Should I fight to reduce the legnth of time my son can't breastfeed prior to surgery?
December 11, 2010 10:49 AM   Subscribe

My nearly 11 month old son is having tubes put in his ears in a couple of weeks. Thanks in part to this previous post, I feel ok about the surgery/anesthesia. But now I am worried about the prep for surgery.

Since I feel ok about the surgery part, my problem then, is with the fact that the coordinator at the surgeon's office told me (unwaveringly) that my son is not to eat or drink anything for 8 hours prior to the appointment time. My son is breastfed, not too interested in solids, and is not night weaned. 8 hours will be pure misery and torture for all involved.

A quick perusal of kellymom produces a list of papers/excerpts that state breastmilk should only be withheld for 3-4 hours prior to surgery, not the 8 hours mandated by the surgeon's coordinator. 3-4 hours is totally doable.

So, How do I manage this? It is great that I have a list of resources to back myself up with, but what do I do with it? I doubt the coordinator has any say in the matter. Do I try to talk to the anesthesiologist or surgeon prior to the procedure? Is this even something worth fighting for (If something happened because I fought for this, I would NEVER forgive myself)? Does anyone have any real world anecdotes about this?
posted by LyndsayMW to Health & Fitness (13 answers total)
Response by poster: Oh, also: YANMD.
posted by LyndsayMW at 10:49 AM on December 11, 2010

On Monday call the coordinator and say "Hi ther.e This is Lyndsay, X's Mom. I just wanted to confirm with you that you said that my son isn't supposed to eat or drink for 8 hours before the procedure. I was under the impression that it was 3-4 hours for a child of this age."

She may say "Oh yeah, sure 3-4 is fine." If she says "No, it is 8," call your ped and ask what s/he thinks.
posted by k8t at 10:58 AM on December 11, 2010 [2 favorites]

If something happened because I fought for this, I would NEVER forgive myself

So for this reason alone, I would not debate the hospital's recommendations. And FWIW, kellymom says at the bottom of their website, "the articles at this website are not written by doctors or other health care professionals. If you are concerned about your health, or that of your child, consult with your health care provider regarding the advisability of any opinions or recommendations with respect to your individual situation.."

My one year old needed surgery and yes, he was hungry and he cried for hours and it was rough. But ultimately my kid needed a procedure to get better, and if he cried for a few hours, it was a small price to pay for his health.
posted by dzaz at 10:58 AM on December 11, 2010 [2 favorites]

My 5-month-old had ear tubes put in on Wednesday, under general anesthesia. She is breastfed. Our orders were for no breastmilk FOUR hours before the procedure. I'm not going to lie, even that was hard.

This was at Children's Hospital of Pittsburgh. The surgery was done by a pediatric ENT specialist and the anesthesia was administered by a pediatric anesthesiologist. The anesthesiologist made the rules, not the surgeon.

Are you having yours done at an office instead of a hospital? They may be more conservative for a lot of possible reasons. Or your child may be getting a different type of anesthesia; our baby's was just gas, and she was awake within 15 minutes.

If the circumstances aren't changing (as in, I personally would feel more comfortable at a pediatric hospital, but that may not be something you wish to change), you should go with what your doctors are comfortable with, under those circumstances.
posted by palliser at 11:12 AM on December 11, 2010

Oh! and did you discuss breastmilk in particular? because the rule would have been 8 hours for all other non-clear-liquid intake, even formula. Only breastmilk was permitted so close to the procedure, because it's so quickly cleared from the body.
posted by palliser at 11:18 AM on December 11, 2010

If they are adamant about nothing for eight hours then make sure to schedule the surgery for as early as possible in the morning.

When my daughter was your son's age she had to have a similar surgery. We scheduled it for first thing in the morning. That way she was fasting while she slept. Got everything ready, then woke her up, changed her diaper, and piled her in the car still in her pajamas.

She was a little upset, but we pulled out all the tricks we knew of (music she liked, new toys, favorite old toys, favorite blanket) and once we got to the Children's Hospital the Nurses took over and knew just how to handle a cranky baby.
posted by TooFewShoes at 12:21 PM on December 11, 2010

Best answer: LyndsayMW: "I doubt the coordinator has any say in the matter. Do I try to talk to the anesthesiologist or surgeon prior to the procedure?"

Yes. Absolutely. This is completely, totally 100% the anesthesiologist's call; aspiration is an anesthesia risk. That is the person you want to run this question by. Nobody else is qualified to answer it. I'd let him or her know that you were under the impression 4 hours for breast fed babies was the norm for peds and listen to what the response is.
posted by DarlingBri at 1:20 PM on December 11, 2010 [1 favorite]

Also, you may also have noted from previous threads that TedW is a pediatric anesthesiologist. He has often invited MeFi members to memail him with specific questions, if you want to know what's going on in other pediatric hospitals or units.
posted by DarlingBri at 1:26 PM on December 11, 2010

Best answer: Echoing what others are saying about anesthesia being the driving factor here. My son had surgery at 5mos old and needed general anesthesia. This was at Boston Children's Hospital, and I got similar restrictions on breast-feeding.

So there are a few things you can do. You can absolutely ask to talk to the anesthesiologist a few days beforehand. Present your dilemma and ask what s/he can accommodate. You can aim for a morning slot (or a slot that lines up well with your son's longest stretch between feeds) if possible, as TooFewShoes suggests. And you can bring a pump since sometimes surgery time slots get moved or things run long. BCH had supplies and a refrigerator for me to do all that but you may have to scout this out in advance for your hospital.
posted by Yoshimi Battles at 1:59 PM on December 11, 2010

Best answer: Ask the anaesthesiologist - I'm one (UK not US) and 3 hours is fine
posted by steve3001 at 2:12 PM on December 11, 2010

Seconding the recommendation to bring along a pump. Our baby was so tired afterward, she hardly nursed, and I was very uncomfortable until I could get home and use the pump.

By the way, best of luck, and memail me if you like; we went through this literally 4 days ago, so everything's very fresh in my memory! And Baby palliserchinston III is doing great, with noticeably better hearing already.
posted by palliser at 3:23 PM on December 11, 2010

Best answer: I wish I was not on my way to bed here (mentally and literally) as am not up to Googling, but -- IIRC breast milk is often not necessarily in with these sorts of nil-by-mouth deals, and some recent research backs this. Dr Jack Newman is notorious for actually answering e-mail sent to him; if this was my baby, I would be bothering him asking if he could boot me in the direction of relevant research on this.

If it looks like 8h is unnecessary -- talking to the anaestheisiologist is well worth your time, in my view. You would spare your baby unnecessary distress, and possibly also spare quite a lot of other babies unnecessary distress. Best wishes to you and your baby going through this!
posted by kmennie at 8:13 PM on December 11, 2010

Response by poster: Thank you everyone! I will definitely discuss this with the anesthesiologist. The procedure is being performed in a Children's hospital, and the quick acting gas will be used. The coordinator actually told me that they have different NPO rules for babies under 6 months old, even when I asked specifically about breastmilk. I was a little bit flummoxed at the time, but she wasn't the person to argue with anyway.

I am feeling pretty confident that I am not going to have to break down any doors in this regard. This can't be the first time the anesthesiologist has encountered a breastfed 11 month old... and if it is, then I think I want a different person in that role.
posted by LyndsayMW at 8:44 AM on December 13, 2010

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