The question of whether or not anesthesia exposure in early childhood causes long term neurodevelopmental harm continues to attract attention. There is already good evidence in humans that surgery and anesthesia in early childhood is not associated with a global neurodevelopmental deficit. However, investigators continue to seek to determine whether specific deficits occur in particular neurodevelopmental domains to identify the so called “phenome” of injury. In this issue, Walkden et al. present data extracted from a large birth cohort and explored the relationship between exposure to anesthesia and surgery before 4 yr of age and a range of neurodevelopmental outcomes tested at ages 7 to 16 yr.