Getting ready for anesthesia starts with a simple plan. Here are tips to help prepare for your child's surgery or procedure, including what to do the night before, fasting rules for food and liquids, guidance on morning medicines and tips to help your child stay calm. Also learn how your pediatric anesthesia team will support your child's safety from check‑in to recovery.
Can my child eat, drink or take medicine on the day of anesthesia?
Except for emergencies, your child's stomach should be empty when anesthesia is started. It is important that you carefully follow guidelines about eating and drinking before the surgery or procedure. Following the fasting (not eating) instructions helps prevent vomiting with aspiration, which is a potentially life-threatening situation when food or stomach acid gets into the lungs.
Be aware that if fasting guidelines aren't followed, your child's surgery may need to be delayed or rescheduled for their safety. Because instructions can vary by age and by hospital, always check with your child's surgeon or anesthesiologist before the day of the procedure. They will give you the specific plan for your child.
General fasting guidelines before anesthesia
Here are general guidelines most families receive (but be sure to confirm details with your medical team):
Infants younger than 1 year of age may have:
Solid food until 6 hours before anesthesia. Keep in mind that baby food, infant formula/milk and infant
cereal are all considered solid foods.
Breast milk until 4 hours before anesthesia.
Clear liquids (such as a prepared electrolyte solution) until 2 hours before anesthesia.
Except in special circumstances, children of all ages may have:
Solid food until 8 hours before anesthesia. Keep in mind that baby food, milk, and cereal are solid foods. It is best not to eat solids after midnight prior to surgery.
Clear liquids until 2 hours before anesthesia. Clear liquids include apple
juice, clear soda, popsicles or a prepared electrolyte solution. Keep in mind that milk, baby formula, juice with pulp and coffee or tea with milk are all considered solids (not clear liquids).
What about routine medicines?
Talk with your child's anesthesiologist about which of your child's routine medicines, if any, may be taken on the day of anesthesia. In general:
Medicines that are important for your child's health can usually be taken with small sips of water.
Non‑essential medicines should wait until after surgery.
Some medicines, like certain laxatives (polyethylene glycol 3350 or Miralax, for example), should be skipped the morning of surgery.
Do not mix medicines with food like applesauce. This can count as a solid and may delay the procedure.
Tell the team about any
herbal and natural types of medicines or supplements. Some of these can interfere with anesthesia medications.
If you're ever unsure, ask your surgeon or anesthesiologist before the day of the procedure.
Morning-of-procedure checklist:
Be sure to follow the fasting instructions exactly as provided.
Dress your child in loose-fitting, comfortable clothes.
Give your child required morning medicines unless instructed not to.
Bring a favorite comfort object, such as a blanket, stuffed animal or toy.
Stay calm and reassuring. Children pick up on a parent's stress, and your confidence can help them feel safer.
What will my child do while waiting for anesthesia?
Most large hospitals have a special waiting area for children. If you have not done so already, you will meet the anesthesia care team at this time. They will review your child's records, do a quick medical exam and make a specific plan for anesthesia based on your child's needs. They'll also explain what they will do to keep your child safe, discuss the risks of anesthesia and answer your remaining questions or concerns.
What if my child is worried?
A calm and supportive family can provide the most help to ensure that your child will not be overly worried or upset. If your child has a special blanket, stuffed animal, or toy, remember to bring it.
Sedatives (medicines to help your child relax and not remember as much) may be given before the start of anesthesia to help reduce fear and worry in children. The choice of whether or not to give a sedative will depend on your child's age, level of anxiety and medical condition, as well as your preference and the hospital's usual practices.
Sedatives may be given through the mouth, through the nose, in your child's bottom or as an injection. If your child has special needs and you think one of these methods would be more successful than others, feel free to suggest that to your child's team.
If a sedative is given, you will need to watch your child carefully to prevent injuries. Your child can get very sleepy and should not try walking after a sedative.
How will anesthesia be given to my child?
Most children can choose one of the following ways for anesthesia to be started:
- Breathing through a mask: By breathing anesthetic gases through a mask. No pain is involved, but not all children will like having a mask placed on their face, and the medication may have a very strong smell. This method may not be possible in all cases, such as for some emergencies, in the case of stomach or bowel problems, or if your child has eaten recently.
