Fasting for General Anesthesia.

Updated on March 14, 2015
J.V. asks from Snohomish, WA
16 answers

My toddler is scheduled for a GA next month. As others who've been through this know, the patient is required to fast the night before. In DD's case, it's 10pm to 6am. We were orgiinally scheduled for a 9am slot, but they insisted the fast had to be the same : 10pm to 9am. I said it's an awfully long time for a toddler, so we chose the earlier time slot for a shorter fast.

Now this shouldn't be a big problem for kids that sleep throughout the night. Problem is, my DD wakes up and wants to nurse at night or get a dirnk. We've tried several times to wean her, but it's been rough and it changes her behavior (scared, upset) so we didn't do cold turkey. I even tried putting on this or that spice to no avail. (Will try vinegar next.) Pleae note: I prefer that she keep on nursing - but for the need for the GA. So unfortunately, we have to find a way to stop her nursing at night at least for a while.

My concern here is dehydration and stress. If vinegar doesn't get her weaned soon enough, and she cries and doesn't get mom's milk, wouldn't all that crying cause dehydration? Wouldn't that be harmful?

I asked the anesthesiologist's office if I could at least offer a bit of water at midnight, or at least 4 hours before the scheduled appointment. They were quite inflexible. I am concerned for my DD. What are your toughts?

ADDITION:

Thank you all. KM, that is a LOT for your little one and your family to have had to go through. Hats off to you for getting through it. I've tried to wean before (at night) to stop night time feeding. Dentist told us to do it. Lots of kicks, punches and scratches that went on for hours til dawn. I do NOT like the idea of using vinegar, and I do not want to put her in danger. I was just wondering if the crying and sweating would be an issue. I was also thinking that I should wean her (at least at night time) to reduce damage to her teeth. If her teeth weren't an issue, I would let her nurse for much longer. In fact, I nursed my older child until he was almost 4 years old. He just quit on his own.

BTW, yes, we are trying to change sleeping routines, like letting DH put her to sleep in his arms.

Another idea I have is to buy the kids a nice toy or two... if she wakes up in the middle of the night before she is to have GA... maybe the new toys would distract her for a bit til she falls back to sleep?

Yes, Margie.. the GA is for getting her crowns. And yes, I know why fasting is necessary for GA. My husband (who's got service-connected illnesses and injuries) has been under several times. He knows the danger of vomiting and choking all too well. I am just concerned with abstaining from water for a child for that long. Like everyone has said, must follow doctor's orders. :)

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So What Happened?

To set the record straight, I did not "reward" my daughter's protests by suckling her. Whenever I tried to wean her cold turkey, she fell asleep from exhaustion. The reason I stopped that was NOT to stop the screaming; it was due to the changes in her during the day, such as being extremely fearful and clingy. My husband talked with me and we agreed to find a gentler way to wean her. As for night-time nursing. Why do you think I have resorted to trying vinegar and herbs? Because I want to do the right thing (quit night nursing as the dentist said) but hopefully with a minimum of distress for my child. I figured her finding my nipples don't taste like before would be less painful than having her pushed away. If you think I'm a bad mom for that, that's fine. You're entitled to your opinion and it doesn't change anything.

I am fine with nursing a toddler as a rule because I nursed my son this way and he came out fine. He has no behavioral problems (BTW, I do NOT let my kids beat me so they can get what they want - my DS begs all the time to sit in the front seat with Dad but I always say "NO, so long as that car seat can support you, you're sitting in IT and nowhere else), he shows all the health benefits of a breastfed child, he falls asleep on his own and he is getting ready to have his own bedroom! His teeth are fine too. I know what my failings are as a mom, and I know where I failed my daughter. But being a mom without a moral backbone who thoughtlessly SPOILS her kids isn't what it is. Frankly, I could've been more diligent brushing my DD"s teeth and given her lower sugar fruits instead of bananas from the start. BAD BAD mom all right. But I'm trying to move past that.

Yes, fasting is necessary. I get that. Yes, I've read the instructions too and I will follow them. My original question was simply whether the distress from crying and sweating would be an issue or not. I thank all the moms who have taken time from their own busy schedules to reassure me and give advice. But I've had enough of the mommy wars. The vast majority of moms who come here are good moms, or they try to be. Just by asking for help from others shows that. Thank you and I wish you all the best.

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G.♣.

answers from Springfield on

You don't have to wean her for this one night. If you were already planning to wean that's one thing. But if you weren't, it's just one night. You can get through one night.

