These fasting guidelines apply to patients ages 0 to 18 years of age receiving anesthesia care from the Department of Anesthesia, including general, regional, monitored anesthesia care, and procedural sedation. The purpose of these guidelines is: 1) to reduce the risk of pulmonary aspiration for patients receiving anesthesia services; 2) to assist health care providers and patients in decisions about fasting intervals; and 3) to be consistent with accepted standards of clinical care and evidence-based practice.

Guidelines may need to be modified by the anesthesia provider for patients with co-existing conditions (difficult airway) or conditions that might affect stomach emptying or fluid volume, such as diabetes, hiatal hernia, gastro-esophageal reflux disease (GERD), ileus or bowel obstruction, and emergency care. For patients with these conditions, risk of aspiration is greater when airway reflexes are compromised by sedative medications. These conditions may alter anesthetic management.

Unless otherwise instructed, before elective procedures, the minimum duration of fasting should be:

For oral intake:

  • Two hours after limited volumes of clear fluids*

    • No more than 2 ounces for patients less than 5 years
    • No more than 4 ounces for patients age 5-13 years
    • No more than 8 ounces (a metric cup) for patients over 13 years
  • Four hours after breast milk or unlimited amounts of clear fluids
  • Six hours after formula
  • Eight hours after a meal

* Clear fluids are limited to water, apple juice, black coffee or tea (NO milk, cream or creamer), Gatorade®, infant electrolyte solutions (Pedialyte®) and carbonated beverages (Coke®, 7-Up®).
Clear fluids should be utilized to take prescribed medications prior to surgery. Crushed medications may be administered with up to 2 tablespoons of plain apple jelly.

For enteral feeds:

  • Four hours after breast milk tube feeds
  • Six hours after formula tube feeds

*If feeding tube is confirmed (radiographically) to be post pyloric, the patient has no residuals on aspiration, and there is no concern for bowel obstruction or abdominal distension, the procedure may proceed without cessation of enteral feeds.
**If patient is hospitalized and intubated with a cuffed endotracheal tube, the procedure may proceed without cessation of enteral feeds.

Patients with chronic tracheostomies must have enteral feeds discontinued a minimum of six hours prior to their procedure.
Noncompliance may result in delay or cancelation of the procedure! When these fasting guidelines are not followed, the risks and benefits of proceeding, with consideration given to the amount and type of liquids or solid ingested, must be weighed.

Questions? Call the Anesthesia desk at 319-356-2724.

Adapted and liberally paraphrased from practice guidelines by the American Society of Anesthesiologists (© 2017) and the European Society of Anesthesiology (© 2011)

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