A recent study presented at the ANESTHESIOLOGY® 2025 annual meeting reveals that most children, including nearly 80% of infants, fast from clear liquids for at least twice the recommended time before anesthesia. The analysis of over 70,000 pediatric patients highlights a widespread deviation from guidelines, potentially affecting surgical outcomes.
The American Society of Anesthesiologists (ASA) recommends that healthy children consume clear liquids—including water, pulp-free fruit juices, or carbohydrate-containing drinks—up to two hours before anesthesia to reduce the risk of lung complications such as choking or pneumonia. However, fasting for longer than this period can cause dehydration and disrupt blood sugar levels, risking increased discomfort and slower recovery.
Infants and children fasting more than four hours without clear liquids experience heightened thirst, anxiety, pain, nausea, and vomiting, which may complicate their surgical experience. According to Dr. Alexander Nagrebetsky, senior author and anesthesiologist at Massachusetts General Hospital, infants are especially vulnerable to dehydration and calorie loss, increasing stress and impairing postoperative recovery.
The study analyzed records of 71,835 children aged up to 17 years, including 3,771 infants under one year, who underwent elective surgeries at 12 U.S. hospitals from 2016 to 2024. Prolonged fasting was defined as abstaining from clear liquids for four hours or longer—double the ASA-recommended limit.
Although the overall rate of children fasting excessively decreased from 84.3% in 2016 to 70.2% in 2024, the opposite trend was observed in infants, increasing from 75.9% to 79.6% during the same period. The median fasting time across all children dropped from 10.9 hours in 2016 to 8.7 hours in 2024, but infants showed no significant improvement, fasting around 6.3 to 6.7 hours on average. In 2024, fasting durations were approximately three times the recommended length for infants and four times for all children.
Reasons for prolonged fasting likely include outdated hospital protocols such as the “nothing after midnight” rule, lack of awareness about ASA guidelines, and misunderstanding the risks of extended fasting on pediatric patients’ health and recovery.
Dr. Nagrebetsky emphasizes that perioperative teams should encourage the intake of water or sugar-containing liquids until two hours before surgery whenever possible, to support hydration and caloric needs. He also advises parents to proactively discuss fasting guidelines with anesthesiologists to ensure their children’s safety and comfort.
Lead author Ethan Lowder from Harvard Medical School noted, “Our findings confirm that many U.S. healthcare providers continue non-adherence to fasting guidelines. Clear liquids with sugar and electrolytes help sustain children’s normal body functions and better prepare them for surgery and recovery.”
Real-Time Health Data Analysis and Advice
Prolonged fasting—more than double the recommended two-hour window—is common in infants, potentially compromising hydration and metabolic stability before surgery.
Data indicate that infants fasting for 6+ hours from clear liquids remain at higher risk for dehydration and delayed recovery, emphasizing the urgent need for guideline adherence.
Healthcare providers should update fasting protocols and educate parents on safe preoperative hydration to reduce anxiety and improve surgical outcomes.
Parents of infants scheduled for surgery should actively consult specialists about current fasting guidelines to minimize fasting duration while maintaining safety.
Following these measures can enhance comfort, reduce perioperative complications, and speed healing for infants undergoing anesthesia.
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