It might really be h*** o* you both. I would think of things you could do with her in the middle of the night to distract her. Maybe you could watch a tv show together or read some books. It may sound crazy to play with her in the middle of the night, but chances are she'll be somewhat tired anyway and won't stay awake too long. The key will be to distract her from her thirst and/or hunger.

One night is not going to dehydrate her. It's really not. I understand you concern, but she is going to be just fine, physically. Besides, the doctor will likely want and IV started, so she should be getting fluids very soon. It's fluid and foods in her stomach that's a concern. Many people do get nauseous from the anesthesia, and it's very dangerous if the body tries to vomit. That's the biggest concern of the doctors. They do not want to risk her choking on her own vomit.

Hang in there! You will get through this together.

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P.G.

answers from Dallas on

Listen to the doctors.

Not drinking during a period of less than 12 hours will NOT cause dehydration.

Per WebMD "kids lose large amounts of water and salts through fever (more water evaporates from the body when body temperature is increased), diarrhea, vomiting, or long periods of exercise with excessive sweating."

Of course the anesthesiologist's office was "inflexible". They are doing their job to protect your daughter.

Having anything in your stomach and throwing it up under anesthesia CAN cause suffocation and other problems - "General anesthesia suppresses the normal throat reflexes that prevent aspiration, such as swallowing, coughing, or gagging. Aspiration occurs when an object or liquid is inhaled into the respiratory tract (the windpipe or the lungs)."

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J.S.

answers from St. Louis on

Crying is not going to dehydrate the child. You are going to have a hard night but don't give your daughter anything. You have to be the parent and make the hard choices. What I don't understand is why you think you have to change her night time habits before the procedure. I think you should change them but I don't get the time frame.

You simply make sure your child has no access to food or water after 10, if that means you get no sleep that night so be it. It is only one night!

If I seem a bit cold, I have had two kids go under general so been there done that. I know the most dangerous thing with children and anesthesia is parents with no backbone.

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D.B.

answers from Boston on

A toddler does not need to eat or drink at night. That does not cause dehydration, and neither does crying. (Of course you don't want her to be upset, but dehydration is not an issue with crying.) Beyond the age of 6 months, children will "make up for" zero nutrition at night by eating and drinking during the day.

You should do some research on sleep interruption, and talk to your pediatrician. Children's brain development is dependent on deep sleep, and they need to learn to self-soothe to put themselves back to sleep at night. These sleep interruptions for any kind of interaction at night (nursing, eating, getting a drink, talking, playing, reading a book, singing a song) are far more detrimental to children than going 8-10 hours without something in their stomachs.

Moreover, YOU are not getting sufficient sleep, and that's not good for you!

That doesn't mean to give up nursing if you both enjoy it - by all means, continue. But it should be during the day. There are many methods of getting child to sleep during the night - please read up, choose one that works, and STICK TO IT. There are many ways to reassure a child so she is not scared or anxious, and the upset feeling will pass.

I know the anesthesiologists seem inflexible, but they are not being mean. The risk of aspiration, severe complications and a life-threatening situation are significant, and they are trying to protect your daughter. You have to take the long view here. It would be absolutely irresponsible of them to allow your daughter to have anything to drink. Please follow these necessary instructions, and take the next month to accomplish the night time sleep habits your daughter needs anyway.

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D.N.

answers from Chicago on

I would start working with her now to sleep through the night, at least as much as possible. My son wsa a yr when he had surgery to insert a port for his medication. Overnight fasting. He was a waker for water or bottle during the night. We had to be tough. Majke sure she drinks plenty during the day. Crying will not make her dehydrated. She may cry, she may fuss a lot but once it is all over, you can go back to normal. One night without will not dehydrate her if she gets plenty otherwise.

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D..

answers from Miami on

I have to wonder why you prefer for a 2 1/2 year old to nurse throughout the night? I get why you still want to nurse your child, but why all night long? You are already having to get dental work done, and I'm assuming that this is because her teeth are rotted from nursing. Am I right? If you keep this up after getting the crowns, you may end up having to have more dental work done with other teeth. That's just nuts.

A 2 1/2 year old should not be allowed to kick, punch and scratch. AT ALL. That is unacceptable behavior. You are actually rewarding this behavior by putting your nipple in her mouth. Wrong, wrong, wrong, mom. Time to realize that attachment parenting is not supposed to be about letting a child beat you up physically to get what he or she wants. All you are doing is preventing your child from learning what she needs to learn to get along in this world. AND having a mouthful of dental problems, to boot.

