Fasting Before Cleft Lip or Palate Surgery

Fasting for this procedure

Cleft repairs are carried out under a general anaesthetic, with a breathing tube placed once your baby is asleep, so an empty stomach genuinely protects them. For infants we use the 6-4-2 rule: stop solids, formula and cow's milk 6 hours before the arrival time we give you, stop breast milk 4 hours before, and offer clear fluids (water or well-diluted squash) up to 2 hours before. Keeping clear sips going until that 2-hour mark means your baby is comfortable and not crying with hunger or thirst. Work out the exact clock times with our child fasting calculator, and never withhold feeds for longer than asked.

Medicines to check

Give your baby's usual regular medicines on the morning of surgery with a small sip of water, unless we have specifically told you to hold one.

Iron drops and any vitamin or herbal supplements are best stopped a few days before, as they can upset the tummy or interact with the anaesthetic; check with us if unsure.

If your child takes a blood-thinning medicine (rare in babies, but some heart conditions need it), tell us early and read which medications to stop before surgery so we can plan the timing safely.

If your baby is on insulin or any diabetes treatment, follow our specific advice and see diabetes medicines before surgery, because fasting changes the dose your baby needs.

Bring any reflux medicine, inhalers or eczema creams in their original packaging so the team can see exact doses.

Tell us about any recent antibiotics or paracetamol given in the last 24 hours, including the time and amount.

When this surgery may be delayed

A cold, cough, runny nose or chest infection in the days before surgery, which makes the airway twitchy and raises anaesthetic risk, so we often wait a couple of weeks until your baby is well.

A fever or new rash on the morning of surgery, or contact with chickenpox or measles, which we need to check before going ahead.

Your baby being fed too recently or accidentally given milk inside the fasting window, meaning the stomach is not empty and it is safer to postpone.

A baby who is too small, underweight or anaemic for safe surgery that day, as good weight and blood levels help healing of the repair.

Significant nappy rash, mouth ulcers or skin infection near the operation site, which raises the chance of the stitches not healing well.

Reports & documents to carry

Your baby's red book / child health record showing weight, growth and immunisations.

Any clinic letters, scans or specialist reports about the cleft, the feeding team, or any heart or hearing findings.

A list of all current medicines, drops and supplements with doses and the time of the last one given.

Your baby's usual special bottles or cleft feeding teats, plus a comforter, dummy or favourite toy.

Spare vests, sleepsuits and nappies, since dressings and a little dribbling of blood-stained saliva are normal afterwards.

What to ask your anesthesia team

What exact arrival and last-feed times should I use for my baby's weight and slot?

Will my baby need soft arm splints (no-no's) to stop them touching the repair, and how long do they stay on?

How will feeding change after surgery -- can I still breastfeed or use our usual cleft bottle, or do we switch to a spoon or open cup?

How long is the hospital stay, and what airway or breathing signs will you watch overnight?

What pain relief will my baby have, and how do I keep the lip or palate clean once we are home?

Your prep checklist

Tick things off as you sort them — saved on this device only, nothing is sent anywhere.

A general guide — your hospital's own instructions always come first.

Frequently asked questions

Why can't I just breastfeed my baby right up to surgery?

Breast milk leaves the stomach faster than formula but not instantly, so we ask you to stop it 4 hours before. If milk is still in the stomach when your baby is anaesthetised, it can come up and enter the lungs, which is dangerous. To keep your baby settled, you can offer clear fluids until 2 hours before. Once the repair is done, most babies can breastfeed again soon, which actually comforts them and aids healing.

Will my baby be in pain, and how soon can they feed afterwards?

Your baby will have pain relief given during the operation and regular paracetamol or ibuprofen afterwards, so most are comfortable and surprisingly settled. Many babies take a clear drink or milk within a few hours of waking, often the same day. We sometimes suggest softer feeding, a wider teat or spoon-feeds for a short while to protect a palate repair, and the cleft nurse will guide you before you go home.

What are the arm splints for and does my baby have to wear them?

Many units use soft elbow splints, sometimes called no-no's or arm restraints, for one to two weeks. They gently stop your baby bending their elbows to rub the stitches, poke the wound or pull at the lip while it heals, without hurting them. You can take them off for cuddles and supervised feeds, then pop them back on. Your surgeon will tell you whether your baby needs them and for how long.

How long will my baby stay in hospital after a cleft repair?

Most cleft lip and palate repairs need a short stay of one to two nights, mainly so we can watch the airway. After a palate repair the mouth and tongue can swell a little, so overnight monitoring of breathing and oxygen is sensible. We keep your baby in until they are feeding reasonably, comfortable on simple pain relief and breathing easily. A few babies with other health needs stay a little longer.