Preoperative fasting in healthy children

The intake of oral fluids during a restricted fasting period

  • Intake of water and other clear fluid* up to two hours before induction of anaesthesia for elective surgery is safe in healthy children, and improves patient wellbeing. [A (age 1 year and above); D (below 1 year)]
  • The volume of administered fluids does not appear to have an impact on patients’ residual gastric volume and gastric pH,when compared to a standard fasting regimen.Therefore, children may have unlimited amounts of water and other clear fluid up to two hours before induction of anaesthesia. [A (age 1 year and above); D (below 1 year)]

          * In practice, a clear fluid is one through which newsprint can be read

The intake of milk during a restricted fasting period

  • Breast milk may be given up to four hours before induction of anaesthesia. [D]
  • Formula milk or cows’ milk may be given up to six hours before induction of anaesthesia. [D]

The intake of solid foods during a restricted fasting period

  • A minimum preoperative fasting time of six hours is recommended for food. [D]

Chewing gum and sweets during a restricted fasting period

  • Chewing gum should not be permitted on the day of surgery. [D(GPP)]
  • Sweets (including lollipops) are solid food. A minimum preoperative fasting time of six hours is recommended. [D]

Pharmacological interventions

Concurrent medications

  • Regular medication taken orally should be continued preoperatively unless there is advice to the contrary. [D(GPP)]
  • Up to 0.5 ml/kg (up to 30 ml) of water may be given orally to help children take their medication. [D(GPP)]

Premedication

  • Administration of premedication as currently practised, for example benzodiazepines,does not appear to affect the fasting recommendations for water and other clear fluid. [A]

Histamine-2 receptor antagonists (H2RAs)

  • The routine use of H2-receptor antagonists (H2RAs) is not recommended for healthy children. [D]

Delayed operations

  • If an elective operation is delayed, consideration should be given to giving the child a drink of water or other clear fluid to prevent excessive thirst and dehydration. If it is confirmed by the anaesthetist and/or surgeon that a delay is likely to be longer than two hours, water or other clear fluid should be given. [D(GPP)]

Excessive fasting

  • If a child admitted for surgery has undergone excessive fasting, consideration should be given to offering them a drink and scheduling their operation slightly later in the operating list. [D(GPP)]