As far as being dehydrated is concerned, she will end up with an IV and plenty of fluids when they give her the surgery. They'll probably give her Versaid (giggle juice) to make her groggy enough for them to handle her when they take her away from you to go into the operating room.

Have you asked what after surgical care should be? Will she be allowed to suck? Will they want her to just eat soft foods? You need to understand this part and make some hard decisions if she's not going to be so sore that she will be in too much pain to nurse.

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B.C.

answers from Norfolk on

The point of the fast is - to make sure there is nothing in her stomach in case she vomits from the anesthesia - you don't want her choking or breathing it in.
So - follow doctors instructions to the letter - fast for the proper amount of time and no water (or anything - even breast milk) when she should have none.
If you don't - they will cancel the surgery and rightly so - you will have put her in danger by not following instructions.
Dehydration isn't a problem - they will put in an IV and she'll be fine whether she pitches a fit or not.
Stress - well there will be some but you and she will get through it.

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K.M.

answers from Fayetteville on

It is so hard. Our son was put under general anesthesia 11 times before he was 5 (3 open heart surgeries, 6 heart caths, 2 MRIs). His last OHS was scheduled for 11am and pushed to 2pm--it was painful keeping a 5 year old from food/water until 2pm. But, you must follow doctors orders.

I would stop giving her middle of the night drinks now. Just find another way to soothe her and get her back to sleep (rock her, read a book, lay with her, etc). Yes, it will be rough, but it should get better. This will also help with potty training when she gets a little older (cutting off liquids before bed to stay dry).

Good luck:)

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J.C.

answers from Anchorage on

I would be more concerned about my toddler possibly vomiting with a breathing tube in then her getting upset she can not have a night feed she does not need for any nutritional reason. Babies no longer need night feedings after the first couple of months, after that it is a learned behavior they do for comfort. You need to find other ways to comfort her. That night if she cries you will just have to snuggle her and try to sooth her without food or drink as a bribe, it is for her own safety during the surgery.

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M.P.

answers from Portland on

I suggest that this is one of those times you just bite the bullet know you have to spend time with her during that time. She will be upset. Dehydration is not an issue. Follow instructions and cope with her reaction. To wean her from night feedings will take time. I suggest that night weaning is an issue separate from the anesthesia. We hate to see our babies suffer. However suffering is a real part of life. All of you will get through this.

Night feeding is not needed at the age of toddlers. I suggest she is using night feedings as a way to get back to sleep. She needs to learn ways to self soothe that doesn't include feeding. After the dental procedure stop feeding her at night. Go in to her, pat her without engaging her. Gradually increase the lengthen the time in between responding to her cries. You will be teaching her how to self soothe.

I 've never heard of vinegar involved in weaning. If it's used because it tastes bad I would not use it. You are concerned about your babies reaction. Giving her a bad tasting drink is tricking her and feels cruel to me.

Added: I suggest you got many of the answers becausee of the way you worded your question. I thought you were wanting to postpone GA until you were able to stop night feedings. Others thought you were suggesting to not follow instructions. After your SWH I think it's possible that the issue of stopping the night feelings has come up because the night feedings are causing her teeth to decay. And that you weren't asking how to handle night feedings for this procedure. Two related but separate issues.

Most of us have difficulty writing in a clear and organized manner Because we don't take the time to organize our thoughts before starting. Writing is a skill that most of us have not perfected.

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S.T.

answers from Washington DC on

my 1 and a half year old need cardiac surgery and had to fast. it's not fun, but you really really don't want anything in the stomach, even water, that could be vomited and aspirated.
none of the process will be fun. the prospect of dangerous dehydration is small in comparison to the prospect of breaking the fast.
good luck to you all.
khairete
S.

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A.V.

answers from Washington DC on

I would just have someone else comfort her at night and not try to use vinegar to wean her. That seems unnecessarily punitive to a nursing child. IMO, what you need to do is change her bedtime routine, not wean. So I would work on the bedtime routine, even if it means that you do something other than nurse her in the middle of the night or offer her comfort. Make it bath, book and bed instead of nursing to sleep, for example. It will be OK. I would not worry for one night about the crying causing dehydration. Make sure she has food and drink right up to the time she has to stop. I agree with others that if she does not sleep well, it's just one night.

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G.B.

answers from Oklahoma City on

She's not going to die from not getting to nurse all night. She'll scream like she is though...lol.

