What Does Matter for Childhood Outcomes?

Emily Oster

8 min Read Emily Oster

The other day, my friend Jon asked to have coffee. He and his wife were expecting their first child and he had some questions. Or, really, he had one question, which went something like this.

I’ve read your books, and you’ve convinced me that most of the individual behaviors people obsess about — breastfeeding, sleep training, stuff like that — do not matter for how kids turn out. I believe you that many of the data findings are correlation and not causation. But: here’s where I’m stuck. You often point out that the issue with these data is that there are differences across groups in variables like income and education, which themselves drive kids’ outcomes.

My question is, if parents’ income and education drive outcomes, it must be because something different is happening for the kids in richer households. If it’s not these behaviors we obsess about, what is it? (And how can I make sure to do the things it is?)

This was quite a deep and hard question (Jon is a smart guy, so I am not too surprised). It’s a parenting question, sort of, but also an important social science question. There is a lot of evidence that the years from 0 to 3 matter enormously for children. By the time kids get to 3, there are significant inequalities across groups, by nearly every metric we have at that point. Somehow we must square this fact with the idea that many of these individual behaviors that many parents stress about do not seem to matter very much.

When Jon asked his question, I didn’t answer well. I just mumbled something about how this was hard and then gave him some other bossy advice about the first weeks with a baby. (Jon’s daughter was born last week and, Jon, if you’re reading this: Congratulations, and I hope you are taking all my advice to the letter.)

But the question stuck with me, so I’m going to try to give a longer answer here, starting with a discussion of a small number of behaviors that do show up in the data as mattering for kids’ outcomes. And then make a larger comment about what is really missing in our support for families.

Before we get going, a note. When we talk about “outcomes for kids,” we are nearly always talking about test scores or behavioral outcomes. This is because these are things we can measure. While they matter, I am aware they are not the only things that we care about. This is a limitation of data, and all we can do is keep it in mind.

Individual behaviors

A central message of Cribsheet and, in some ways, of Expecting Better is that many of the decisions that get so much attention and emphasis do not have good data backing them. Breastfeeding is probably the most familiar example. Despite claims of all kinds of long-term benefits to breastfeeding (higher IQ, lower obesity, less illness, and on and on), the data supports only a limited set of short-term health benefits. These lack-of-effect conclusions seem almost universal on these child development metrics, where virtually all of the links we see seem to be driven by other biases in the data.

There are, however, a few behaviors where we do see some effects; each of these deserves its own newsletter or book chapter (some of them have it), so this will be brief, with references to where you can read more.

  • Reading to kids: There is high-quality evidence to suggest that reading to young kids impacts outcomes, including their own literacy. There are some small randomized trials, though with short follow-up. There is evidence based on the timing of second-child births that makes a more compelling causal case about the positive impacts of reading on kids. There is even some brain-scan evidence that kids who are read to more at home seem to react to hearing stories with the part of their brain that processes imagery; basically, they seem to be getting more from the story than kids who are read to less often at home. (More: Cribsheet, chapter 18)
  • Talking to kids: Beginning with a famous study in the early 1990s, researchers have noted the relationship between spoken-language exposure and language development (and documented differences in exposure across socioeconomic groups). This is a somewhat contentious literature, but experts mostly agree that there is some relationship in the data (here is a nice summary paper on measurement). (More: Thirty Million Words, by Dana Suskind)
  • Quality child care: At ParentData we talk a lot about child care choices, and emphasize that there are many good approaches. Differences in outcomes for children between being at home with a parent, having a full-time caregiver, or going to a high-quality out-of-home child care setting are negligible. However, there is a quality dimension here, and we do have evidence that neglectful child care — caregivers who do not pay attention to children, with limited opportunities for interaction, etc. — has negative impacts. As I’ve underscored many times, high-quality child care isn’t about who has the most organic snacks; it’s about more basic needs being met. (More: Day Care and Children)
  • Spanking: There are a number of approaches to discipline for kids, and there are many good options that are supported by evidence. One that is not is spanking. Physical punishment has been shown, in a variety of studies, to worsen behavior in the long term. (More: Cribsheet, chapter 17)

There’s one important thing to say here. Nearly all of the effects we observe from these behaviors are small and the range of behavior that is producing the effect is large. It is tempting to look at this and conclude (as many people do) that if reading to your child is good, it’s best to chase them around all the time with a book even when they are not interested. This isn’t the case, and certainly isn’t supported by what we see in the data.

