Revisiting Pediatric NPO Guidelines: a 5-Year Update and Practice Considerations

Purpose of Review From 2018 to 2019, several international pediatric anesthesia societies challenged the current fasting guidelines, moving to decrease the fasting increment for clear liquids to 1 hour (h). Both the American Society of Anesthesiologists (ASA) and the Society for Pediatric Anesthesia (SPA) have hesitated to change, citing insufficient support. We sought to better understand the evidence related to fasting in children. Recent Findings We reviewed the literature from the past 5 years and conducted an informal survey of 51 United States (US) pediatric medical centers. Some medical institutions in the US caring for children have implemented policies to mirror the international guidelines. Our search revealed many patient, family, and system reasons to move to a shorter clear fluid fasting period. However, some medical conditions create increased risk of aspiration. Available evidence supports a shorter fasting period, but individual patient factors should be considered.