Last update Dec. 3, 2020
If a breastfed infant requires surgery under general or regional (epidural) anesthesia, or requires some type of sedation, there is a risk of pulmonary aspiration of gastric contents if no time is taken to fast prior to anesthesia or sedation (Brady 2009) .
Intakes of clear liquids (water, sugary solutions, juices, infusions) and breastmilk are digested in two to three hours and do not affect the acidity and amount of liquid that remains in the stomach after this time, thus not interfering with anesthesia.
Children, especially very young ones, arrive much calmer in the operating room if they are not forced to fast for long periods (Beck 2019, ABA 2017, Costa 2016, ABM 2012, Brady 2009).
If the infant is to be operated on, the child can breastfeed and/or ingest clear liquids up to 3 to 4 hours before anesthesia. Longer fasting times are not necessary (ABA 2017). Anesthesiology associations consider sufficient minimum fasts in breastfed infants of 3 (Cook 2006) to 4 hours (ASA 2017, Lawrence 2016 p517, Arun 2013, Sumiyoshi 2013, Hanna 2012, ABM 2012 , ASA 2011, Smith 2011, Weiss 2010, Søreide 2005, Ferrari 1999, Splinter 1999, Emerson 1998, van der Walt 1990), even in preterm infants (Beck 2019).
These 4 hours can be difficult for very young infants and newborns to bear, causing them to cry and be irritable due to hunger. One feed up to 2 hours before of a clear liquid solution (solution of water with sugar and electrolytes, juice without pulp, infusion), followed by the use of a pacifier or the attention of a relative other than the mother until the moment of anesthesia can help mitigate the problem (ASA 2017 and 2011, ABM 2012; Lawrence 2005). Several pediatric associations advocate taking clear liquids up to 1 hour before anesthesia (Thomas 2018).
Minimum recommended fasting times (ASA 2017 and 2011, ABM 2012):
- Clear liquids ......: 2 hours (Thomas 2018: 1 hour)
- Breastmilk .........: 4 hours
- Artificial formula: 6 hours
- Animal milk ........: 6 hours
- Light solids .........: 6 hours
If the surgical procedure does not require sedation or general anesthesia, no type of fasting is necessary and breastfeeding simultaneously with the procedure can serve as analgesia (ABM 2012).
Rescheduling and changes or delays in the surgical schedule are the most common cause of unnecessarily prolonged fasting (Arun 2013), along with the lack of specific preoperative fasting guidelines (Ramírez 2002).
Most surgical procedures allow breastfeeding as soon as the baby is awake; an individual assessment is required according to the type of operation and illness; as long as the infant cannot be breastfed, the mother should express and store milk (CW 2019, ABA 2017, Lawrence 2016 p517).
Suggestions made at e-lactancia are done by APILAM team of health professionals, and are based on updated scientific publications. It is not intended to replace the relationship you have with your doctor but to compound it. The pharmaceutical industry contraindicates breastfeeding, mistakenly and without scientific reasons, in most of the drug data sheets.
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e-lactancia is a resource recommended by Academy of Breastfeeding Medicine - 2015 of United States of America
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