Morbidity and mortality caused by aspiration of gastric contents are extremely rare in children undergoing elective surgery. What is becoming increasingly clear is that prolonged periods of starvation in children, especially the very young infant, are harmful. These children, who have a rapid turnover of fluids and a high metabolic rate are, at risk of developing hypoglycaemia and hypovolaemia. Research has shown that children allowed unrestricted clear fluids up to 2 h before elective surgery have a gastric residual volume equal to or less than that of children who have been fasted overnight. The essential message is that children should, rather than could, be given clear fluids up to 2 h before induction. Solids (including breast and formula milk) should not be given for at least 4 h before the anticipated start of induction. In the emergency setting, e.g. the child who has sustained trauma shortly after ingesting food, it is probably best (if possible) to wait 4 h before inducing anaesthesia. Clearly in this situation risk-benefit judgements have to be made. If it is surgically possible to wait 4 h, an i.v. infusion of a glucose-containing solution must be commenced and, if necessary, appropriate fluid resuscitation undertaken.
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