSION AND THE POTENTIAL FOR TRIGGERING MOTOR TICS AND TOURETTE S SYNDROME IN RARE CASES WORSENING OF PSYCHOSIS HAS BEEN REPORTED AS WITH ALL OTHER STIMULANTS USED IN TREATING ADHD ONE OF THE MORE TROUBLESOME SIDE EFFECTS IS A DECREASE IN BRAIN GROWTH ALTHOUGH THERE IS SOMETHING OF A REBOUND EFFECT ONCE THE CHILD IS REMOVED FROM THE DRUG THE REBOUND GENERALLY DOES NOT BRING THE CHILD BACK TO THE SAME LEVEL ON THE BRAIN GROWTH CHARTS PRIOR TO DRUG TREATMENT ADDERALL SHOULD NOT BE TAKEN WITH MONOAMINE OXIDASE INHIBITORS MAOI BECAUSE SERIOUS EVEN FATAL INTERACTIONS CAN OCCUR AT LEAST 14 DAYS MUST PASS BETWEEN TAKING MAOIS AND ADDERALL ACIDIFY ING AGENTS SUCH AS GUANETHIDINE RESERPINE AND FRUIT JUICES CAN INTERFERE WITH THE ABSORPTION OF ADDERALL WHEREAS SUBSTANCES SUCH AS DIAMOX ACETAZOLAMIDE INCREASE ABSORPTION TRICYCLIC ANTI DEPRESSANTS SUCH AS TOFRANIL BECOME MORE POTENT WHEN TAKEN WITH ADDERALL THORAZINE CHLORPRO MAZINE LITHIUM AND HALDOL HALOPERIDOL CAN INTERFERE WITH THE EFFECT OF ADDERALL ADENOIDS ARE SMALL LUMPS OF LYMPHATIC TISSUE NESTLED ABOVE THE TONSILS THAT HELP PROTECT AGAINST UPPER RESPIRATORY TRACT INFECTIONS ADENOID DISORDERS ALSO KNOWN AS ADENOIDISM OR ADENOIDITIS OCCUR WHEN THE ADENOIDS BECOME SWOLLEN MAKING IT HARD TO BREATHE OR SWALLOW EXPERTS DO NOT KNOW WHY ADENOIDISM IS SO COM MON IN TODDLERS AND YOUNG CHILDREN ALTHOUGH THEY SUSPECT IT MAY BE DUE TO FREQUENT COLDS OR ALLERGIES TYPICALLY CHILDREN WITH ADENOID DISORDERS SPEAK WITH A NASAL TONE AND BREATHE THROUGH THEIR MOUTHS THEY MAY SNORE HAVE TROUBLE SWALLOW ING AND PERIODICALLY STOP BREATHING WHILE SLEEPING A CONDITION KNOWN AS OBSTRUCTIVE SLEEP APNEA THEY ALSO MAY HAVE A RASPY COUGH AFTER AWAKEN ING BAD BREATH REPEATED EAR INFECTIONS OR SORE THROATS PERSISTENT RUNNY NOSE LABORED AND NOISY BREATHING SNORING OR UNUSUAL SLEEP PATTERNS ADENOID DISORDERS ARE HARD TO DETECT BECAUSE OF THE LOCATION OF THE ADENOIDS WHICH CANNOT BE SEEN BY LOOKING INTO THE MOUTH A SPECIAL VIEWING INSTRU MENT IS NEEDED IN THE PAST SURGICAL REMOVAL OF THE ADENOIDS ADE NOIDECTOMY AND TONSILS IN CHILDREN WAS QUITE COM MON TODAY BEFORE RECOMMENDING SURGERY A DOCTOR MAY RST SUGGEST WAITING TO SEE IF A CHILD OUTGROWS THE PROBLEM ADENOIDS GROW MOST QUICKLY DURING THE RST VE YEARS OF A CHILD S LIFE AFTER THIS THEY BEGIN TO SHRINK UNTIL THEY DISAPPEAR BY ADOLESCENCE IF THE ADENOID SWELLING PERSISTS HOWEVER THE DOCTOR MAY RST RECOMMEND ANTIBIOTIC TREATMENT TO ELIMINATE POSSIBLE BACTERIAL INFECTION IF THE ADE NOID PROBLEM IS CAUSED BY RESPIRATORY ALLERGIES TREATMENT MAY EASE ALLERGY SYMPTOMS AND GRADU ALLY REDUCE SWELLING IF ALL OTHER TREATMENTS FAIL AND A CHILD CONTINUES TO SUFFER FROM AN ADENOID DISORDER THE DOCTOR MAY RECOMMEND AN ADENOIDECTOMY THE OPERATION SHOULD BE PERFORMED ONLY AFTER CAREFUL EVALUATION BY AN EAR NOSE AND THROAT SPECIALIST OR OTOLARYN GOLOGIST MOST CHILDREN SHOULD NOT HAVE THE OPERA TION UNTIL THEY REACH SCHOOL AGE IF A BACTERIAL INFECTION HAS OCCURRED SURGERY SHOULD BE DELAYED UNTIL TWO TO FOUR WEEKS AFTER IT HAS CLEARED UP