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My baby is having surgery under general anesthesia. How long before the surgery can I breastfeed him?

Although some doctors require that a patient be given nothing by mouth (NPO) for eight hours before surgery, the American Association of Anesthesiologists recommend only a four hour restriction for human milk. Different hospitals put human milk into different categories, which affects the length of time breastfeeding is restricted.

Recent studies indicate that a more reasonable fasting time before surgery for children is six hours for formula (Spear 1992), three hours for human milk, and two hours for clear liquids (Nicholson and Schreiner 1995; Litman 1994; Schreiner 1994).

Drs. Ruth and Robert Lawrence suggest that since four hours without nursing can be stressful, the mother be allowed to nurse the baby for comfort on a pre-pumped breast during that time.

It is important to talk to the baby’s anesthesiologist, since s/he is the one who will make the decision about how long your baby should fast before the surgery. S/he may not realize that babies on only human milk have empty stomachs in only 2 to 4 hours after a feeding due to the easy digestibility of human milk. Nothing after midnight would be a very long time for a baby.

Some mothers find it helpful to schedule the surgery so that they can take advantage of a 3-4 hour length of time when their baby or toddler is fairly content without nursing. For example, if the NPO period is 3 hours, then baby could nurse through the night until 7 a.m., get up early, and then play with mom or dad until the scheduled surgery time of 10 a.m. It may be easier to skip breakfast and to distract a child from nursing in the morning than it would be to keep the child from nursing through the night.

Contact a local La Leche League Leader for more information and support during this challenging time.

Resources for additional information

The last two paragraphs of this BREASTFEEDING ABSTRACTS article are especially helpful when NPO guidelines are being discussed: "Feed the Babies," by Susan C. Nicholson, MD and Mark S. Schreiner, MD

A Collection of articles from NEW BEGINNINGS:

The following items may be found in the LLLI Online Store:

Babies and Children in the Hospital: This information pamphlet was written for parents who have a baby or child in the hospital. It offers advice on trusting your instincts, shopping for a doctor and hospital, preparing yourself and your child and when to be with your child. It tells of other parents' experiences and has a section on questions parents should ask doctors.

Safe and Healthy: A Parent's Guide to Children's Illnesses and Accidents, by William Sears: Dr. Sears guides parents through some of the most stressful episodes of parenting in this book on child care. As a pediatrician, he answers the most frequently asked questions about childhood illnesses and provides parents with invaluable information on what to do in case of an accident. This is an essential guide for all parents. Softcover, 239 pages.

Breastfeeding: A Guide for the Medical Profession, 5th edition, by Ruth Lawrence, MD and Robert Lawrence MD: The classic reference book has been revised and includes new research findings related to the 1991 Baby Friendly Hospital Initiative of WHO and UNICEF, new information on the mother/baby bonding process that takes place because of breastfeeding as well as management techniques for handling breastfeeding in adverse conditions, advances in biochemical, nutritional, and immunologic aspects of human lactation, up-to-date information on drugs and human milk, and more. It remains one of the most comprehensive breastfeeding resources available. Hardcover, 966 pages.

References for quotes from BREASTFEEDING ANSWER BOOK

Nicholson, S. and Schreiner, M. Feed the babies. BREASTFEEDING ABSTRACTS 1995; 15(1):3-4.

Litman, R. et al. Gastric volume and pH in infants fed clear liquids and breast milk prior to surgery. Anesth Analg. 1994; 79: 482-85.

Schreiner, M. Preoperative and postoperative fasting in children. Ped Clinics N. Am. 1994; 41(1):111-20.

Spear, R. Anesthesia for premature and term infants: perioperative implications. J Pediatr 1992:120(2 pt 1): 165-75.

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