A pediatrician’s unbothered case for treating general anesthesia like the big deal it actually is.
Let’s get one thing out of the way immediately, because I can already feel the comments: yes, some surgeries are absolutely necessary, urgent, and life-changing in the best way, and if your child needs one, please, for the love of all that is holy, do not go home and Google yourself into a panic based on this blog post. Appendicitis does not resolve with “watchful waiting” and good vibes. But — and you knew there was a but, if you’ve read this blog before — a genuinely large chunk of the surgeries kids get put under for are not that. They’re closer to “the fluid’s been there three weeks and everyone’s tired of waiting,” which, when you’ve read my ear tubes post (coming soon), you already know is exactly the kind of reasoning that gets a toddler wheeled into an OR on the strength of impatience rather than evidence.
Anesthesia Is Not a Long Nap With Extra Steps
Somewhere along the way, general anesthesia got filed in the parental brain under “routine,” right next to flu shots and dentist visits. It is not routine. It is a medically induced, drug-controlled unconscious state that shuts down your child’s ability to breathe on their own, and someone in scrubs is actively managing that fact in real time. The FDA didn’t add a warning label to eleven different anesthetic and sedation drugs because it enjoys paperwork. In 2016, and again with label changes finalized in 2017, the FDA concluded that repeated or lengthy — meaning over three hours — exposure to these drugs in children under three “may affect the development of children’s brains,” based on both animal studies and accumulating human data (FDA Drug Safety Communication). That’s not a fringe opinion. That’s on the label.
The Data Isn’t Subtle Either
A 2022 systematic review and meta-analysis of 31 studies published in JAMA Network Open found that childhood exposure to general anesthesia was significantly associated with more behavioral problems, deficits in executive function, motor function, and a notably higher incidence of ADHD diagnoses (JAMA Network Open, 2022). Multiple exposures were worse than a single one — an odds ratio increase for ADHD that showed up more strongly the more times a child went under. To be fair, the reassuring caveat exists too: single, brief exposures in otherwise healthy kids have not been shown to cause the same lasting deficits, and trials like GAS and PANDA back that up (Anesthesia Progress, PMC). The risk isn’t “one shot of propofol will doom your toddler.” The risk is treating repeated, elective, arguably avoidable trips under anesthesia as no different from a trip to get a haircut.
Which Brings Us Back to the Overuse Problem
I’ve written, a coming soon blog, about ear tubes — a surgery that, per a landmark BMJ study reviewing 682 children, was classified as appropriate in only 7% of cases, with nearly 70% flagged as outright inappropriate (Keyhani et al., BMJ 2008). I’m also writing about tonsillectomy, still performed on hundreds of thousands of American children a year, where a UK study found only 11.7% of cases met evidence-based criteria — meaning roughly 7 out of 8 tonsillectomies happened without the evidence to actually support them (BBC News). Every one of those unnecessary procedures came with an unnecessary trip under general anesthesia attached to it, on a developing brain that the FDA has explicitly flagged as vulnerable. Somewhere in the space between “the guideline says wait three months” and “we scheduled the OR for next Tuesday,” a kid is absorbing a real, measurable risk for a problem that was, more often than not, already on track to resolve without a scalpel anywhere near it.
The Actual Advice
If a surgery is genuinely necessary — appendicitis, a real airway obstruction, a documented hearing loss with fluid that’s been there for months, a tumor, a fracture that needs setting — go. Don’t delay it, don’t second-guess your surgeon, and don’t let a sarcastic blog talk you out of care your kid needs. But if the recommendation feels rushed, if nobody’s mentioned a guideline or a waiting period, or if the honest answer to “how long has this actually been documented” is “not that long,” ask the question anyway. Ask what happens if you wait. Ask whether this specific case actually meets the criteria, or whether it’s just the path of least resistance for everyone in the room except your child.
Necessary surgery is worth the risk. Convenience surgery is not, and your kid’s brain doesn’t get a vote in which one they’re getting.
Any advice or information given in this blog should not supersede consultation with your pediatrician or practitioner of choice. Every child is unique, and medical decisions must be made in partnership with the healthcare provider who knows your child’s full history. This blog is intended for educational and informational purposes only, not as a substitute for personalized medical care.
If you are looking for medical advice that is evidence-based, ethically grounded, and uncompromised by industry influence, you are in the right place.
Sources:
FDA Drug Safety Communication: FDA approves label changes for use of general anesthetic and sedation drugs in young children
Anesthetic Exposure During Childhood and Neurodevelopmental Outcomes: A Systematic Review and Meta-Analysis, JAMA Network Open (2022)
The FDA Warning on Anesthesia Drugs, Anesthesia Progress (PMC)
Keyhani S, et al., “Overuse of tympanostomy tubes in New York metropolitan area: evidence from five hospital cohort,” BMJ (2008)
‘Too many children’ have tonsils removed unnecessarily, BBC News (2018)