Which is to say: there is a partial answer to Jon’s question. Some of these are actionable behaviors and they are generally different by socioeconomic status. But the collective impact of these is likely small.

Bigger picture

I asked this question — of how to square the small behavior impacts and the larger differences across groups — months ago, when I interviewed Dana Suskind about her book Parent Nation. I cannot think of a better way to answer than how she did, so I will quote her: “There are two crucial and specific things children need to build a healthy foundation of cognitive and socio-emotional skills that will serve them throughout life: nurturing interaction with caregivers and protection from toxic stress.”

In that conversation (and in her book), she goes on to talk more about what this means. She discusses the value of having a stable relationship with one or several caregivers; various people can fill this role, but kids need someone. She also talks about the idea of toxic stress. The experience of significant adversity, trauma, lack of consistent food or housing, loss of a parent or caregiver — any of these events are incredibly stressful for young children, and they leave lasting impacts.

In a sense, the bigger picture is both simple to explain and (seemingly) difficult to implement. There are problems that society needs to solve. Better and more affordable child care. Paid parental leave. Access to quality health care during the prenatal and postpartum period, plus access to health care for children. More resources — child poverty roughly halved during the pandemic because of the Child Tax Credit; when that expired, rates came back up again. These issues are in the way of giving every child equal opportunity.

The answer to Jon’s question is that by virtue of his family’s circumstances, his kid is already going to have the things they need to thrive. A stable place to live. Consistent and nurturing caregivers with some time to spend. Access to nutritious food. Health care. The basic things he was taking for granted are, really, the whole thing.

The problem is that those basic things are what too many people in America — and globally — are lacking. This is the problem that needs our attention.


If this has you feeling like you want to do something, check out Zero to Three for an organization doing great work on equality of opportunity in the early years. And Moms First if you’re looking to advocate for paid leave, affordable child care, and support for parents. 

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Is side sleeping important during pregnancy? Comment “Link” for a DM to an article on whether sleep position affects pregnancy outcomes.

Being pregnant makes you tired, and as time goes by, it gets increasingly hard to get comfortable. You were probably instructed to sleep on your side and not your back, but it turns out that advice is not based on very good data.

We now have much better data on this, and the bulk of the evidence seems to reject the link between sleep position and stillbirth or other negative outcomes. So go ahead and get some sleep however you are most comfortable. 💤

Sources:
📖 #ExpectingBetter pp. 160-163
📈 Robert M. Silver et al., “Prospective Evaluation of Maternal Sleep Position Through 30 Weeks of Gestation and Adverse Pregnancy Outcomes,” Obstetrics and Gynecology 134, no. 4 (2019): 667–76. 

#emilyoster #pregnancy #pregnancytips #sleepingposition #pregnantlife

Is side sleeping important during pregnancy? Comment “Link” for a DM to an article on whether sleep position affects pregnancy outcomes.

Being pregnant makes you tired, and as time goes by, it gets increasingly hard to get comfortable. You were probably instructed to sleep on your side and not your back, but it turns out that advice is not based on very good data.

We now have much better data on this, and the bulk of the evidence seems to reject the link between sleep position and stillbirth or other negative outcomes. So go ahead and get some sleep however you are most comfortable. 💤

Sources:
📖 #ExpectingBetter pp. 160-163
📈 Robert M. Silver et al., “Prospective Evaluation of Maternal Sleep Position Through 30 Weeks of Gestation and Adverse Pregnancy Outcomes,” Obstetrics and Gynecology 134, no. 4 (2019): 667–76.

#emilyoster #pregnancy #pregnancytips #sleepingposition #pregnantlife
...

My new book, “The Unexpected: Navigating Pregnancy During and After Complications” is available for preorder at the link in my bio!

I co-wrote #TheUnexpected with my friend and maternal fetal medicine specialist, Dr. Nathan Fox. The unfortunate reality is that about half of pregnancies include complications such as preeclampsia, miscarriage, preterm birth, and postpartum depression. Because these are things not talked about enough, it can not only be an isolating experience, but it can also make treatment harder to access.

