Nearly 14 million Americans underwent cosmetic procedures last year, according to the American Society of Plastic Surgeons, and injections of Botox were up five percent from the year before.

A major chunk of recipients of those procedures were in their 30s and 40s, and many have children. That raises the question: How does Botox affect relationships between parents and children?

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Confused infants might be one unintended consequence, CNN reported recently.

"(Botox) likely does limit and distort parent-infant communication, possibly making the parent look 'flat' emotionally," Ed Tronick, associate professor of pediatrics and psychiatry at the University of Massachusetts told CNN. "Facial expressions for parents and young children are really critical ways in which we communicate our intentions or whether we're angry or sad, and that involves this very complex array of all the muscles that go into making facial expressions. So if you limit that range of expression, especially with very young children who are really attuned to reading facial expressions, then you limit the amount of information, the amount of emotion that you communicate using a facial expression."

According to the Daily Mail, Kelly Ripa, the 41-year old talk-show host and mother of three, told In Touch magazine, "I work out every day. I don't overeat. I try to drink water, but I prefer wine, and when all else fails, I get Botox injected right here, right into my forehead as much as possible!"

But injections of Botox, which use bacterial neurotoxins to reduce the appearance of wrinkles by blocking the activity of muscles in the face, may impair people's ability to read the emotions of others, found a study published last year in the journal Social, Psychological and Personal Science, making them less empathic.

Plenty of Botox-recipients and their doctors disagree with these concerns, arguing that a well-done procedure should look subtle and preserve emotional expressiveness, according to CNN reporter Shanon Cook. Some also argue that looking more relaxed has helped their relationships.

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But what message does it send to children when their parents attempt to fight aging and change the way they look? That's a question that gets explored repeatedly on blogs, message boards and even on the websites of plastic surgeons.

McCormack Plastic Surgery in Reno offers this advice:

"Do not let your kids think you are having surgery because you were hurting, it is okay to tell them you are doing it to make yourself feel good. That being said, I would not hesitate to emphasize inner beauty no matter what. Inner beauty and confidence are the most attractive things about a person. This is just something you are doing for yourself to enhance those attributes. You can use this opportunity to emphasize that your kids are perfect the way they are and just because you are making this choice does not mean there is something wrong with them. Furthermore, it is not their fault that your body has changed as you are the one who made the choice to have babies (and you are so happy you did!)."

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Whether influenced by their parents or not, more teenagers are getting plastic surgery, too, often in response to bullying. In 2001, more than 16,000 kids ages 13 to 19 received Botox injections, according to the American Society of Plastic Surgeons, up 20 percent from the year before.

It's not yet clear how those procedures affect a teen's relationship with her parents.