As if surgery isn’t scary enough, recent warnings issued by the U.S. Food and Drug Administration (FDA) are causing widespread concern among parents.
Earlier this week, the FDA once again warned that repeated or lengthy use of general anesthesia and sedation drugs during surgeries in children younger than 3 years may affect the development of children’s brains.
It’s very concerning considering more than 1 million children under the age of 4 undergo general anesthesia each year in this country.
The issue first came to light in the 1990s when studies on young rats showed some impairment in brain functioning after exposure to anesthetics. Concerns then escalated when similar results were found in monkeys. This led to several studies on children.
“Because the studies on children were observational, they did not prove a causal link between anesthesia and changes in cognition, memory or behavior,” said Dr. Ibrahim Farid, chairman of the Department of Anesthesia and Pain Medicine at Akron Children’s Hospital. “However, they did heighten concerns, particularly for children who receive anesthesia multiple times at a young age.”
Because more definitive research was needed, the FDA and the International Anesthesia Research Society formed SmartTots in 2009, a nonprofit group to fund pediatric anesthesia research.
Three major studies are now in progress with the goal of answering these important questions:
- Does anesthesia affect developing brains?
- Does it cause learning, memory or behavior changes?
- If so, can we reverse or mitigate the effects?
The results are expected in the next 2 to 3 years as the children in the studies are followed over a period of time.
What are parents to do?
In the meantime, Dr. Farid doesn’t want to induce panic. These studies are not conclusive and, at this time, there is no direct evidence linking anesthesia to learning, behavior or memory problems. In fact, the Society for Pediatric Anesthesia has recommended no major changes in practice.
“The goal is to inform parents without alarming or overstating the risk,” he said. “Millions of children receive general anesthesia every year in the U.S. If it does affect developing brains, the effects are subtle. If there was significant cell damage, it would be very evident.”
But until definitive data is available, the FDA, SmartTots and the American Academy of Pediatrics recommend postponing any surgeries that are not medically necessary until a child is at least 3 years old.
However, for some children, such as those born with heart defects, postponing surgery isn’t an option. The last thing Dr. Farid wants to happen is for parents to delay or cancel surgeries that are life-threatening. The risks and benefits need to be weighed. “When a child needs surgery, especially for a serious medical problem, this should supersede the unproven risk associated with anesthesia,” he said.
If your child under 3 needs general anesthesia for surgery, he recommends parents ask their provider about the following:
- Risks related to brain development.
- The timing of the surgery or procedure and whether it can be delayed without creating health problems.
- How long the surgery or procedure will last and if repeated surgeries are necessary.