American Academy of Pediatrics – Section on Neurological Surgery

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March 15, 2021

Do not routinely perform imaging or routine elective procedures requiring sedation or general anesthesia for very young children with low-risk asymptomatic lesions.

Low-risk asymptomatic lesions such as small rubbery scalp masses representing dermoid cysts or shallow midline sacral dimples do not routinely require intervention as a young infant. Routine magnetic resonance imaging requiring anesthesia is typically not recommended. Given the US Food and Drug Administration’s Drug Safety Communication on pediatric anesthesia ( warning that general anesthesia and sedation drugs used in children younger than 3 years for anesthesia of more than 3 hours or repeated use of anesthetics may affect the development of children’s brains, risks and benefits of elective imaging or procedures should be carefully weighed ( If imaging is necessary, consider approaches such as feed-and-wrap for MRI in infants or referral to specialists to develop a clinical follow-up plan and timing of intervention as appropriate.

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

The pediatric neurosurgery Choosing Wisely topics were chosen after discussion among the Section on Neurological Surgery (SONS) Executive Committee members regarding the most common pediatric neurosurgery issues and treatments general pediatricians see in their practices. Various expert committees and sections of the AAP reviewed and approved the list. The AAP Executive Committee then granted final approval of the list.

AAP’s disclosure and conflict of interest policy can be found at


Andropolous DB, Greene MF. Anesthesia and developing brains: implications of the FDA warning. N Engl J Med. 2017;376(10):905-907