Last update Dec. 3, 2020

Procedural Fasting

Likely Compatibility

Fairly safe. Mild or unlikely adverse effects. Compatible under certain circumstances. Follow-up recommended. Read Commentary.

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).

See below the information of these related products:

  • Infant Hospitalization (Fairly safe. Mild or unlikely adverse effects. Compatible under certain circumstances. Follow-up recommended. Read Commentary.)
  • Surgical intervention of the infant (Fairly safe. Mild or unlikely adverse effects. Compatible under certain circumstances. Follow-up recommended. Read Commentary.)

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.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

Your contribution is essential for this service to continue to exist. We need the generosity of people like you who believe in the benefits of breastfeeding.

Thank you for helping to protect and promote breastfeeding.

José María Paricio, founder of e-lactancia.

Other names

Procedural Fasting is also known as Preoperative Fasting. Here it is a list of alternative known names::


  1. Beck CE, Witt L, Albrecht L, Winstroth AM, Lange M, Dennhardt N, Boethig D, Sümpelmann R. Ultrasound assessment of gastric emptying time in preterm infants: A prospective observational study. Eur J Anaesthesiol. 2019 Jun;36(6):406-410. Abstract
  2. Thomas M, Morrison C, Newton R, Schindler E. Consensus statement on clear fluids fasting for elective pediatric general anesthesia. Paediatr Anaesth. 2018 May;28(5):411-414. Full text (link to original source) Full text (in our servers)
  3. ASA. [No authors listed] Practice Guidelines for Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration: Application to Healthy Patients Undergoing Elective Procedures: An Updated Report by the American Society of Anesthesiologists Task Force on Preoperative Fasting and the Use o... Anesthesiology. 2017 Mar;126(3):376-393. Abstract Full text (link to original source) Full text (in our servers)
  4. ABA - Australian Breastfeeding Association. Breastfeeding and hospitalization. 2017 Full text (link to original source) Full text (in our servers)
  5. Lawrence RA, Lawrence RM. Breastfeeding. A guide for the medical profession. Eighth Edition. Philadelphia: Elsevier; 2016
  6. Sumiyoshi R. [Preoperative fasting and fluid management in pediatric patients]. Masui. 2013 Abstract
  7. Arun BG, Korula G. Preoperative fasting in children: An audit and its implications in a tertiary care hospital. J Anaesthesiol Clin Pharmacol. 2013 Abstract Full text (link to original source) Full text (in our servers)
  8. Hanna AH, Mason LJ. Challenges in paediatric ambulatory anesthesia. Curr Opin Anaesthesiol. 2012 Abstract
  9. Academy of Breastfeeding Medicine. ABM Clinical Protocol #25: Recommendations for preprocedural fasting for the breastfed infant: "NPO" Guidelines. Breastfeed Med. 2012 Abstract Full text (link to original source) Full text (in our servers)
  10. Academia de Medicina de Lactancia Materna. Protocolo clínico de la ABM n.º 25: Recomendaciones para ayunos previos a procedimientos en bebés lactantes: Pautas “NPO”. Breastfeed Med. 2012 Full text (link to original source) Full text (in our servers)
  11. ASA - American Society of Anesthesiologists Committee. Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures: an updated report by the American Society of Anesthesiologists Committee on Standards and Practice Parameters. Anesthesiology. 2011 Abstract Full text (link to original source) Full text (in our servers)
  12. Smith I, Kranke P, Murat I, Smith A, O'Sullivan G, Søreide E, Spies C, in't Veld B; European Society of Anaesthesiology. Perioperative fasting in adults and children: guidelines from the European Society of Anaesthesiology. Eur J Anaesthesiol. 2011 Abstract
  13. Brady M, Kinn S, Ness V, O'Rourke K, Randhawa N, Stuart P. Preoperative fasting for preventing perioperative complications in children. Cochrane Database Syst Rev. 2009 Abstract Full text (link to original source)
  14. Weiss G, Jacob M. [Preoperative fasting 2008: medical behaviour between empiricism and science]. Anaesthesist. 2008 Abstract
  15. Cook-Sather SD, Litman RS. Modern fasting guidelines in children. Best Pract Res Clin Anaesthesiol. 2006 Abstract
  16. Lawrence RA. Lactation support when the infant will require general anesthesia: assisting the breastfeeding dyad in remaining content through the preoperative fasting period. J Hum Lact. 2005 Abstract
  17. Søreide E, Eriksson LI, Hirlekar G, Eriksson H, Henneberg SW, Sandin R, Raeder J; (Task Force on Scandinavian Pre-operative Fasting Guidelines, Clinical Practice Committee Scandinavian Society of Anaesthesiology and Intensive Care Medicine). Pre-operative fasting guidelines: an update. Acta Anaesthesiol Scand. 2005 Abstract Full text (in our servers)
  18. Ramírez-Mora J, Moyao-García D, Nava-Ocampo AA. Attitudes of Mexican anesthesiologists to indicate preoperative fasting periods: A cross-sectional survey. BMC Anesthesiol. 2002 Abstract Full text (link to original source) Full text (in our servers)
  19. Splinter WM, Schreiner MS. Preoperative fasting in children. Anesth Analg. 1999 Jul;89(1):80-9. Review. No abstract available. Abstract
  20. Ferrari LR, Rooney FM, Rockoff MA. Preoperative fasting practices in pediatrics. Anesthesiology. 1999 Abstract Full text (link to original source)
  21. Emerson BM, Wrigley SR, Newton M. Pre-operative fasting for paediatric anaesthesia. A survey of current practice. Anaesthesia. 1998 Abstract Full text (link to original source) Full text (in our servers)
  22. van der Walt JH, Foate JA, Murrell D, Jacob R, Bentley M. A study of preoperative fasting in infants aged less than three months. Anaesth Intensive Care. 1990 Abstract

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