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Sleep is essential for optimal health in children and adolescents. Members of the American Academy of Sleep Medicine developed consensus recommendations for the amount of sleep needed to promote optimal health in children and adolescents using a modified RAND Appropriateness Method. The recommendations are summarized here. A manuscript detailing the conference proceedings and the evidence supporting these recommendations will be published in the Journal of Clinical Sleep Medicine. CO NSENSUS RECO M M ENDATI O NS• Infants* 4 months to 12 months should sleep 12 to 16 hours per 24 hours (including naps) on a regular basis to promote optimal health. • Children 1 to 2 years of age should sleep 11 to 14 hours per 24 hours (including naps) on a regular basis to promote optimal health. • Children 3 to 5 years of age should sleep 10 to 13 hours per 24 hours (including naps) on a regular basis to promote optimal health. • Children 6 to 12 years of age should sleep 9 to 12 hours per 24 hours on a regular basis to promote optimal health. • Teenagers 13 to 18 years of age should sleep 8 to 10 hours per 24 hours on a regular basis to promote optimal health.• Sleeping the number of recommended hours on a regular basis is associated with better health outcomes including: improved attention, behavior, learning, memory, emotional regulation, quality of life, and mental and physical health.• Regularly sleeping fewer than the number of recommended hours is associated with attention, behavior, and learning problems. teenagers is associated with increased risk of self-harm, suicidal thoughts, and suicide attempts.• Regularly sleeping more than the recommended hours may be associated with adverse health outcomes such as hypertension, diabetes, obesity, and mental health problems.• Parents who are concerned that their child is sleeping too little or too much should consult their healthcare provider for evaluation of a possible sleep disorder.* Recommendations for infants younger than 4 months are not included due to the wide range of normal variation in duration and patterns of sleep, and insufficient evidence for associations with health outcomes. BACKG ROUND A ND M ETHO DO LOGYHealthy sleep requires adequate duration, appropriate timing, good quality, regularity, and the absence of sleep disturbances or disorders. Sleep duration is a frequently investigated sleep measure in relation to health. A panel of 13 experts in sleep medicine and research used a modified RAND Appropriateness Method 1 to develop recommendations regarding the sleep duration range that promotes optimal health in children aged 0-18 years. The expert panel reviewed published scientific evidence addressing the relationship between sleep duration and

pii: jc-00414-15 http://dx.doi.org/10.5664/jcsm.5176 V ersion 2.2 of the American Academy of Sleep Medicine (AASM) Manual for the Scoring of Sleep and Associated Events was released on July 1, 2015. The Scoring Manual Editorial Board (previously the Scoring Manual Committee) would like to call attention to the most important changes. As discussed below, there are two new major chapters providing rules for the staging of infant sleep and scoring respiratory events in home sleep apnea testing (HSAT) studies. The new chapters were approved by the AASM Board of Directors to fi ll two obvious gaps in the Scoring Manual. The Scoring Manual Editorial Board would like to emphasize that any changes in the manual are instituted after long deliberation and consultation with area content experts.Version 2.2 of the Scoring Manual, for the fi rst time, includes rules for scoring sleep studies in term infants less than two months of age. This milestone acknowledges the importance of studying sleep across the lifespan, beginning with our youngest patients. The new scoring rules address sleep staging in infants and are based on the classic infant scoring rules of Anders et al.1 Development of these new rules benefi tted from expert consultation from Madeleine Grigg-Damberger, MD, and Mark Scher, MD. One important difference between the current manual and Anders is that sleep is now classifi ed into three stages: REM, NREM and transitional, as compared to the Anders classifi cation of active, quiet and indeterminate sleep. This new classifi cation was based on the physiologic similarities between active and REM sleep, and quiet and NREM sleep. Further, it was realized that young infants have stages of sleep that manifest elements of both REM and NREM sleep; hence, the term "transitional" rather than "indeterminate." Note that respiratory events in infants should be scored using the standard AASM pediatric scoring criteria. devices and are consistent with AASM accreditation standards for HSAT. Incorporating these rules not only standardizes reporting from sleep center to sleep center, but also provides a foundation for monitoring quality metrics and patient outcomes. This chapter includes specifi c reporting parameters for newer monitoring technology such as peripheral arterial tonometry (PAT). As the number and types of HSAT devices evolve, and new technology and evidence emerge, these scoring rules will also evolve to keep pace with the dynamic HSAT landscape.Going forward, our major goals are to clarify scoring rules (by providing additional examples) and address areas of ambiguity or controversy. To this end, the Editorial Board will begin an ongoing dialog with the panel of "gold standard" reviewers of the AASM Inter-scorer Reliability (ISR) program. This will provide important feedback concerning diffi culties that arise when participants apply the scoring rules to "real life" sleep studies. Each month, we also receive thoughtful inquiries about interpretation of the current rules. Many of these questions raise interesting p...

Objective. This update of a 2011 guideline developed by the American Academy of Otolaryngology-Head and Neck Surgery Foundation provides evidence-based recommendations on the pre-, intra-, and postoperative care and management of children 1 to 18 years of age under consideration for tonsillectomy. Tonsillectomy is defined as a surgical procedure performed with or without adenoidectomy that completely removes the tonsil, including its capsule, by dissecting the peritonsillar space between the tonsil capsule and the muscular wall. Tonsillectomy is one of the most common surgical procedures in the United States, with 289,000 ambulatory procedures performed annually in children \15 years of age based on the most recent published data. This guideline is intended for all clinicians in any setting who interact with children who may be candidates for tonsillectomy. KAS 14 (Postoperative codeine), and KAS 15a (Outcome assessment for bleeding). (6) Addition of an algorithm outlining KASs. (7) Enhanced emphasis on patient and/or caregiver education and shared decision making.

A commentary on this article apears in this issue on page 1439.