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New Australian research has found that young children exposed to general anesthesia may have poorer development and lower literacy and numeracy school scores later in childhood than children not exposed to anesthesia.

Carried out by researchers at the University of Sydney, the large-scale study looked at 211,978 healthy children and compared the developmental and school results of those who had been exposed to general anesthesia before age four to children of the same age who hadn’t been exposed.

The researchers looked at either the children’s school entry developmental assessment in 2009 or 2012, or their Grade 3 school test results (when children are aged 8 to 9). They found that those who had been exposed to general anesthesia more than once had a 17 percent increased risk of poor child development, a 34 percent increased risk of lower numeracy scores on school tests, and a 23 percent increased risk of lower reading scores on school tests.

When the researchers looked at the children who had undergone only one procedure requiring general anaesthesia, they found that there was no increased risk for poor development or reduced reading scores, but there was still an increased risk of poor numeracy scores.

“There are many reasons why a child requires surgery or investigation, and, in some cases, this may be lifesaving or unavoidable,” said the study’s senior author, Prof. Natasha Nassar. “For these children, our findings suggest that it is important to follow-up and monitor their literacy and numeracy skills when they reach school, and ensure early intervention, if required.”

“Determining exactly what is causing this effect is not easy. The children receiving a general anaesthetic in this study also had surgery, and often had other associated medical conditions,” said co-author Dr. Justin Skowno. “There are some procedures where alternative approaches or management may be possible, but the majority of surgeries in young infants and children cannot easily be postponed.”

“Parents can certainly discuss with their doctor and explore whether these procedures can be avoided, combined with other procedures, delayed to older ages or treated with alternatives to surgery, or other methods of sedation,” added Dr. Skowno.

The findings come after a study published just last week found that, despite concerns, there is no evidence to suggest that giving anesthesia to children under the age of three years can affect intelligence. However, it concluded that being exposed to anesthesia several times as a small child could cause modest declines in fine motor skills, such as ability to draw figures with a pencil, and how quickly children process information when reading.

Children who had anesthesia just once before their third birthday may also have more problems with executive functions, the skills which help with memory, impulse control, planning and flexibility.

The results of the new study were published in Pediatric Anesthesia. JB

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