General Anaesthetic / for 4 Year Old

[LDN1]

Hi all,

Following on from my last thread regarding some dental issues with our DD4, there are two teeth that never fully formed and they are causing issues. We have been given the options (we see a well respected specialist this weekend so will see if there's any other options) - of a potential crown situ' or removal of the two teeth in question.

Now... with DD4 being very timid and nervous, we've already been told that gas might not be an option, which leaves general anaesthetic.

Of course, with her being only 4, we have some reservations and anxiety about that. Rather than lean on Google and the rabbit hole that might bring, I wanted to ask on here... has anyone else had their child, as young as 4, go under GA?

My daughter had lengthy surgeries at 5 months old, 1 year, 3 years and 8 years.

She's absolutely fine (apart from the issue that required the surgery in the first place) and doesn't remember much of any of them expect the most recent one.

Please don't worry about it, if it needs doing for her health then it needs doing.

You'll generally find that the doctors and nurses and especially the anaesthetists are used to dealing with anxious children.

They are the same. For instance, medicines.org gives details for an antibiotic called Clarithromycin 250mg/5ml Oral Suspension.

Thank you again to everyone. You've all been a help. We are now a few steps along in the process and looking at dates. We can only see two private options as it stands / as the NHS route could be months (or in one case we heard, years (two to be exact!)):

• GA at a private hospital

vs

• IV sedative at ToothBeary in London

The IV sedative route seems to be exclusively for over 6 year olds (from what we can find), but they say they can do it in younger children.

Our own dentist seemed to think it an odd route for a 4 year old, which raised some questions, but their reviews seem very good.

Does anyone have any experience of Toothbeary and the IV sedation route - that seems to be off limits to young children and toddlers, everywhere else other than here?

Obviously as an anaesthetist I have a particular viewpoint as a result of my own training and experience, so read my comments with that in mind. I am also an experienced dental sedationist, though only for adults. Personally, I would not be enthusiastic about iv sedation for a small child, especially outside a hospital. People sometimes talk about sedation and general anaesthesia as if they are 2 completely different things but they are really just different points on a spectrum with many of the same benefits but also similar risks.

Both as a professional and as a parent my personal preference would be for a general anaesthetic in a small child because the airway is controlled and once the child is anaesthetised the dental team can get on with things quickly. As I say, I have no experience of dental sedation in this age group, but with adults the aim is to have the patient sedated enough to be calm and but still awake enough to maintain their own airway and to be sufficiently cooperative with the dentist. I can't imagine that is very easy with a very young child. There is a fine line to walk. Too little and the child may be distressed and the procedure difficult to perform. Too much and you risk crossing the line from heavier sedation into a GA but without a controlled airway.
I'm sure the clinic you mention does have very well trained staff, enough equipment etc or they they wouldn't get through the necessary statutory inspections and so on, and I'm sure it's possible for a skilled practitioner to provide safe sedation for even very small children but I think the fact that it is not something that is widely offered in either the private sector or the NHS does say something. Personally, if a small child of mine needed to be sedated I would prefer the safety net of being in a hospital and for them to have a GA with the airway controlled from the outset.

I would want to know how many 4 year olds they were sedating each year and how they maintain their anaesthetic skills for that group if it's not many (even if it's 'just' sedation you need to be able to manage an anaesthetic because it's a pretty fine line). I'd also want to know how well the local is likely to work if there's current infection (local doesn't work so well when there's infection so the sedation may need to be deeper...which runs the risk of becoming an anaesthetic). I wouldn't be wildly keen on sedation for shared airway in a remote site in a 4 yr old (but perhaps that's just because I work in a hospital where it's not common practice).

DD did at 4 months for an MRI and was totally fine. I actually managed to get her to sleep before the GA which was easier, although she did get upset as she was going under. I just wish they'd had me there when she woke up but they called me in soon after. Needed to be done x

Very interesting points made here and it sort of matches my own views after a lot of research.

I really appreciate the posts as it helps to build a picture. So thank you again.

My 4yr old had his tonsils out. They put him under GA while he was looking at his iPad. I was taken to recovery and he was crying as he came around (v common) so I went on the trolley with him. Within an hour he was fine. He can't remember any of the crying now but does remember the hospital food!

Not quite the same thing.... But my elderly hamster recently had general anaesthetic for dental surgery amd he cam through it just fine.

My 2 year old has had multiple ga. You can have gas or canula. Can also have an oral sedate before (like calpol) which relaxes them. I’m not gonna lie of course it’s not a nice time as a parent and you always worry. But the teams we’ve been under have been fab, so reassuring and kind

One thing you can do is go on the nhs list and then call repeatedly to ask about cancellations - these happen all the time, so are a good way to get seen.