Fluids

The adult patient or the family member supervising the pediatric patient will be asked the exact time and nature of any ingestion of food or drink after midnight by the patient and this time will be documented by nursing in ASU/PSCU/hospital floor.

Infants
birth to
6 months
Toddlers
6 months to
36 months
Young children
36 months to
12 years
Older children & adults
Healthy Children over 12
to Adults

INSTRUCTIONS FOR PARENTS OF PEDIATRIC PATIENTS [Note 1]

BIRTH TO 6 MONTHS OLD

Clear liquids such as pedialyte, glucose water, or clear juices without pulp such as apple juice, clear pear juice, and white grape juice should be encouraged until 3 hours prior to the scheduled procedure. [Note 2]

Breast milk may be offered until 4 hours prior to the scheduled procedure if the infant refuses clear liquids. Special instructions for ambulatory surgery patients.

Formula may be offered until 4 hours prior to the scheduled procedure only if the infant refuses clear liquids. Special instructions for ambulatory surgery patients.

No solid food after midnight prior to the scheduled procedure.


6 MONTHS TO 36 MONTHS

Clear liquids such as pedialyte, water, or clear juices without pulp such as apple juice, clear pear juice, white grape juice, and clear Jell-O should be encouraged until 3 hours prior to the scheduled procedure. [Note 2]

Breast milk may be offered until 4 hours prior to the scheduled procedure if the baby refuses clear liquids.

Formula may be offered in infants under 12 months until 6 hours prior to the scheduled procedure, only if the baby refuses clear liquids.

No solid food or pulp containing juices after midnight prior to the scheduled procedure.

 


36 MONTHS TO 12 YEARS

Clear liquids such as pedialyte, water, or clear juices such as apple juice, clear pear juice, white grape juice, flat soda, and clear Jell-o should be encouraged until 3 hours prior to the scheduled procedure. [Note 2]

No solid food or non-clear liquids such as milk or orange juice after midnight prior to the scheduled procedure unless approved by the anesthesiologist.

 


INSTRUCTIONS FOR HEALTHY [Note 3] ADULTS AND CHILDREN OVER 12

Medication with sips of water may be taken until 30 minutes before the procedure.

Clear liquids such as water, or clear juices such as apple juice, white grape juice, flat soda, tea, black coffee (no milk), and clear Jell-O may be offered until 3 hours prior to the scheduled procedure.

No solid food or non-clear liquids such as milk or orange juice after midnight prior to the scheduled procedure unless approved by the anesthesiologist.


Note 1. Healthy pediatric patients without history of delayed gastric emptying scheduled for elective procedures under general anesthesia or sedation should be encouraged to take clear liquids until 3 hours before the procedure to prevent dehydration and low blood sugar.

Children with delayed gastric emptying or reflux should remain NPO (Nil Per Os - Nothing By Mouth) after midnight with the exception of only small sips of water with required medication and may be considered for IV fluid preoperatively if the procedure is scheduled late in the day.


Note 2. It is considered safe to receive general anesthesia or sedation after 2 hours of ingestion of clear liquids according to the American Academy of Pediatrics and the American Society of Anesthesiologists. Should the procedure start an hour early, the required time for the stomach to empty is only 2 hours after clear liquids.


Note 3. Patients at risk for pulmonary aspiration of gastric contents (vomiting) should limit intake of clear liquids to small "sips". Examples include:

GE reflux

esophageal dysfunction

dysphagia (difficulty in swallowing)

gastromotility disorders such as gastroparesis

potential for difficult airway

extreme obesity

pregnancy

metabolic disorders such as diabetes mellitus