The book lays out the data on recurrence and delves into treatment options shown to lower risk for these conditions in subsequent pregnancies. It also guides you through how to have productive conversations and make shared decisions with your doctor. I hope none of you need this book, but if you do, it’ll be here for you 💛

#pregnancy #pregnancycomplications #pregnancyjourney #preeclampsiaawareness #postpartumjourney #emilyoster

My new book, “The Unexpected: Navigating Pregnancy During and After Complications” is available for preorder at the link in my bio!

I co-wrote #TheUnexpected with my friend and maternal fetal medicine specialist, Dr. Nathan Fox. The unfortunate reality is that about half of pregnancies include complications such as preeclampsia, miscarriage, preterm birth, and postpartum depression. Because these are things not talked about enough, it can not only be an isolating experience, but it can also make treatment harder to access.

The book lays out the data on recurrence and delves into treatment options shown to lower risk for these conditions in subsequent pregnancies. It also guides you through how to have productive conversations and make shared decisions with your doctor. I hope none of you need this book, but if you do, it’ll be here for you 💛

#pregnancy #pregnancycomplications #pregnancyjourney #preeclampsiaawareness #postpartumjourney #emilyoster
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We are better writers than influencers, I promise. Thanks to our kids for filming our unboxing videos. People make this look way too easy. 

Only two weeks until our book “The Unexpected” is here! Preorder at the link in my bio. 💙

We are better writers than influencers, I promise. Thanks to our kids for filming our unboxing videos. People make this look way too easy.

Only two weeks until our book “The Unexpected” is here! Preorder at the link in my bio. 💙
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Exciting news! We have new, high-quality data that says it’s safe to take Tylenol during pregnancy and there is no link between Tylenol exposure and neurodevelopmental issues in kids. Comment “Link” for a DM to an article exploring this groundbreaking study.

While doctors have long said Tylenol was safe, confusing studies, panic headlines, and even a lawsuit have continually stoked fears in parents. As a result, many pregnant women have chosen not to take it, even if it would help them.

This is why good data is so important! When we can trust the data, we can trust our choices. And this study shows there is no blame to be placed on pregnant women here. So if you have a migraine or fever, please take your Tylenol.

#tylenol #pregnancy #pregnancyhealth #pregnancytips #parentdata #emilyoster

Exciting news! We have new, high-quality data that says it’s safe to take Tylenol during pregnancy and there is no link between Tylenol exposure and neurodevelopmental issues in kids. Comment “Link” for a DM to an article exploring this groundbreaking study.

While doctors have long said Tylenol was safe, confusing studies, panic headlines, and even a lawsuit have continually stoked fears in parents. As a result, many pregnant women have chosen not to take it, even if it would help them.

This is why good data is so important! When we can trust the data, we can trust our choices. And this study shows there is no blame to be placed on pregnant women here. So if you have a migraine or fever, please take your Tylenol.

#tylenol #pregnancy #pregnancyhealth #pregnancytips #parentdata #emilyoster
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How many words should kids say — and when? Comment “Link” for a DM to an article about language development!

For this graph, researchers used a standardized measure of vocabulary size. Parents were given a survey and checked off all the words and sentences they have heard their child say.

They found that the average child—the 50th percentile line—at 24 months has about 300 words. A child at the 10th percentile—near the bottom of the distribution—has only about 50 words. On the other end, a child at the 90th percentile has close to 600 words. One main takeaway from these graphs is the explosion of language after fourteen or sixteen months. 

What’s valuable about this data is it can give us something beyond a general guideline about when to consider early intervention, and also provide reassurance that there is a significant range in this distribution at all young ages. 

#cribsheet #emilyoster #parentdata #languagedevelopment #firstwords

How many words should kids say — and when? Comment “Link” for a DM to an article about language development!

For this graph, researchers used a standardized measure of vocabulary size. Parents were given a survey and checked off all the words and sentences they have heard their child say.

They found that the average child—the 50th percentile line—at 24 months has about 300 words. A child at the 10th percentile—near the bottom of the distribution—has only about 50 words. On the other end, a child at the 90th percentile has close to 600 words. One main takeaway from these graphs is the explosion of language after fourteen or sixteen months.

What’s valuable about this data is it can give us something beyond a general guideline about when to consider early intervention, and also provide reassurance that there is a significant range in this distribution at all young ages.

