ARE YOU HUNGRY?

ARE YOU THIRSTY?

Engelhardt et al. 2011. Are you hungry? Are you thirsty?-fasting times in elective
outpatient pediatric patients. Pediatric Anesthesia. 21, pp.964-968.
INTRODUCTION
Prospective observational study
(Consecutive case series or clinical series)

P - Healthy children aged <16 presenting for elective

dental treatment under general anesthesia were enrolled.

I - The duration of pre-operative fasting in children and its

impact on the subjective feeling of hunger and thirst was
assessed prior to elective outpatient anesthesia.

C – No comparison group was used.

O - The children presenting suffered from a considerable

amount of pre-operative discomfort due to excessive fasting.
PURPOSE
To assess pediatric fasting guidelines and whether fasting
times are excessive.
Fasting guidelines aim to minimize patient discomfort while
minimizing risk of peri-operative aspiration.

FASTING GUIDELINES

6-8hrs for solids

4hrs for breast milk

2hrs for clear fluids

METHODS
Prospective study carried out over a 1-year period at the
Royal Aberdeen Children’s Hospital in UK.

1350 consecutive healthy children aged <16 presenting for

elective dental treatment under general anesthesia were
enrolled.

All parents were given written instructions for fasting at the

time of booking.

On arrival, all children were asked by an independent

researcher (receptionist) what and when they last ate or
drank, and to rate their degree of hunger and thirst.
Age range 2-16yrs, median age 7.7yrs.

674 girls and 676 boys, median weight 25kg (10-90kg).

Children were excluded from study if:

• English was not their first language

• unable to self-report because of medical reasons
(such as autism or severe developmental delay)
• they had dental trauma within the last 24hrs
RESULTS
Fasting times for solids and fluids and subjective feelings
of hunger and thirst were presented in Table 1.

Rating scale:
Hunger
1 - not hungry at all, 2 – a bit hungry, 3 – very hungry,
4 – starving
Thirsty
1 – not thirsty at all, 2 – a bit thirsty, 3 – very thirsty,
4 – too thirsty

Median fasting times:

Solids - 12:05hrs
Fluids - 07:57hrs
Whether children fasted before or after midnight was
also considered in the results.

56% children were ‘very hungry’.

26.7% were ‘very thirsty’.
21.3% of all children reported severe hunger and thirst.
45.8% of children fasted before midnight reported severe
hunger in comparison to 69.3% who had food after midnight.

The difference in fluids was not as significant, with 29.1%

and 24.4% respectively.
Longer fasting times from solids and fluids for children
fasted before midnight.

Longer fasting times resulted in reporting less hunger,

with a correlation between the severity of hunger and
duration of fasting from solids for patients who fasted
before midnight.

This was insignificant again for fluids.

Severe hunger more prevalent than severe thirst.

DISCUSSION
Median fasting time for the study exceeded the guidelines
given to parents.

Majority of children fasted as per guidelines were severely

hungry and thirsty suggesting need for further research.

Study shows only small number of children reported severe

hunger or thirst when fasted for ~4hrs (solids) and 2hrs (fluids).

There is no reported higher incidence of pulmonary

aspiration in children fasted for these times.

Suggestion of imaging (MRI) to investigate gastric volume and

specific fasting times may be considered.
RCH FASTING GUIDELINES
Fasting guidelines for all patients having an anaesthetic

• The goal of these guidelines is to minimise the fasting

times for clear fluids to 2 hours.
• Only the anaesthetist may adjust these guidelines.
• If a patient appears likely to fast for much longer than
these times then please contact the anaesthetist.

Elective surgery and anaesthesia

Children less than 6 months of age:

• Please plan for the last breast feed to finish no later than
3 Hours before anaesthesia.
• Please plan for a formula or cow's milk feed to finish no
later than 4 Hours before anaesthesia.
All other patients:

• Please do not give milk drinks, food, lollies or chewing

gum for 6 Hours before anaesthesia.
• Please offer clear fluids up to 2 Hours before anaesthesia.

Oral Medication:

• Please continue regular oral medications unless

otherwise requested by the anaesthetist.
• Medications can be taken with a sip of clear fluid.
Patients with a specific (staggered) admission time:
• The fasting orders above should be applied to that
admission time.

Patients on a morning or afternoon list:

• Morning Operation: List starts at 0830:

Please fast from 0230 for food or milk and continue clear
fluids until 0630

• Afternoon Operation: List starts at 1330:

Please fast from 0730 for food or milk and continue clear
fluids until 1130

• Cardiac Surgery: List starts at 0800:

Please fast from 0200 for food or milk, and continue clear
fluids until 0600