Related Experiment Video
Updated: Feb 3, 2026
Assessing the Coherence of Parents' Short Narratives Regarding their Child Using the Five-Minute Speech Sample Procedure
Published on: September 19, 2019
Influence of Surgical Procedures and General Anesthesia on Child Development Before Primary School Entry Among
James D O'Leary1,2,3,4, Magdalena Janus5,6, Eric Duku5,6
1Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
Children undergoing general anesthesia before primary school did not show adverse developmental outcomes compared to siblings. This study suggests anesthesia exposure in early childhood is not linked to detectable developmental issues.
Area of Science:
- Pediatric Anesthesiology
- Developmental Pediatrics
- Child Psychology
Background:
- Preclinical studies indicate anesthetics may harm developing brains.
- Clinical evidence on anesthesia's neurotoxic effects in children is mixed.
- Confounding factors complicate understanding of anesthesia's impact on child development.
Purpose of the Study:
- To investigate the association between early childhood surgery requiring general anesthesia and child development.
- To compare developmental outcomes in siblings with and without anesthesia exposure.
Main Methods:
- Retrospective sibling-matched cohort study in Ontario, Canada (2004-2012).
- Included sibling pairs (5-6 years old) assessed using the Early Development Instrument (EDI).
- EDI measures 5 key developmental domains: physical health, social competence, emotional maturity, language/cognition, and communication skills.
Main Results:
- No significant differences in overall developmental vulnerability between exposed and unexposed children (aOR, 1.03; 95% CI, 0.98-1.14).
- No significant differences observed in any of the 5 EDI developmental domains.
- Findings remained consistent after adjusting for confounding factors like age, sex, and maternal age.
Conclusions:
- Early childhood surgery requiring general anesthesia was not associated with increased risk of adverse developmental outcomes.
- Anesthesia exposure in early childhood does not appear linked to detectable adverse child development outcomes.
- These findings contribute to understanding the safety of anesthesia in pediatric populations.
Importance:
Substantial preclinical evidence suggests that the developing brain is susceptible to injury from anesthetic drugs. Findings from clinical studies of the neurotoxic effects of anesthesia are mixed, but these effects can be influenced by unmeasured confounding from biological and environmental risk and protective factors on child development.
Objective:
To examine the association between surgical procedures that require general anesthesia before primary school entry and child development in biological siblings.
Design, Setting, And Participants:
This retrospective sibling-matched cohort study included sibling pairs aged 5 to 6 years with the same birth mother who had Early Development Instrument (EDI) data completed. The EDI is a population-based measure of child development that assesses children's readiness to learn in 5 major domains (physical health and well-being, social knowledge and competence, emotional health and maturity, language and cognitive development, and communication skills and general knowledge). All eligible children in public and Catholic schools in Ontario, Canada, from 2004 through 2012 were included. Data were analyzed from December 13, 2017, through July 27, 2018.
Exposures:
Surgical procedures that require general anesthesia from the date of birth to EDI completion.
Main Outcomes And Measures:
Early developmental vulnerability, defined as any major domain of the EDI in the lowest 10th percentile of the Ontario population.
Results:
Of the 187 226 eligible children for whom the EDI was completed, a total of 10 897 sibling pairs (21 794 children; 53.8% female; mean [SD] age, 5.7 [0.3] years) were subsequently identified, including 2346 with only 1 child exposed to surgery. No significant differences were found between exposed and unexposed children in early developmental vulnerability (697 of 3080 [22.6%] vs 3739 of 18 714 [20.0%]; adjusted odds ratio [aOR], 1.03; 95% CI, 0.98-1.14; P = .58) or for each of the 5 major EDI domains (aOR for language and cognitive development, 0.96 [95% CI, 0.80-1.14]; aOR for physical health and well-being, 1.09 [95% CI, 0.96-1.24]; aOR for social knowledge and competence, 0.98 [95% CI, 0.84-1.14]; aOR for emotional health and maturity, 0.98 [95% CI, 0.84-1.14]; and aOR for communication skills and general knowledge, 0.90 [95% CI, 0.77-1.05]), after adjusting for confounding factors (age at EDI completion, sex, mother's age at birth, and eldest sibling status).
Conclusions And Relevance:
In this provincial cohort study, children who had surgical procedures that require general anesthesia before primary school entry were not found to be at increased risk of adverse child development outcomes compared with their biological siblings who did not have surgery. These findings further support that anesthesia exposure in early childhood is not associated with detectable adverse child development outcomes.
Related Concept Videos
01:17Sign Test for Matched Pairs
To conduct the sign test, we first calculate the differences in...
01:09Wilcoxon Signed-Ranks Test for Matched Pairs
01:26Kidney Transplant II: Surgical Procedure
01:29Relationship with Other Adult Family Members and Siblings
02:27DNA Base Pairing
02:27DNA Base Pairing