The Royal Children’s Hospital Melbourne

If your child is scheduled to have surgery, they will need to fast (not have anything to eat or drink) for a number of hours before their procedure.

Fasting before surgery is important because your child’s stomach needs to be empty for the general anaesthesia medicines to be safe.

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You will be told in person or get a letter telling you the time that your child must stop eating or drinking before their surgery. Your child’s doctor or anaesthetist will let you know if the times can be adjusted for your child. An anaesthetist is a specialist doctor who gives general anaesthesia medicines and looks after your child while they are asleep for their surgery. See our fact sheet Preparing your child for surgery – general anaesthesia.

You will need to make sure you follow all instructions given to you, otherwise your child’s surgery may be delayed or rescheduled for another date.

Why does my child need to fast?

The reason for fasting is to make sure your child has an empty stomach when under general anaesthetic. Having an anaesthetic lessens a child’s cough or gag reflexes, so anything that comes up from the stomach has the risk of being breathed into the lungs and causing pneumonia.

Always check with your medical team about what your child can or can’t have before surgery. You will be told by your doctor or nurse when your child has to stop eating and drinking before surgery. Your child’s appointment letter will also have the fasting instructions written on it.

There are different fasting guidelines for solids and milk products, including breastmilk. This is because food and milk liquids take longer than clear liquids to be emptied by the stomach.

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Remember that clear liquids are see-through when held to the light. They include sugar-based drinks, cordials and clear juices (e.g. apple or blackcurrant juice, but not orange juice). This does NOT include liquids with particles in them, milk-based products or jelly.

Breastmilk is not considered a clear liquid as it forms a curd which is semi-solid when it is in the stomach. The Royal Children’s Hospital (RCH) allows breastmilk up to three hours before surgery for infants under six months.

Current RCH fasting guidelines for solids, milk products, and clear liquids are as follows:

Children under six months

• Breastmilk can be given up to three hours before surgery.
• Formula and cow’s milk can be given up to four hours before surgery.
• Clear liquids (e.g. water) can be offered up to one hour before surgery.

Children six months and older

• No food or milk products for at least six hours before surgery (this includes all food, milk, lollies and chewing gum).
• Clear liquids (e.g. water, clear fruit juice, cordial) can be offered up to one hour before surgery.

These fasting guidelines can only be modified after discussion with your child’s anaesthetist. You will need to make sure you follow all instructions given to you, otherwise your child’s surgery may be delayed or rescheduled for another date.

If you have any questions or you are unclear about the fasting instructions for your child, contact your doctor or treating hospital.

Regular medicines

Your child should continue taking their regular oral medicines at the usual time unless otherwise requested by your doctor or nurse. Medicines can be taken on the day of surgery with a sip of clear liquid.

If your child takes blood thinners (e.g. aspirin, warfarin) or medicines for diabetes (e.g. insulin), please contact your doctor at least two weeks before your child’s scheduled surgery for a plan in taking these medicines, as your child may need to stop or adjust their usual medicines for their surgery.

After surgery

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During and after the surgery, while your child is not drinking, liquids are given into a vein through a drip (intravenous or IV cannula). Your child’s doctors and nurses will let you know when your child is able to start eating and drinking again.

• Your child will usually start with clear liquids once they are awake after surgery. If they tolerate this without vomiting, they can start a light diet.
• Babies under six months will be able to have glucose water mix, breastmilk or formula once they wake after surgery.

Your child’s bowel may slow down after surgery and this can take a few days to start working again. If you are concerned, speak to your doctor who can advise if medicines (e.g. laxatives) to help the bowel work are needed.

Emergency surgery

The fasting guidelines above apply to non-urgent surgeries. Emergency or urgent patients have unpredictable stomach emptying, and the anaesthetist will advise on fasting times for individual cases.

Key points to remember

• Your child will need to fast before they are scheduled to have surgery.
• If you do not follow all instructions given to you, your child’s surgery may be delayed or rescheduled for another date.
• For children under six months, breastmilk can be given up to three hours before surgery and formula or cow’s milk can be given up to 4 hours before surgery.
• For children six months or older, no food or milk products can be given for at least six hours before surgery.
• Clear liquids (e.g. water, clear fruit juice, cordial) can be offered up to one hour before surgery.
• Clear liquids are see-through when held to the light.
• If you have any questions or are unclear about the fasting instructions for your child, contact your doctor or treating hospital.

For more information

• If you are unsure about appropriate fasting times for your child, or have questions about preparing your child for surgery, contact your doctor.
• If your child is having their procedure at The Royal Children’s Hospital, you can contact the Pre-Admission Resource Centre (PARC) on 9345 4115 or 9345 4193 during office hours
• The Royal Children’s Hospital: Anaesthesia and Pain Management
• Kids Health Info fact sheet: Preparing your child for surgery – general anaesthesia
• Be Positive: A child’s guide to hospital: Surgery

Call an ambulance (000) immediately in an emergency.

Developed by The Royal Children’s Hospital Anaesthesia and Pain Management department. We acknowledge the input of RCH consumers and carers.

Developed October 2019.

This information is awaiting routine review. Please always seek the most recent advice from a registered and practising clinician.

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