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.
17 comments for “Thirsty work at the RCH”
Ruth Dunn
This is fantastic. It would be great if it could be done for adults as well. Well done Royal Children’s Hospital.
Renae Haynes
Thank you for the update. You’ve publish info encouraging highly sugared drinks yet not included any information about breast milk. Please consider amending your poster. Thank you.
Cheryl
This is fantastic to know as my son is about to go in for surgery but I would like to know where breastmilk falls into this?
Thanks
RCH Communications
Hi Cheryl, we have updated this blog post to include this information. if you re-read this story, you will see at section on breast milk. In short, 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 is an excellent choice for this age group.
Cath
Thank you for the update. Fasting a baby or small child is just one more stress for an already anxious family!
I wonder if the RCH could also amend their policy regarding breastfeeding before surgery. Many hospitals consider breastmilk a ‘clear fluid’. And most recommend withholding for a maximum of 4 hours, not the 6 hours that RCH currently recommends. Those two hours make a big difference in the depths of the night before surgery!
A Jude
This is mostly great but I’m a little concerned that a major health institution is encouraging/endorsing the drinking of high refined sugar and preservative drinks (cordial, lemonade, cola) despite knowing the effects this has on health. Yet no mention of breast milk which is also classed as a clear fluid.
Kate
How does this information apply to an exclusively breastfed baby (under 6months)? Or i guess breastmilk for any breastfed child despite their age…
Thanks
Schayne
So what about breastmilk? I mean aside from breastmilk being better than soft drink in terms of hydration, the emotional comfort is fantastic.
Kathryn
With the World Health Organisation advocating for reduced sugar consumption in children it seems counterproductive to suggest lemonade and cola as a suitable beverage for children. Some information of breastmilk would have been more appropriate especially in light of the WHO recommendation: “exclusive breastfeeding for 6 months is the optimal way of feeding infants. Thereafter infants should receive complementary foods with continued breastfeeding up to 2 years of age or beyond.” Surely many of your patients fall into this category?
Quote from http://www.who.int/nutrition/topics/exclusive_breastfeeding/en/
RCH Communications
Hi Kathryn, we have updated this blog post in include breast milk information. 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, this is an excellent choice for this age group.The RCH does not recommend regular consumption of sugar-based drinks. However, we know that many children will not drink plain water pre-surgery.
Michelle
Wow- cordial, lemonade, cola being advertised by RCH despite knowing the effects this has on ongoing health issues and public healths o going issues with health promotion.. shame the guideline poster doesnt clarify for breast feeding mums what the ok is and timeframes for this? Pretty sure bubs would prefer to aspirate on breastmilk rather than cola which can strip car paint? No, just me?!
Belinda Chambers
Hi RCH, I rely on your website and fact sheets for information when my kids are sick. Thanks for this service. Can you please update this info to include advice about breastmilk and fasting? As you know WHO guidelines recommend breastfeeding until 2 years. Breastmilk is a fluid but breastfeeding offers comfort too, among other benefits, which is exactly what families need in the lead up to surgery.
RCH Communications
Hi Belinda, this blog post has now been updated to include breast milk information.
MrEthanRichRCHPatient1997
Whoa Hold on a Minute I Think Children should not drink anything before Theatre because if they do it can make them vomit before Surgery and that is very, very,very very Dangerous so no I don’t think they should have this new Guideline in Place!
Karen
I have concerns about the mention of high sugar drinks as ok for children. Especially Cola? RCH needs to send a message about healthy choices. What about breastmilk?!
RCH Communications
Hi Karen, this blog post has now been updated to include information about breast milk. The RCH does not recommend regular consumption of sugar-based drinks. However, we know that many children will not drink plain water pre-surgery.
Fardous
If you ever had an ill child going in for surgery, giving your child a ” 1 sugary drink” before OP would the last of your worries. Be a healthy parent after the surgery for GOD sake. Great job RCH. Keep leading the world in reseach and technology…. For our future generations (our kids).