#cribsheet #emilyoster #parentdata #languagedevelopment #firstwords
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I saw this and literally laughed out loud 😂 Thank you @adamgrant for sharing this gem! Someone let me know who originally created this masterpiece so I can give them the proper credit.

I saw this and literally laughed out loud 😂 Thank you @adamgrant for sharing this gem! Someone let me know who originally created this masterpiece so I can give them the proper credit. ...

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Perimenopause comes with a whole host of symptoms, like brain fog, low sex drive, poor energy, and loss of muscle mass. These symptoms can be extremely bothersome and hard to treat. Could testosterone help? Comment “Link” for a DM to an article about the data on testosterone treatment for women in perimenopause.

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Summer is quickly approaching! You might be wondering if it’s the right time to have your kid start swim lessons. The AAP recommends starting between 1 and 4 years old. This is largely based on a randomized trial where young children were put into 8 or 12 weeks of swim lessons. They found that swimming ability and water safety reactions improve in both groups, and more so in the 12 weeks group.

Below this age range though, they are too young to actually learn how to swim. It’s fine to bring your baby into the pool (if you’re holding them) and they might like the water. But starting formal safety-oriented swim lessons before this age isn’t likely to be very helpful.

Most importantly, no matter how old your kid is or how good of a swimmer they are, adult supervision is always necessary!

#swimlessons #watersafety #kidsswimminglessons #poolsafety #emilyoster #parentdata

What age is best to start swim lessons? Comment “Link” for a DM to an article about water safety for children 💦

Summer is quickly approaching! You might be wondering if it’s the right time to have your kid start swim lessons. The AAP recommends starting between 1 and 4 years old. This is largely based on a randomized trial where young children were put into 8 or 12 weeks of swim lessons. They found that swimming ability and water safety reactions improve in both groups, and more so in the 12 weeks group.

Below this age range though, they are too young to actually learn how to swim. It’s fine to bring your baby into the pool (if you’re holding them) and they might like the water. But starting formal safety-oriented swim lessons before this age isn’t likely to be very helpful.

Most importantly, no matter how old your kid is or how good of a swimmer they are, adult supervision is always necessary!

#swimlessons #watersafety #kidsswimminglessons #poolsafety #emilyoster #parentdata
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Can babies have salt? 🧂 While babies don’t need extra salt beyond what’s in breast milk or formula, the risks of salt toxicity from normal foods are minimal. There are concerns about higher blood pressure in the long term due to a higher salt diet in the first year, but the data on these is not super compelling and the differences are small.

Like with most things, moderation is key! Avoid very salty chips or olives or saltines with your infant. But if you’re doing baby-led weaning, it’s okay for them to share your lightly salted meals. Your baby does not need their own, unsalted, chicken if you’re making yourself a roast. Just skip the super salty stuff.

 #emilyoster #parentdata #childnutrition #babynutrition #foodforkids

Can babies have salt? 🧂 While babies don’t need extra salt beyond what’s in breast milk or formula, the risks of salt toxicity from normal foods are minimal. There are concerns about higher blood pressure in the long term due to a higher salt diet in the first year, but the data on these is not super compelling and the differences are small.

Like with most things, moderation is key! Avoid very salty chips or olives or saltines with your infant. But if you’re doing baby-led weaning, it’s okay for them to share your lightly salted meals. Your baby does not need their own, unsalted, chicken if you’re making yourself a roast. Just skip the super salty stuff.

#emilyoster #parentdata #childnutrition #babynutrition #foodforkids
...

Is sleep training bad? Comment “Link” for a DM to an article breaking down the data on sleep training 😴

Among parenting topics, sleep training is one of the most divisive. Ultimately, it’s important to know that studies looking at the short- and long-term effects of sleep training show no evidence of harm. The data actually shows it can improve infant sleep and lower parental depression.

Even so, while sleep training can be a great option, it will not be for everyone. Just as people can feel judged for sleep training, they can feel judged for not doing it. Engaging in any parenting behavior because it’s what’s expected of you is not a good idea. You have to do what works best for your family! If that’s sleep training, make a plan and implement it. If not, that’s okay too.

What’s your experience with sleep training? Did you feel judged for your decision to do (or not do) it?

