The World Health Organization (WHO) has listed a number of recommendations for preoperative care of a pediatric patient in situations when resources may be limited.


(1) Explain the procedure to and obtain informed consent from the parents or guardians.

(2) Rehydrate if the patient is dehydrated.

(3) Correct anemia prior to surgery, especially if operative blood loss is anticipated. Take special care if the child has an unstable hemoglobinopathy.

(4) Correct malnutrition before surgery if possible, else correct in the postoperative period.

(5) Make sure that the patient has an empty stomach. If a preoperative fast is prolonged (> 6 hours) give intravenous fluids that contain glucose.

(6) Measure a hemoglobin and hematocrit for infants < 6 months, before major surgery, or if the child has a history of anemia.

(7) Additional tests may be ordered based on clinical findings and availability but are not required.

(8) Provide prophylactic antibiotics:

(8a) prior to bowel, bladder or other surgery if there is contamination, infection or risk of infection.

(8b) if the child is at risk for bacterial endocarditis (see Chapter 25).



• For an infant (age < 12 months) an empty stomach entails no solid food for 8 hours, no formula for 6 hours, no breast milk for 4 hours and no clear liquids for 4 hours.


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