Authors' conclusions:

exposure to anaesthesia before the age of four years has a small association with academic or cognitive performance in adolescence. While more vulnerable groups of children may exist, the low overall difference in academic performance after childhood exposure to surgery is reassuring.

Reviewers' commentary:

although this is a minimal and doubtful effect, this information should be taken into account when assessing toddlers for whom we are considering programmed surgery for indications that could be postponed.

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