IF YOU LET HER HAVE ANYTHING she could aspirate during the procedure and drown on her own stomach contents.

Just get over it, she's going to cry and she's going to be horrid, especially in the morning when she's super hungry.

If you let her eat or sip anything or nurse or nibble or anything she could die. So don't do it. It's that serious.

When one of my grand kids was going to go in for dental work we got there around 6:30am. The out patient surgery center had opened it's doors the day before. It had been completely remodeled and was gorgeous.

There was an infant sitting with her family across from us and she hadn't had a bottle since the night before. She was livid.

The surgery center staff noticed something was wrong with the equipment in the surgery area so all surgeries were put off for a little while. This little baby was supposed to go in around 7, first of course, and they ended up not getting to go back until almost 11am. The baby lived and was very happy when it was done so she could eat. They were in recovery when our girl was done and starting to wake up. We got to see their girl eat and she was chowing down on her bottle.

Your little one will be just fine. She'll be noisy and you'll feel bad but if you risk her lift just because you can't handle her crying then please tell the doc she's not going to be there because you just can't let them put her under with anything in her stomach, all she has to do is burp while lying down and that food or goo can go into her lungs and drown her/aspirate.

As for stopping night time feedings, that's silly. You know that right? If feeding gave cavities they'd have them from eating the same thing during the day.

Milk is milk is milk, no matter what time of day they drink it. Their saliva rinses it out. If she was sleeping with a bottle of milk in her mouth all night long then that would be contributing to cavities but just drinking then stopping won't hurt her.

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A.C.

answers from Washington DC on

Make sure she's well hydrated up to that point. Most of us sleep that many hours (including small children) and don't get dehydrated. You have to lose quite a bit of water before you become dehydrated ... in a healthy person getting plenty of fluids, there are of course always exceptions. Even crying a lot isn't going to dehydrate her.

As others have said distract her for the one night if weaning isn't really on your radar yet. Or have someone else tend to her that night.

The choice to wean is of course an option also since you have time to do it. But ONE night of not nursing/drinking isn't a concern in general.

The reason they say NOTHING after a certain time until surgery is that anesthetics can make you nauseous. And they don't want to risk vomiting then breathing in what came up from the stomach.

Good luck with everything.

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M.G.

answers from Portland on

Hi Mom :)

Is this for your 2 1/2 year old that getting crowns? It will be hard to get her through the night if she's used to feeding but you can either distract her and soothe her for the one night, or you can try to give up night time feeds altogether. If you have a month, you could start now - and gradually get her off them. There are a lot of ways to do this.

If it's the child who's teeth had the decay, it might be a good time to get her off night time feeds - I saw a post here recently about tooth decay from falling asleep with milk - I don't know if that contributed to the problem with her teeth, but maybe view this as time to get rid of them?

I think at 2 1/2 (if I have that right) she'll benefit from the extra sleep and less disruption at night, so my advice would be to begin weaning at night. You can still breast feed of course in the day if that's your choice. That way too it's not as drastic a change.

I think it's very important to not have anything in the stomach during surgery. The general anesthetic relaxes all the muscles including the air way and the digestive ones - so contents of her stomach can come up and go down into her lungs. You'll probably have to sign something (I can't remember if we did but we signed a lot of papers!) saying that she fasted. I doubt they would consider operating if there was any chance for aspiration. They will fully check her before surgery, so even if she was by chance dehydrated (very unlikely I think), they will monitor all that.

We had our kids fast for surgeries as toddlers. When they wake up you just keep them distracted - books in the car, movies, whatever. She may sleep on ride in where it's so early. And so much to see at the hospital, she won't really be focussed on hunger. Ours did fine.

I was able to get my very bottle dependent child off night time feeds in 2-3 nights. He woke happy and smiling, I was sleep deprived, but it was worth it. It wasn't near as bad as I thought it would be. He fussed, never bawled. And my nerves made it through!

Good luck :)

** If you haven't weaned her at night by then and she becomes really upset during the night, what about driving around with a movie in the car or something so she drifts off? I had to drive my colicky baby around a few times - it's one night, and maybe at least then you have a back up plan if necessary? Just a thought.

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S.L.

answers from New York on

Ask to talk to the anesthesiologist Ask him if he agree with the exact timing for fasting you've been given. and if there is a different time table for obstaining from water. My granddaughter had to fast for a procedure at just a few months old. She was able to nurse at midnight or right before midnight, and have water until 2 AM. She was fine!

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