By Madeline Kennedy – Reuters

More than 10 million U.S. children don’t live near a pediatric anesthesiologist, a doctor who specializes in sedating children during surgery, according to a recent study.

Pediatric anesthesiologists give children the medications needed to sedate them or put them completely to sleep during surgery and other procedures. They also monitor children’s heart rate and other health measures while surgery is going on.

Small children needing more serious medical care should be treated by pediatric anesthesiologists, who have a special certification to work with children, rather than doctors without this training, according to new guidelines from the American College of Surgeons.

However, many young children with medical needs, particularly in rural areas, live more than 50 miles away from a pediatric anesthesiologist, the researchers write in the journal Anesthesia and Analgesia.

“Families are faced with the choice of traveling long distances to centers where experts practice, or to utilize the services of anesthesiologists in their locality who may care for children on an occasional basis only,” lead author Dr. Matthew Muffly told Reuters Health by email.

In addition to surgery, very young children may need anesthesia to stay still during procedures like body scans, and their risks of complications from sedative medications are much higher than those of older children, said Muffly of Stanford University Medical Center in California.

Using four medical registries and databases, Muffly and colleagues identified just over 4,000 pediatric anesthesiologists practicing in the U.S. in 2015. They compared this information with 2010 census data on children under the age of 18 and created a map of driving distances of families to the nearest pediatric anesthesiologist.

The results showed that 90 percent of child anesthesiologists work in urban areas, which the researchers defined as counties with more than 50,000 young children.

The majority of children, 71 percent, live within a 25-mile drive of a pediatric anesthesiologist.

But more than 10 million children, or nearly 15 percent, live more than 50 miles from the nearest pediatric anesthesiologist, particularly in the western region of the country.

This includes more than 2.7 million children under age 5 – the group that needs these specialists the most, according to the American College of Surgeons.

Muffly told Reuters Health that six states had ten or fewer pediatric anesthesiologists: Alaska, Idaho, Montana, North Dakota, South Dakota, and Wyoming.

“Younger children have physical and emotional needs that obviously differ from adults. Their anatomy and physiology, particularly under anesthesia, change in ways that are unlike anesthetized adult patients,” Dr. Alison Ross, chief of the pediatric anesthesia division at Duke University Medical Center, said by email.

Ross stressed the importance of specialized training but noted that in areas without trained pediatric anesthesiologists, medical facilities are likely to have staff with a lot of experience treating children.

“It is important to realize that it is often more important in an emergency to be taken to the nearest facility for care rather than to delay care due to a desire to be in a pediatric facility, depending on the nature of the event or the medical condition of the child,” said Ross, who was not involved in the study.

Muffly said that for families living far from pediatric anesthesiologists, older children may fare perfectly well. “But for young children,” he added, “particularly younger than 2 years old, and for older children with complex medical conditions, they may need to travel to an institution that routinely cares for these vulnerable patients.”