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Frequently asked questions about fasting guidelines for children

Patient Education
Jun 28, 2017

What can my child eat and drink the night before and day of surgery?

  • No food for eight hours before your child’s surgery (even food given through a feeding tube)
  • Your child may have:
    • Formula or milk up to six hours before surgery
    • Breast milk up to four hours before surgery
    • Clear fluids up to two hours before surgery. The defining feature of a “clear fluid” is the ability to see through it and clearly read text.
  • Clear fluids are:
    • Water
    • Apple or white grape juice
    • Carbonated drinks, such as soda pop
    • Sports drinks such as Gatorade®
    • Pedialyte®
    • Clear tea
  • No milk, creamer, or lemon added to any drinks
  • No swallowing of gum, mints, or candy
  • Crushed medicines may be given with up to 2 tablespoons of plain apple jelly at least two hours before surgery.
  • Do not use apple pudding, apple sauce, or yogurt.

Your child’s stomach must be empty for surgery. We do not want food from your child’s stomach to get into the lungs during surgery. Surgery will be delayed or rescheduled if you do not or cannot follow these instructions.

Why can’t my child eat or drink before surgery?

Our protective reflexes slow down when we are given anesthesia. One protective reflex is to keep stomach contents from going into our airway. Aspiration can happen when stomach contents enter our airway. This is less likely to happen when the stomach is empty. Fasting (not eating or drinking) keeps your child’s stomach empty.

Why is aspiration so bad?

Solid or semi-solid stomach contents may not let the lungs get air. Liquid stomach contents that are acidic may burn the lungs and stop them from getting air. Both types of aspiration may cause brain damage or death.

Aspiration can be treated. Most people survive, but treatment in an intensive care unit (ICU) is often needed. Aspiration may lengthen your child’s hospital stay by days to weeks.

Should I wake my child up two hours before the scheduled time for the surgery to give him/her clear liquids?

Yes; do not let them get dehydrated. If your child’s surgery is scheduled to start at 8 a.m., give them a clear fluid before 6 a.m. You may want to wake your child for fluids at 5 a.m. so he/she is done drinking by 6 a.m.

My child was in an automobile accident and needs emergency surgery. My child ate just before the accident, and it has only been 4 hours. The doctor says my child needs the surgery now. Why does my child not have to wait eight hours?

Guidelines help doctors and patients decide about health care. Fasting guidelines are not meant to be the final decision. The risk of aspiration must be weighed against the risk of not having surgery in a timely manner. Your child’s anesthesiologist may change the type of anesthesia to lower your child’s risk.

Can my child chew gum or suck on hard candy while waiting for surgery?

Your child cannot swallow gum or candy before surgery. Swallowing these items counts as ingesting “solid food” and may result in a delay or rescheduling of your child’s procedure.

What about carbohydrate-rich drinks?

Your child can drink clear carbohydrate-rich drinks up to two hours before surgery (for example, Ensure Clear, Premier Protein, or Fizzique). Your child cannot drink fluids that have dairy or pulp. Talk with your child’s health care team if you have questions about a specific drink. If you do not know the ingredients of a drink, eight hours of fasting is thought to be a safe time frame.

What about Jell-O?

Jell-O® is a trade name for one company that makes many forms of gelatins. Plain Jell-O or other gelatins without fruits or other solids are considered clear liquids and are allowed up to two hours before your child’s procedure.

Can my child have honey?

No. Honey is not considered a clear liquid.

Why can I only use apple jelly to give crushed medicines to my child?

Apple jelly is made from apple juice that has been boiled and cooled, causing it to thicken. Apple juice is an approved clear fluid. Plain apple jelly can be eaten up to two hours before surgery. On the day of your child’s surgery, apple jelly may be used to take crushed medicine. Do not use pudding, yogurt, or apple sauce.

Who came up with the fasting guidelines?

They are based on medical research and expert opinion. The American Society of Anesthesiologists and the European Society of Anesthesiologists each have task forces to make them. Faculty in the Department of Anesthesia at the University of Iowa adapts these guidelines for University of Iowa Stead Family Children’s Hospital.

If my child takes food in through an enteral or nasogastric tube (gastric/stomach tube, enteral/jejunostomy tube), should I follow the same fasting instructions?

Yes. Fast for six hours from formula/non-human milk feeds. Fast for four hours from breast milk feeds. Fast for two hours from clear fluids.

My child’s doctor wants to cleanse his/her bowel (do a bowel prep) before the procedure. The doctor prescribed GoLYTELY® (polyethylene glycol electrolyte [PEG]). What is the fasting time between taking GoLYTELY® he/she can have regional, general, or monitored anesthesia care?

Please follow GoLYTELY or MiraLAX instructions from the GI clinic and complete ingestion the day prior to the procedure. Clear liquids are allowed up to two hours before the procedure.