See also

Fasting in PICU 
Diabetes mellitus and surgery

Key points

1. The goal of these guidelines is to minimise fasting times
2. If a child appears likely to fast for longer than these times, consult anaesthetist
   
3. Children with a higher risk of hypoglycaemia (diabetes mellitus, certain metabolic disorders) will have special requirements; consult anaesthetist
   

Background

• Fasting prior to anaesthesia or sedation is designed to reduce the volume of gastric contents with the aim to reduce the risk of gastric regurgitation and the consequences of any pulmonary aspiration 

• Aspiration during anaesthesia is a rare event in children 

• The stomach empties clear fluids in an efficient and predictable manner; a shorter period of fasting is required for clear fluids 

Definitions of fluids and food 

Clear fluids are those which when held to light, are transparent

Chewing gum does not significantly affect fasting but should be discarded prior to anaesthesia or sedation 

More information on classification of fluids and food in Appendix 1 (see below) 

‘Sip til Send’ 

Practice that allows children to safely sip on clear fluids when they are thirsty, up until the time they are brought to pre-op hold. Children should not be forced to sip.  

Children who are nil by mouth for medical or surgical reasons should not be offered any fluids

Specific considerations 

• Oral medications should be given with clear fluids unless otherwise directed by the anaesthetist 

• If there is a clinical concern or history consistent with increased risk of regurgitation/aspiration, consult anaesthetist 

• Some procedures have specialised fasting plans, eg patients undergoing nuclear medicine (PET scans) or colonoscopy. Seek specific instructions 

• Children with enteral tube or gastrostomy feeding should be fasted according to the same guidelines as other children (see above) 

• Interruptions to enteral nutrition for children in intensive care may lead to significant calorie deficits. See Fasting in PICU 

Acute surgery and anaesthesia

A fasting plan should be made at the time of booking 

For surgical emergencies, risk is balanced between surgical delay and perceived aspiration risk

Communication    

Information given to families and staff should be accurate and consistent            

RCH specific information

• Elective cases: anaesthetist for the list should be contacted first for all queries related to fasting

• Emergency cases: after hours or when unable to contact elective list anaesthetist, phone anaesthetist in charge 

• Deviation from ‘Sip til Send’: Individual anaesthetists choosing to vary from ‘Sip til Send’ must communicate directly with the treating team/nursing team 
  

Last updated August 2024