Anesthesia

MY BABY IS HAVING SURGERY

If your baby needs to have surgery they will be given a general anaesthetic to ensure they are unconscious and free of pain during the operation or procedure. Anaesthetists are specialist doctors who give the anaesthetic and look after the health of your child during surgery, and then continue to support them with pain relief afterwards.

Usually, before having a general anesthetic, your baby won’t be allowed anything to eat or drink. Anesthesia will make your baby relaxed and sleepy and stops their body’s reflexes working temporarily. If your baby’s stomach has food or drink in it, there’s a risk of vomiting, or regurgitation (bringing up food into their throat). If this happens, the regurgitated food could spill into your baby’s lungs and affect their breathing.

Human milk is digested more quickly than formula so many breastfed babies will be allowed shorter recommended fasting times prior to having a general anaesthetic.

Different hospitals put human milk into different categories, which affects the length of time breastfeeding is restricted, and guidelines vary around the world.

Discuss the safest fasting time for your baby with your baby’s health professionals. If you can, speak to your baby’s anaesthetist, since they will make the decision about how long your baby should fast before the surgery. They may not realise that babies fed exclusively on human milk have empty stomachs in only two to four hours after a feeding due to the easy digestibility of human milk.

Most organisations recommend a fasting period of four hours.

American paediatricians Ruth and Robert Lawrence agree with a fasting time of four hours before surgery and also suggest that as four hours without nursing can be stressful, a mother may wish to nurse her baby for comfort on a pre-pumped breast during that time.1

Some families find it helpful to schedule surgery so that they can take advantage of a three-four hour length of time when their baby or toddler is fairly content without nursing. For example, if the fasting period is four hours, baby could nurse through the night until 6 a.m., and then be distracted with other activities 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.

BEFORE SURGERY:

You might find these ideas to distract your baby from breastfeeding useful:

  • Give your baby a dummy/ pacifier
  • Go for a walk or a drive
  • Have someone other than you hold or comfort your baby so they don’t expect to nurse
  • Offer a new toy that might interest your baby

If you start to feel uncomfortably full during the fasting period you can express your milk.

DURING AND AFTER SURGERY:

You can continue to pump your milk while your baby is having surgery. Unless your healthcare team tell you otherwise you will be able to breastfeed as soon as your baby is ready to feed by mouth after surgery.

EXAMPLES OF FASTING TIME GUIDELINES FROM AROUND THE WORLD:

UK and Ireland: The Royal College of Anaesthetists (RCoA), Association of Anaesthetists of Great Britain and Ireland (AAGBI) and Association of Paediatric Anaesthetists of Great Britain and Ireland (APAGBI) have produced a guide which states:

“Six hours before, your child can have a light meal or a glass of milk. Bottle-fed babies can have formula feed. Four hours before, babies can have breast milk. Two hours before, children should have a drink of water or very dilute squash.” (Squash is known as cordial in some parts of the world).

USA: The Academy of Breastfeeding Medicine (ABM) states that babies can have breast milk up to four hours before surgery. It is listed in their Clinical Protocol #25.

Canada: The Department of Anesthesiology and Perioperative Medicine at Queen’s University lists a fasting time of four hours for breast milk.

Israel: The Sha’aray Tzeddek hospital website (one of the biggest hospitals in Jerusalem) lists a fasting time for breastmilk of four hours.

Spain: Anaesthesist Dra. Ana Abad Torrent refers to a number of resources and states a fasting time of four hours for breastmilk should be used.

New Zealand and Australia: The Australian and New Zealand College of Anaesthetists (ANZCA) say:

“For children over six months of age having an elective procedure, breast milk or formula and limited solid food may be given up to six hours and clear fluids up to two hours prior to anaesthesia.

For infants under six months of age having an elective procedure, formula may be given up to four hours, breast milk up to three hours and clear fluids up to two hours prior to anaesthesia.”

References:
1 Lawrence and Lawrence, Breastfeeding A Guide for the Medical Profession, 8e, 2016, p 517