- Through an IV: For older children and those who prefer it, anesthesia may be started through a needle put into a vein (IV). If an IV is used, local anesthetic (numbing medicine) at the IV site or other techniques may be used to make this less stressful for them.
- With a quick shot: Through a needle put into a muscle (an injection). A shot may be necessary if your child is not able to remain still. A shot may be scary to a child, but it's fast and the discomfort is brief.
If your child is older, you may want to talk with them about their preferences before the day of the planned anesthesia. Pediatric anesthesiologists are experts at working with children, and will do their best to honor preferences as long as it will be safe for your child.
No matter how anesthesia is started, your child will be kept comfortable and asleep with inhaled or IV anesthetics. Your child will stay asleep during the surgery, test, or treatment and will usually be woken up once the procedure is finished. If your child needs may need to remain asleep after the procedure, your anesthesiologist will explain this to you.
Can I be with my child when anesthesia is started?
Some hospitals allow a parent or guardian to go into the operating room or other area where the child is to receive anesthesia. This may or may not be possible for scheduled procedures or surgeries but is often not possible for emergency surgery.
If you're deciding whether to be present, think about what will help your child, not what might feel better for you. In some cases—like when a child has taken a sedative—being present could be more stressful for you without helping your child. Also remember that any anxiety, fear, or stress you show will be detected by your child and will make it harder for them.
If you do join your child for the start of anesthesia, ask the anesthesiologist beforehand what you should expect to see and how your child might react. Understanding what is expected to happen will make you feel more comfortable, since watching your child undergo anesthesia can be traumatic.
It is important to know that even if you are allowed to be with your child for the start of anesthesia, they may still get upset before going to sleep. This depends on your child's age, temperament and past experiences.
The anesthesia care team has a lot of experience helping children stay calm and will do their best to support your child. Many children will not have memories of being upset later, but it can still be stressful for parents to witness in the moment. No matter what, the team will stay focused on your child.
Where will my child go after the procedure?
After the procedure, most children go either to a recovery room or to an intensive care unit. The location depends on the type of procedure, the anesthesia plan and your child’s medical condition. In most cases, parents can be with their child in these areas once the child is stable. Expect a short wait while the recovery room nurses make sure your child is safe before they call you back.
After a routine procedure, the recovery stay is usually 30 minutes to 2 hours. Then your child may go to a regular hospital bed or a short-stay unit, or they may be discharged home.
How will my child behave after the procedure?
Children awaken from anesthesia in different ways, and each time may be different even for the same child. Some are alert and calm right away. Others may remain groggy longer.
Some children wake up with agitation or confusion that can be scary for parents to see. In some cases, they may need additional sedation medicine while sleeping off the remaining effects of anesthesia, especially if they are moving around a lot. In general, this agitation is temporary and will pass within 30 minutes.
During that time, it is important that you know that any strange behaviors your child shows are not in their control (that is, they are not "misbehaving." They are just confused).
Will my child feel pain?
One of the main goals of anesthesia is to try to prevent pain during and after the procedure. If your child is in pain in the recovery room, additional pain medicine may be needed.
Pain medicine comes in many different forms and can be given in different ways such as oral, IV or others. Your child's doctors will discuss the options with you and your child ahead of time, and the plan may be changed based on your child's needs.
Will nausea and vomiting be a problem?
Nausea and vomiting are common after anesthesia and may result from your child's underlying medical condition, the procedure or as a side effect of anesthesia. If your child is vomiting a lot, your child may need to stay in the hospital even if they were supposed to go home. Most children will receive medicine to prevent nausea while they are still under anesthesia, but if they are not feeling well there are usually additional medications that can be added.
Anything else?
Discuss your questions or concerns with your anesthesia care team and your child's other doctors and health care providers. Pediatric anesthesiologists work as part of a team that is specially trained to provide your child with comfort and safety throughout what would otherwise be a dangerous, painful, and scary process.
Be sure to keep your anesthesia care team informed about your child's health just before the procedure. It is also important to call the team or your child's surgeon if your child develops a cold or other illness within 4 weeks of the procedure, or if your child has been exposed to chickenpox (varicella) within 3 weeks of the procedure.
More information
About Dr. Lockman
Justin Lockman, MD, MSEd, FAAP, is a professor of clinical anesthesiology and critical care and professor of pediatrics at Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine. Dr. Lockman serves on executive committee for the American Academy of Pediatrics Section on Anesthesiology and Pain Medicine.
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