By: Justin Lockman, MD, MSEd, FAAP
Anytime a child undergoes a procedure requiring anesthesia or sedation, it is normal for parents to have questions about possible risks. This is especially true when the child is a newborn, infant or toddler.
To help your family prepare, here are answers to frequently asked questions about the safety of anesthesia for babies and young children.
Is anesthesia safe for my baby?
Anesthesia and sedation are safer than they have ever been. Pediatric anesthesiologists—specially trained anesthesiologists who care for infants and children—help millions of kids, including the tiniest and sickest babies, get the surgeries and procedures they need as safely as possible.
Like any medicine, anesthetic medications have some risks for everyone, whether young and old. Doctors and researchers continue to look at how these medicines and medical techniques affect infants and children so they can keep improving safety. Before the procedure, your child’s anesthesiologist will review your child’s medical history and create a plan tailored to their needs. This helps make the procedure as safe as possible with what we know today.
When infants or young children need surgery, will anesthesia affect their developing brains?
Researchers have been studying how anesthesia affects developing brains for many years. Studies have suggested that mice and other animals who have high-dose and very long anesthesia may have problems with learning and behavior later in life. But so far, there's no evidence that a single, properly given anesthetic causes these problems in children.
To keep ensuring safety, the Food and Drug Administration (FDA) and the International Anesthesia Research Society created
SmartTots (Strategies for Mitigating Anesthesia-Related neuroToxicity in Tots). The program supports continued research on how anesthesia may affect young children's brain development.
As we continue to learn more and minimize any potential risks to children, it is also essential that children receive the surgery or other procedures they need. We know that avoiding a needed surgery because of a theoretical and unproven risk could be very dangerous for a child.
What should I do if my baby needs surgery?
Start by talking with your child's doctors about the risks and benefits of the surgery or procedure. Ask what the surgery will do, why it's needed now and what recovery looks like.
Ask about timing. If your child's doctors believe it's safe to wait, you can discuss delaying surgery. Some research suggests that possible effects of anesthesia on the brain decrease with age. But in many cases, delaying will lead to other complications for your child. Your child's doctor can help you weigh those trade-offs.
Talk to your anesthesiologist. If your hospital allows you to have a say in choosing an anesthesiologist, ask for pediatric anesthesiologist. Pediatric anesthesiologists complete special training for the care of infants and children, and use the least harmful medications at the lowest necessary doses to avoid problems based on your child's age, weight, gender and specific medical issues.
Remember the big picture. Today's anesthetics and sedatives are as safe as we can make them, and they are necessary for infants and children who need surgery or other painful and stressful procedures.
While we are still researching any connections between anesthesia and brain development, we know for sure that surgery without anesthesia causes physical and emotional harm. And delaying needed surgery can also harm your child.
How will the pediatric anesthesiologist keep my child safe?
Your child will be closely monitored the entire time. The pediatric anesthesiologist tracks heart rate, blood pressure, temperature, breathing and oxygen levels, and adjusts medications as needed. Their goal is to keep your child safe and to prevent or treat pain, fear and anxiety. Children respond to anesthesia and the stress of surgery differently than adults, which is why pediatric anesthesiologists receive special training.
Are there any alternatives to general anesthesia for surgery?
For most young children, the safest way to perform a majority of surgeries is under general anesthesia—meaning that your child will be completely asleep and will not move during surgery. In some cases (such as with older children), lighter sedation may be possible, but importantly the medications used for sedation have very similar risks and side effects as those used for general anesthesia.
In other cases, your pediatric anesthesiologist may recommend regional or neuraxial anesthesia, meaning that a needle is used to create numbness in part of the body without putting the brain completely to sleep. This can be done instead of general anesthesia in rare situations; more commonly for children it is used in addition to general anesthesia in order to decrease the amount of anesthesia needed and to provide pain relief after surgery.
Are any anesthesia or sedation medications safer than others?
All medications currently used for anesthesia or sedation have been shown to affect normal brain development in animal studies when given repeatedly or for long periods of time. Researchers are working hard to find new medication options. In the meantime, there is no conclusive evidence of impacts from a single anesthetic on the brain development of human infants and children.
My 2-year-old needs an MRI scan. Can it be done without anesthesia?
It depends on the child. Some older kids and teens may not need anesthesia or sedation. Talk with your child's doctors if you think your child can have an MRI scan or other non-painful procedure without sedation to stay still. However, nearly all infants and young children cannot remain still long enough for an MRI scan and need general anesthesia to help them relax or sleep during the procedure.
Several factors are considered when determining if a child will need general anesthesia, including:
The age and developmental level of child. Infants and toddlers generally will not understand why they are having the MRI and will be scared during the procedure.
The length of time it takes to do the procedure. It can take 1-2 hours or longer to obtain a complete MRI scan.
The amount of discomfort and anxiety expected during the procedure. MRI scanners are quite noisy, and your child will be moved into a long, narrow pipe and must remain completely motionless for the entire time.
My newborn has an intestinal blockage and needs surgery. Does anesthesia harm babies this young?
This surgery, like many other infant surgeries, is considered an emergency. Waiting can lead to
serious and life-threatening complications for your child. Pediatric anesthesiologists are trained to provide the safest and most effective anesthesia possible for your baby.
While it can be scary when your baby needs surgery, delaying emergency surgery because of unproven anesthesia risks is dangerous. Your pediatric anesthesiologist will do their best to answer your questions and keep you well informed.
My 1-year-old needs ear tubes for frequent ear infections. Should I wait until they're older to get this done?
Follow the advice of your
pediatric otolaryngologist (ENT). While ear tubes can seem like something that can wait, chronic ear infections can cause long term problems with hearing and speech development if not treated.
Ear tube surgery is generally very short and involves very little anesthesia exposure. A single, brief anesthetic has not been associated with any developmental problems.
Also see
Language Delays in Toddlers: Information for Parents for more information.
My 18-month-old has a large cut on her face. The pediatric surgeon wants to repair it in the operating room (OR). Is it safer to get sedation in the emergency department or anesthesia in the OR?
For complex facial cuts, your child needs to stay completely still for a careful repair and the best cosmetic result. General anesthesia in the operating room is usually the safer choice than trying to sedate a toddler in the ER for a long, delicate procedure. Also, sedative medicines have similar risks to anesthesia medicines.
Studies haven't shown that emergency department sedation is safer for infants or young children in the short or long term. If you're unsure, ask the team to explain why the OR is recommended and how they'll manage pain and anxiety.
Also see "Cuts, Scrapes & Scar Management: Parent FAQs."
Have more questions?
If you have other questions, please contact your local children's hospital and ask to talk to a pediatric anesthesiologist.
More information
About Dr. Lockman Justin Lockman, MD, MSEd, FAAP, is a professor of clinical anesthesiology and critical care and professor of pediatrics at Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine. Dr. Lockman serves on executive committee for the American Academy of Pediatrics Section on Anesthesiology and Pain Medicine.
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