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Patient Resources | Overview

Your guide to eating and drinking before a surgery or procedure (NPO) — links to printable PDF guides — other language options linked below!

Before a surgery/procedure, eating and drinking are not allowed for certain periods of time. Follow these directions carefully to prepare your child. If your child eats or drinks after the indicated time, the surgery/procedure may be cancelled.

  • Eight hours before the surgery/procedure: stop eating solid foods, including: candy, gum, non-human milk (cow, soy, etc.), thickened formulas including commercial ones such as AR (which is added rice).
  • Six hours before surgery/procedure: stop drinking formula for children under 12 months of age.
  • Four hours before surgery/procedure: stop drinking breast milk.
  • Two hours before surgery/procedure: stop drinking clear* liquids.
  • G-tube formula feeding should be stopped 8 hours before the surgery/procedure. (Children under 1 year of age may continue G-tube formula feeding until 6 hours prior to the surgery/procedure).

* — Clear liquids include water, apple juice, Pedialyte. No carbonated beverages should be consumed from eight hours before surgery/procedure.

Other important guidelines for the day of surgery:

  • Plan to arrive at Boston Children’s Hospital third floor main building 90 minutes before the surgery is scheduled (unless otherwise told). No food or drinks are allowed in pre-operative holding areas.
  • Prepare to verify all medications. Bring photos of medication bottles (to show details), printout from physician office, or pharmacy receipts showing dose info.
  • All female patients over 12 years old and/or who have started menstruating will need to give a urine sample on the day of surgery/procedure for required pregnancy testing.
  • Consents for surgery/procedure must be signed by the child’s parent or legal guardian if under age 18 or if patient is over 18 and is unable/not competent to consent.
  • All jewelry (including body piercing) and all nail polish must be removed.
  • Please remove your contact lenses and bring glasses.
  • We strongly discourage siblings coming to the hospital on the day of surgery/procedure.
  • Plan on leaving the hospital by 11 a.m. on the day of discharge. Please be sure that all arrangements (transportation, work schedules, child care needs) have been made to allow for a morning discharge.
  • Please call the PCCC at 617-355-3765 with any questions.

Special considerations

Herbal remedies: If your child is taking (or may have recently taken) any herbal therapy or natural remedy (such as St. John's Wort) or any weight-reduction medications, please notify the nurse, nurse practitioner, or physician during your PCCC preoperative appointment. Some of these herbs and medications can interact with drugs used during anesthesia.

Piercings: Also, if your child has any body piercing that cannot be seen, please let the nurse, nurse practitioners, and physicians know. All metallic objects must be removed prior to surgery and anesthesia.

Antibiotic resistant organisms and communicable diseases: In order to protect your child and other patients, please notify the PCCC prior to your appointment if your child needs special precautions for antibiotic resistant organisms (an infection that does not go away with antibiotics). We would also like to be notified if your child either has or has been exposed to a communicable disease. Please call 617-355-3773 and ask to speak to a nurse to discuss these situations. 

Family Education Sheets

Parents in the OR/Parent Present Induction (PPI)

At Boston Children's Hospital, we allow a parent to be present at the start of anesthesia when the anesthesiologist considers it to be beneficial for the child. This is called a Parent Present Induction (PPI). A formal program in existence since 1989, PPI helps prepare a parent who accompanies his or her child during the start of anesthesia.

There are a variety of medications that may be given in the preoperative (Pre-Op) holding area while the child's parent(s) is present. These medications help eliminate the distress of separation at the beginning of anesthesia. When these preoperative medications are inadequate or are not recommended, a parent may go with a child into the operating room for the start of anesthesia.

The decision to offer a PPI is individualized, and is made by evaluating factors like the child's age, developmental stage, emotional status, degree of anxiety and willingness to cooperate. Children less than 1 year of age do not usually require parental presence.

At the time of the preoperative evaluation, the anesthesiologist makes an assessment of the child and parents to determine their ability to participate in a PPI in the operating room. This decision process is very important as its goal is to prevent an undesirable situation. For example, a parent who is very anxious or frightened may have difficulty providing the psychological support needed during the start of anesthesia.

If a PPI is chosen, the anesthesiologist will discuss the plan for induction with you and your child. Since no one form of induction is suitable for every child, a backup plan will be made. Parental teaching will also be provided by nurses who explain the role of the parent to his or her child in the operating room, and how the child may react and look during the induction process.

Commonly asked questions about parents in the operating room

Why can't both parents accompany a child into the operating room for the start of anesthesia?

Although both parents provide support for their child, we have learned that it is easier for a child to focus on one parent at the start of anesthesia. During the induction process, we encourage the parent to talk to and comfort the child as he or she would at home. It can become confusing for the child to have more than one parent talking to him or her at the same time. In addition, we can safely focus our teaching and support on one parent.

If I am not the legal parent, may I still participate in the Parent Present Induction program?

The most appropriate person to accompany the child is the one who will be able to provide the necessary support to the child. This selection is individualized and does not have to be the legal parent.

What are the criteria for choosing a parent to accompany a child?

The parent should be healthy, have a calming influence on the child and must feel comfortable with his or her role in the operating room.

Do I have to accompany my child into the operating room?

No. There is no form of induction that is suitable for every child, and there are medications that can be given in the patient preparation area decrease the child's anxiety. Many children who are informed and prepared for surgery may not experience fear and anxiety.

Why can't I accompany my child if I am pregnant?

We are unable to protect pregnant women from anesthetic medications during an inhalation (mask) induction, and we prefer to avoid unnecessary exposure.

Will I have to wear special clothes?

You will be asked to put on a one piece coverall (a jumpsuit that fits over your street clothes), a hat and a mask. Because the attire is strange, it can be frightening for a child. We encourage parents to put the jumpsuit on in front of the child and then reassure the child that you will only be dressed like this for a short period of time.

If my child cries, does that mean the start of anesthesia was bad?

Children cry for many reasons: when they are sleepy, hungry, in pain or upset, for example. It also depends upon the child's stage of development. Some children, especially preschoolers, will cry when the mask is first introduced or when they notice a change in the environment. The operating room staff members consider this normal and sometimes even expect it.

What if my child becomes uncooperative upon arrival in the operating room?

A backup plan is always made during the preoperative evaluation. Your child's anesthesiologist will discuss this plan with you before starting a Parent Present Induction.

When do I leave the operating room?

The anesthesiologist determines when the parent should leave the operating room. The anesthesia induction process is quick, and parents are escorted from the operating room to the Family Waiting Room by a member of the operating room staff at that time.

For more information, please call the Perioperative Care Coordination Clinic at 617-355-3765.

Perioperative Care Coordination Clinic (PCCC) | Contact Us

Contact the Perioperative Care Coordination Clinic (PCCC)