Too many children go without clear liquids before surgery for at least twice as long as recommended by guidelines.
This is based on an analysis of data from more than 70,000 children in the US, presented at the ANESTHESIOLOGY 2025 annual meeting. It included nearly 80% of infants,
Healthy infants and children may safely drink clear liquids, including water, fruit juices without pulp and carbohydrate-containing beverages, until two hours before receiving anaesthesia.
The American Society of Anaesthesiologists (ASA) guidelines recommend that children not drink anything within two hours before the procedure to reduce the risk of liquid entering the lungs, which could cause choking or pneumonia.
However, fasting for longer can be harmful because it may cause dehydration and unhealthy changes in blood sugar and other chemicals in the body.
Alexander Nagrebetsky, senior author of the study and an anaesthesiologist and intensivist at Massachusetts General Hospital, Boston and assistant professor at Harvard Medical School, Cambridge, Massachusetts, said: ‘Prolonged fasting from clear liquids of four hours or longer can be uncomfortable and increase thirst, anxiety, pain, nausea and vomiting. It can be harmful too. Children and infants are especially vulnerable to dehydration and calorie loss, which may heighten stress and slow recovery from surgery.’
While the study didn’t address why parents and health care professionals withheld clear liquids from children for longer than recommended, there are likely several reasons.
The authors suggested that some parents and physicians may be following outdated practices, such as prolonged fasting, including not drinking after midnight.
There might also be a lack of awareness of ASA fasting guidelines, and they noted that ‘efforts should be made to allow clear liquids in healthy children as close to two hours before the procedure as possible’.
Perioperative team members should encourage patients to drink water and sugar-containing liquids for up to two hours before the procedure, when appropriate, said Dr Nagrebetsky.
Ethan Lowder, lead study author and a student at Harvard Medical School, added: ‘Drinking sugar-containing clear liquids such as juices or those with electrolytes provides water and calories that children’s bodies need for normal functioning, including dealing with the stress of surgery and recovery.’
