historically recommend a minimum of 2 h. In particular, the published guideline from European Society of Anaesthesiology (ESA) in 2011, dedicated a section to peri-operative fasting in children and infants.

This guideline stated that: ‘Children should be encouraged to drink clear fluids (including water, pulp-free juice and tea or coffee without milk) up to 2 h before elective surgery’, with an evidence level 1++ and a recommendation grade A.

Similarly, the American Society of Anaesthesiology (ASA) published their updated guidelines in 2017.

ASA guidelines stated that ‘clear fluids may be ingested for up to 2 h before procedures requiring general anesthesia, regional anesthesia, or procedural sedation and analgesia’, with category A1-E evidence on gastric volume and category A2-B evidence demonstrating children are more thirsty and hungry when fasted in excess of 4 h.