#sleeptraining #newparents #babysleep #emilyoster #parentdata

Is sleep training bad? Comment “Link” for a DM to an article breaking down the data on sleep training 😴

Among parenting topics, sleep training is one of the most divisive. Ultimately, it’s important to know that studies looking at the short- and long-term effects of sleep training show no evidence of harm. The data actually shows it can improve infant sleep and lower parental depression.

Even so, while sleep training can be a great option, it will not be for everyone. Just as people can feel judged for sleep training, they can feel judged for not doing it. Engaging in any parenting behavior because it’s what’s expected of you is not a good idea. You have to do what works best for your family! If that’s sleep training, make a plan and implement it. If not, that’s okay too.

What’s your experience with sleep training? Did you feel judged for your decision to do (or not do) it?

#sleeptraining #newparents #babysleep #emilyoster #parentdata
...

Does your kid love to stall right before bedtime? 💤 Tell me more about their tactics in the comments below!

#funnytweets #bedtime #nightimeroutine #parentinghumor #parentingmemes

Does your kid love to stall right before bedtime? 💤 Tell me more about their tactics in the comments below!

#funnytweets #bedtime #nightimeroutine #parentinghumor #parentingmemes
...

Got a big decision to make? 🤔 Comment “Link” for a DM to read about my easy mantra for making hard choices. 

When we face a complicated problem in pregnancy or parenting, and don’t like either option A or B, we often wait around for a secret third option to reveal itself. This magical thinking, as appealing as it is, gets in the way. We need a way to remind ourselves that we need to make an active choice, even if it is hard. The mantra I use for this: “There is no secret option C.”

Having this realization, accepting it, reminding ourselves of it, can help us make the hard decisions and accurately weigh the risks and benefits of our choices.

#parentingquotes #decisionmaking #nosecretoptionc #parentingadvice #emilyoster #parentdata

Got a big decision to make? 🤔 Comment “Link” for a DM to read about my easy mantra for making hard choices.

When we face a complicated problem in pregnancy or parenting, and don’t like either option A or B, we often wait around for a secret third option to reveal itself. This magical thinking, as appealing as it is, gets in the way. We need a way to remind ourselves that we need to make an active choice, even if it is hard. The mantra I use for this: “There is no secret option C.”

Having this realization, accepting it, reminding ourselves of it, can help us make the hard decisions and accurately weigh the risks and benefits of our choices.

#parentingquotes #decisionmaking #nosecretoptionc #parentingadvice #emilyoster #parentdata
...

Excuse the language, but I have such strong feelings about this subject! Sometimes, it feels like there’s no winning as a mother. People pressure you to breastfeed and, in the same breath, shame you for doing it in public. Which is it?!

So yes, they’re being completely unreasonable. You should be able to feed your baby in peace. What are some responses you can give to someone who tells you to cover up? Share in the comments below ⬇️

#breastfeeding #breastfeedinginpublic #breastfeedingmom #motherhood #emilyoster

Excuse the language, but I have such strong feelings about this subject! Sometimes, it feels like there’s no winning as a mother. People pressure you to breastfeed and, in the same breath, shame you for doing it in public. Which is it?!

So yes, they’re being completely unreasonable. You should be able to feed your baby in peace. What are some responses you can give to someone who tells you to cover up? Share in the comments below ⬇️

#breastfeeding #breastfeedinginpublic #breastfeedingmom #motherhood #emilyoster
...

Potty training can feel like a Mount Everest-size challenge, and sadly, our evidence-based guidance is poor. So, I created a survey to collate advice and feedback on success from about 6,000 participants.

How long does potty training take? We found that there is a strong basic pattern here: the later you wait to start, the shorter time it takes to potty train. On average, people who start at under 18 months report it takes them about 12 weeks for their child to be fully trained (using the toilet consistently for both peeing and pooping). For those who start between 3 and 3.5, it’s more like nine days. Keep in mind that for all of these age groups, there is a range of length of time from a few days to over a year. Sometimes parents are told that if you do it right, it only takes a few days. While that is true for some people, it is definitely not the norm.

If you’re in the throes of potty training, hang in there! 

#emilyoster #parentdata #pottytraining #pottytrainingtips #toddlerlife

Potty training can feel like a Mount Everest-size challenge, and sadly, our evidence-based guidance is poor. So, I created a survey to collate advice and feedback on success from about 6,000 participants.

