If your child has ever had to fast, you’ll know how difficult it can be to keep them preoccupied – especially when they can’t have anything to eat or drink for several hours before theatre.
But after extensive research, the RCH has found a way for children to be more comfortable in the lead up to surgery.
Deputy director of anaesthetics Philip Ragg and his team are now actively encouraging children to drink clear fluids right up until one-hour before theatre. And clear fluids can be tasty – they include water, apple juice, cordial and even lemonade.
How does it help?
Allowing children to have clear fluids closer to their surgery has many benefits, most notably the comfort level of the child. Philip says children are happier because they have something in their tummies, and nurses are happier because they’re not bearing the brunt of the unhappy family with the unhappy, thirsty child.
Having fluids close to surgery also reduces the chances of a patient having a low blood sugar level, plus it is easier to schedule operating theatres.
“A big problem is if we have a cancellation on the operating theatre list,” says Philip.
“We would like to bring the next patient forward, but if they’ve not fasted, they’ve got to wait.
“A two-hour fast for the clear fluids didn’t give us the opportunity to bring patients forward, but now with one hour it really does allow a huge amount of flexibility.”
Why do we need to fast?
The reason for fasting is to make sure the patient has a relatively empty stomach when under anaesthetic. Having an anaesthetic reduces a patient’s cough or gag reflex, so anything that comes up from the stomach is at risk of being inhaled into the lungs.
We now know that the longer a patient fasts, the more stomach acid is produced, and stomach acid is more damaging to lungs than clear fluids. So a shorter fasting time is not only more comfortable for the child, it is safer as well.
Leading the way
The RCH is setting the benchmark for these new fasting guidelines, and the rest of the world is watching with interest.
“We’re one of the only departments in Australia that has a one-hour clear fluids guideline,” says Philip.
“There are a lot of other institutions looking at us to see how we go, but after more than 12 months we’ve had no issues whatsoever.
“It’s a guideline that we are very happy with.”
Always check with your medical team about what your child can or can’t have in the lead-up to surgery.
EDIT: Breastmilk and fasting
There are different fasting guidelines for solids and milk products, including breastmilk. This is because food and milk fluids take longer than clear fluids to be emptied by the stomach.
Breastmilk is not considered a clear fluid as it forms a curd when it reaches the stomach and then behaves as a semi-solid.
The RCH allows breastmilk up to 3 hours before surgery for infants under 6 months, and Philip says this is an excellent choice for this age group.
Current RCH fasting guidelines for solids, milk products, and clear fluids are as follows:
Children under 6 months
- Breastmilk can be given up to 3 hours before surgery
- Formula and cow’s milk can be given up to 4 hours before surgery
Children 6 months and older
- Solids and milk products can be given up to 6 hours before surgery
- Clear fluids up to 1 hour before surgery
EDIT: Sugary drinks
The RCH does not recommend regular consumption of sugar-based drinks. However, we know that many children will not drink plain water pre-surgery.
Philip says the glucose in fruit juice, cordial and even soft drink can be beneficial in the unique situation of fasting before surgery (fortunately a rare event for most children), as it prevents low blood sugar.
“Our preference would always be for water,” Philip says.
“But if a distressed child refused water and would prefer juice, cordial or soft drink or needed something to disguise the taste of medication, then we would consider soft drink as a one-off treat before surgery.”
Remember that fluids are “clear” only if they can be seen through and have no particles. These guidelines apply to non-urgent surgeries. Emergency or urgent patients have unpredictable stomach emptying, and the anaesthetist will advise on fasting times.