Difference in Pediatric Anesthesia Training Between North American and European Countries

Date Submitted: 10/21/2025

Date Accepted: 10/26/2025

When a child needs surgery, a parent’s biggest question is often, “Will they be safe?” A critical part of the answer lies in the hands of the pediatric anesthesiologist, the specialized doctor responsible for putting the child to sleep, managing their pain, and monitoring their vital signs throughout the operation. However, the required training and regulations to become a pediatric anesthesiologist are not the same everywhere. A study titled “Pediatric anesthesia in Europe: Variations within uniformity” highlights that recent reviews of practices across Europe, Canada, and the United States reveal major contrasts between the regions, meaning a child’s treatment or safety during surgery can depend heavily on their area that they live in (1).

Countries compared for Pediatric Anesthesia training in this article.

Anesthesia is more than just “going to sleep.” It is a carefully controlled medical state that blocks or reduces pain, keeps the patient still, and manages critical body functions like breathing, heart rate, and blood pressure (2). Children’s bodies metabolize, or process the drugs differently than adults. Their airways are more delicate, and their physiological responses are unique. A specialist trained in these situations is essential for safe care of the child.

The role of Pediatric Anesthesiologist explained.

The role is often shared with Certified Registered Nurse Anesthetists (CRNAs), who are advanced practice nurses with specialized training in the field of anesthesia (3). Both are vital members of the care team, but the key difference lies in the depth and focus of their medical training. Pediatric anesthesiologists, as medical doctors, complete a longer and more intensive training pathway specifically designed to master the complex physiology of infants and children, preparing them to manage the most high-risk and complex pediatric cases.

The core conflict lies in who is qualified to provide this care. In some countries, pediatric anesthesiology is a distinct, officially recognized specialty requiring years of extra training. In others, any doctor qualified to give anesthesia to adults is legally permitted to treat a child, regardless of their specific experience with infants or complex pediatric conditions.

The United States:

The United States has the most formalized system. In another study titled “Pediatric anesthesia in North America” emphasized that becoming a pediatric anesthesiologist in the U.S. is a long and challenging process (4). After medical school and a four-year anesthesiology residency, doctors must complete an additional, accredited one-year fellowship solely in pediatric anesthesia. Residencies are essentially on-site training to become a specialist doctor after finishing medical school, and fellowships are often referred to as a period of extra highly specialized training that a doctor takes after they complete their core residency programs. They are required to train for a minimum of two months, which involves managing a hundred children that are less than the age of twelve years old. Within the hundred children, twenty of them should be infants that are less than three years old, and five of those should be newborn children. They must then pass a difficult national board exam to earn a special certification. They also offer even further specialization in Pediatric Cardiac Anesthesia, where they focus on children born with heart illnesses (5). 

The process to become a Pediatric Anesthesiologist in the U.S. visualized.

For regulation, there is a strong trend toward “regionalization,” in the United States, where the youngest and children with more complex symptoms are sent to major children’s hospitals run by these specialists. Due to this factor, the centralization of care for the U.S. is extremely high and is still increasing. Although the U.S. has a qualitative and formal system for establishing high standard care, they also have a few problems. The U.S. faces significant shortage in workforce and supply chains, struggling to staff the growing number of procedures performed outside the main operating room, like MRIs and endoscopies.

Canada: 

Canada’s system is very similar to that of the U.S. and is becoming even more standardized. While general anesthesiologists receive four months of pediatric training during their five-year residency, those who want to specialize in pediatrics anesthesia complete a one-year fellowship. In a major step forward, Canada officially recognized Pediatric Anesthesiology as a distinct sub-specialty in 2023, creating a national diploma to ensure consistent training quality across all its provinces (4).

Like the U.S., Canada has no national regulations except British Columbia, and uses 15 major children's hospitals as specialized hubs for complex cases. Canada’s large geographically dispersed population means many children in remote communities are cared for by Family Practice Anesthesiologists, who have only one extra year of general anesthesia training, highlighting the tension between access and specialized expertise. Due to this factor, over half of all pediatric anesthetics are done in non-specialist centers.

Europe: A Continent of Contrasts

Unlike the U.S. and Canada, Europe presents a diversity in systems. There is no common standard training for a pediatric anesthesiologist, resulting in a patchwork of training standards and regulations.

The strictest countries will be the United Kingdom (UK) and Serbia. These countries most resemble the North American model. The UK recognizes pediatric anesthesia as a “Special Interest Area,” and Serbia offers an official one-year program to become a “Pediatric Anesthesiologist.” The UK follows a national curriculum with an extra 6-12 months fellowship needed to work in pediatric centers. The UK mainly focuses on competencies, meaning that they value having appropriate skills over numbers of experience. Serbia also requires four months in pediatric anesthesia training after four years of anesthesiology and intensive therapy. Both have very high centralization of care, directing younger and complex cases to specialist centers or children’s hospitals (1).

