Why fast before surgery?
The reason for not eating or drinking for several hours before having a general anaesthetic is so that the stomach is empty. This reduces the risk of any stomach contents entering the lungs (pulmonary aspiration) while patients are relaxed and sleepy.
Not eating can be stressful for baby
While an adult or older child will understand why they must not eat for a certain number of hours, a breastfed baby doesn’t understand why he can’t feed on demand, even if he isn’t especially hungry— because he breastfeeds for many other reasons. Expecting a breastfed baby not to eat can be stressful to mother and baby so it is important to know the minimum safe fasting time so that stress and upset can be reduced.
Breastmilk is digested quicky
Breastmilk is digested much more quickly than formula or solid food which has a bearing on the fasting interval (Breastfeeding and Human Lactation, Wambach & Riordan, 2015 p 727)
Guidelines for a baby fasting for surgery
Opinions vary slightly on the safest fasting time for a breastfed baby. Most organisations recommend four hours. The Royal College of Anaesthetists (RCoA), Association of Anaesthetists of Great Britain and Ireland (AAGBI) and Association of Paediatric Anaesthetists of Great Britain and Ireland (APAGBI) have produced a guide as follows:
Children are much more comfortable if they do not have to wait longer than necessary without food and drink. The following are generally agreed timings for when you can give your child something to eat or drink before non-urgent surgery.
- Six hours before, your child can have a light meal or a glass of milk. Bottle-fed babies can have formula feed.
- Four hours before, babies can have breast milk.
- Two hours before, children should have a drink of water or very dilute squash.
What do others say?
At the time of writing the Academy of Breastfeeding Medicine, American Society of Anesthesiologists and the Royal College of Nursing all recommend four hours as a recommended fasting time for a breastfed baby prior to surgery. See the links below for their policies:
ABM Clinical Protocol #25: Recommendations for Preprocedural Fasting for the Breastfed Infant: ‘‘NPO’’ Guidelines, The Academy of Breastfeeding Medicine, 2012
Practice Guidelines for Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration, American Society of Anesthesiologists 2011
Perioperative Fasting in Adults and Children. An RCN guideline for the multidisciplinary team, Royal College of Nursing, 2005
Is a shorter fasting interval of three hours ever recommended?
A paper by Cook-Sather and Litman (2006) discusses whether shorter fasting periods for breast milk (3 hr), formula (4 hr) and light meals (6 hr) may be possible:
…the relative safety and benefits of allowing clear liquids up to 2 hr prior to anesthesia for otherwise healthy children are well established. Shortened fasting periods for breast milk (3 hr), formula (4 hr) and light meals (6 hr) are supported by accumulated experience and an evolving literature that includes evidence of minimal gastric fluid volumes (GFVs) at the time of surgery. Ideal fasting intervals for children with disorders that may affect gastrointestinal transit have yet to be determined.
In Breastfeeding Answers Made Simple, 2010, p. 317 Nancy Mohrbacher states re fasting for surgery that breast milk can be given up to 3 hours before surgery and she cites studies by Brady et al and Cook-Slather & Litman (above). She adds that it may be possible to comfort the baby on a pre-pumped breast up to 2 hours before the surgery. The decision on whether this is appropriate and on the fasting time for your baby will need to be taken with your baby’s surgeon and anaesthetist.
Distraction from breastfeeding
Ideas to distract your baby during the fasting period include going for a drive or perhaps trying a pacifier. It may be helpful if someone other than the breastfeeding mother tries to comfort the baby so that the little one doesn’t expect to nurse. The timing of surgery can make a difference: later in the day may make distraction easier than if the fasting period is through the night.
Unless your health professionals have any concerns, breastfeeding can continue as soon as your baby is ready to feed by mouth (Mohrbacher, 2010).