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Interestingly, although the majority of significant AEs reported pertained to worsening behavior and sleep, some studies have demonstrated significant improvements in such symptoms, including hyperactivity [32,49] and sleep [48], suggesting that overall many children have improvements in these key symptoms, and that having such symptoms at baseline is not necessarily a contraindication for starting B12 treatment

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Rushing the escalation increases the likelihood and severity of nausea, which is the most commonly reported adverse effect