The middle ground countries include Germany, France, Switzerland, Netherlands, and Nordic Countries. In these countries, there is no mandatory special license for pediatric anesthesia. However, national guidelines often recommend or mandate that younger children or those with health problems be treated in better-equipped hospitals. For example, Switzerland has a clear three-level system defining which hospitals can care for which children. France and the Netherlands also have a similar system with three or four levels of care, sorting them by age. Nordic countries and Germany also mandates vulnerable babies/children to go to specialized hospitals. Nordic Countries include several countries in Northern Europe, including Denmark, Finland, Iceland, Norway, and Sweden. It is mandatory in these countries for younger or children with more complex symptoms to go to higher level centers, increasing the centralization of care. Out of these countries, France offers an extra year of training for “Pediatric Anesthesiologist”, Nordic Countries offer a formal two years national fellowship, and Switzerland also has a specialty title under discussion (1). 

The most flexible countries are Belgium and Hungary. Here, the regulations are the most lenient. Any certified anesthesiologist can anesthetize any child in any hospital. While both countries have active professional societies, there are no national rules restricting practice, leading to a more decentralized model of care. Although they are lacking in centralization, both countries are trying to improve the situation and are currently in development (1).

The summary for all of the countries discussed, including United States and Canada.

Conclusion:

So, what's the big takeaway? The rules and training for who can give anesthesia to kids are different all over the world. The United States and Canada have established formalized pathways to create experts in children’s anesthesia. Europe, meanwhile, is a complex patchwork where a child’s safety during surgery can depend on the national borders within which they get treatment. Pediatric Anesthesia License is rare and not officially recognized sub-speciality in many European countries currently. If a doctor is certified as a general anesthesiologist, they are legally allowed to treat children of any age without specific training or experience. A lot of countries are moving towards sending 1-3 years old and children with more complex symptoms to specialized pediatric centers to cure them with proper equipment, staff, and experience (1). However, local hospitals will be challenged to maintain their skills for pediatric emergencies. Professional societies are in charge of setting guidelines and spreading awareness to the community since there are no uniform national laws.

Comparison of centralization of care within Europe and highlighting transfers.

The most frequent form of transfer is international medical graduates coming to the U.S. to complete a pediatric anesthesia fellowship.  This is due to the varied education systems in Europe and other countries, and medical students seek training in the United States since they are highly structured with vast case volumes and exposure to high quality techniques and complex pathologies (4). U.S. fellowship regarding Pediatric Anesthesia on resume is a significant mark of excellence and qualification globally.

Experts agree that the current system is inconsistent, and the future goal is to create one common standard. The push for a common European training curriculum is not just an academic exercise, but it is a matter of patient safety and to provide better healthcare. As mentioned in the beginning, the parent’s biggest question when their child has a surgery is whether they will be safe or not. Parents care about expertise and safety more than they care about the number of years of training or experience of the doctor. When a family moves from Germany to Belgium, or a child on vacation in the Hungarian countryside needs emergency surgery, the level of specialized care they receive should not drop dramatically. Consistent, high-quality training ensures that every child, regardless of nationality or location, has access to the same safe standard of care. Research has shown that country-specific differences in training may be linked to differences in patient outcomes, making this a critical issue for children's health across the continent (1). By learning from each other and striving for a common high standard, the global medical community can ensure that every child has access to the same high standard of safe anesthesia care.

About the Author:

Kaito Dao: kidao@ucsd.edu, University of California, San Diego 

References:

1. Jurgen, Peter Frykholm, Thomas Engelhardt, Ehrenfried Schindler, Tamas Kovesi, Dusica Simic, Ignacio Malagon, et al. 2024. “Pediatric Anesthesia in Europe: Variations within Uniformity.” Pediatric Anesthesia 34 (9): 919–25. https://doi.org/10.1111/pan.14873.

2. Cleveland Clinic. 2023. “Anesthesia: Anesthesiology, Surgery, Side Effects, Types, Risk.” Cleveland Clinic. May 30, 2023. https://my.clevelandclinic.org/health/treatments/15286-anesthesia.

3. American Association of Nurse Anesthesiology. 2023. “Become a CRNA.” American Association of Nurse Anesthesiology. 2023. https://www.aana.com/about-us/about-crnas/become-a-crna/.

4. Srinivasan, Ilavajady, Simon Whyte, Katherine Bailey, Tiffany Antrobus, Karisha Hinkson‐LaCorbinière, Timothy W Martin, Joseph P Cravero, and Linda J Mason. 2024. “Pediatric Anesthesia in North America.” Paediatric Anaesthesia, March. https://doi.org/10.1111/pan.14872.

5. “Cardiac Anesthesiology | Children’s Hospital Colorado.” 2019. Childrenscolorado.org. 2019. https://www.childrenscolorado.org/doctors-and-departments/departments/heart/programs-and-clinics/cardiac-anesthesia/.