700 Children's® – A Blog by Pediatric Experts

NPO: What Can Kids Eat and Drink Before Surgery?

Jul 25, 2018
Image of a girl drinking water

What Is Aspiration?

Aspiration is when food or other stomach contents enter the lungs when vomiting, especially under anesthesia. There is no control or ability for children to cough as they would when they are awake.

It is a fact that your child’s life and safety are at risk under general anesthesia. If a child vomits and food content goes into their lungs while going to sleep or waking up during anesthesia, they can get pneumonia - or worse. For a scheduled, elective procedure, no one wants to increase the risk for your child. The majority of the time, nothing happens, but it’s important to be vigilant about eating and drinking instructions. 

Why Can’t My Child Eat Eight Hours Before Their Procedure? 

Your child is cranky and irritable, why can’t you just feed them a little piece of candy or apple right before their procedure? Who will know? This is just an old wives tale told by the doctors and nurses. No one has problems because they eat or drink. 

Not true. If stomach contents go into your child’s lungs, it is a serious problem. 

If your child cannot tolerate not eating for eight hours or drinking for two hours, let your child’s nurse know so that the time for the operation can possibly be moved. 

Why Does It Matter What They Drink? Aren’t All Liquids the Same?

No, milk is very different from apple juice, orange juice and water. It is made up of proteins, fats and carbohydrates and is more complex. It takes longer for the body to break down. Apple juice is mainly water and carbohydrates, which are easier for the body to digest. Orange juice has pulp which puts it in the same category as food. It is important to follow the rules of what to drink and when. If you are not sure, please call the hospital and find out if it is safe for your child to drink before their surgery. 

Does a Little Apple Sauce or Ice Cream to Take Their Medicines Count?

Yes, please let the nurse know if your child takes medications with apple sauce or ice cream. The hospital staff may try to see if your child can take medicine with an apple juice slushy or administer it through an intravenous line while your child is asleep.

What About Formula or Breast Milk with Thickener or Rice Cereal?

Thickener or rice cereal are generally added due to reflux or other problems keeping formula down. Please let the nurse know if your child is on this supplement. You will not be able feed your child for longer times due to this supplement.

Do We Really Need to Delay or Reschedule the Surgery If My Child Eats or Drinks After the Time We Are Told?

The safety of your child is most important. It may be a problem and inconvenience to delay the procedure, but it is only due to safety concerns and making sure everything goes well during their procedure.

What About Studies Which Have Shown Thousands of Children Eat or Drink Before Surgery with No Problems? Why Are Some Hospitals so Strict?

It is always best to err on the side of caution. Your child’s safety and well-being are important. Eating and drinking instructions are based on the American Society of Anesthesia Guidelines and outline the safest way to prepare for surgery.

Surgery Guide
For more information on what your child may experience before, during or after surgery, click here.

Featured Expert

Nationwide Children's Hospital Medical Professional
Vidya Raman, MD
Anesthesiology and Pain Medicine

Vidya T. Raman, MD, is a pediatric anesthesiologist at Nationwide Children's Hospital and a Clinical Assistant Professor of Anesthesiology at The Ohio State University College of Medicine.

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