How long does potty training take? We found that there is a strong basic pattern here: the later you wait to start, the shorter time it takes to potty train. On average, people who start at under 18 months report it takes them about 12 weeks for their child to be fully trained (using the toilet consistently for both peeing and pooping). For those who start between 3 and 3.5, it’s more like nine days. Keep in mind that for all of these age groups, there is a range of length of time from a few days to over a year. Sometimes parents are told that if you do it right, it only takes a few days. While that is true for some people, it is definitely not the norm.

If you’re in the throes of potty training, hang in there!

#emilyoster #parentdata #pottytraining #pottytrainingtips #toddlerlife
...

For children or adults with severe food allergies, they can be incredibly scary and restrictive. We may imagine that it’s easy to deal with a peanut allergy by, say, not eating peanut butter sandwiches. But for someone with a severe version of this allergy, they may never be able to go to a restaurant, for fear of a severe reaction to something in the air. Right now, there’s only one approved treatment for severe allergies like this and it’s limited to peanuts.

This is why the new medication Xolair is very exciting. It promises a second possible treatment avenue and one that works for other allergens. A new trail analyzed data from 177 children with severe food allergies. Two-thirds of the treatment group were able to tolerate the specified endpoint, versus just 7% of the placebo group. This is a very large treatment effect, and the authors found similarly large impacts on other allergens. 

There are some caveats: This treatment won’t work for everyone. (One-third of participants did not respond to it.) Additionally, this treatment is an injection given every two to four weeks, indefinitely. This may make it less palatable to children. 

Overall, even with caveats, this is life-changing news for many families!

#xolair #foodallergies #allergies #peanutallergy #emilyoster #parentdata

For children or adults with severe food allergies, they can be incredibly scary and restrictive. We may imagine that it’s easy to deal with a peanut allergy by, say, not eating peanut butter sandwiches. But for someone with a severe version of this allergy, they may never be able to go to a restaurant, for fear of a severe reaction to something in the air. Right now, there’s only one approved treatment for severe allergies like this and it’s limited to peanuts.

This is why the new medication Xolair is very exciting. It promises a second possible treatment avenue and one that works for other allergens. A new trail analyzed data from 177 children with severe food allergies. Two-thirds of the treatment group were able to tolerate the specified endpoint, versus just 7% of the placebo group. This is a very large treatment effect, and the authors found similarly large impacts on other allergens.

There are some caveats: This treatment won’t work for everyone. (One-third of participants did not respond to it.) Additionally, this treatment is an injection given every two to four weeks, indefinitely. This may make it less palatable to children.

Overall, even with caveats, this is life-changing news for many families!

#xolair #foodallergies #allergies #peanutallergy #emilyoster #parentdata
...

If you have a fever during pregnancy, you should take Tylenol, both because it will make you feel better and because of concerns about fever in pregnancy (although these are also overstated).

The evidence that suggests risks to Tylenol focuses largely on more extensive exposure — say, taking it for more than 28 days during pregnancy. There is no credible evidence, even correlational, to suggest that taking it occasionally for a fever or headache would be an issue.

People take Tylenol for a reason. For many people, the choice may be between debilitating weekly migraines and regular Tylenol usage. The impacts studies suggest are very small. In making this decision, we should weigh the real, known benefit against the suggestion of this possible risk. Perhaps not everyone will come out at the same place on this, but it is crucial we give people the tools to make the choice for themselves.

#emilyoster #parentdata #tylenol #pregnancy #pregnancytips

If you have a fever during pregnancy, you should take Tylenol, both because it will make you feel better and because of concerns about fever in pregnancy (although these are also overstated).

The evidence that suggests risks to Tylenol focuses largely on more extensive exposure — say, taking it for more than 28 days during pregnancy. There is no credible evidence, even correlational, to suggest that taking it occasionally for a fever or headache would be an issue.

People take Tylenol for a reason. For many people, the choice may be between debilitating weekly migraines and regular Tylenol usage. The impacts studies suggest are very small. In making this decision, we should weigh the real, known benefit against the suggestion of this possible risk. Perhaps not everyone will come out at the same place on this, but it is crucial we give people the tools to make the choice for themselves.

#emilyoster #parentdata #tylenol #pregnancy #pregnancytips
...