National Survey of Paediatric Clear Fluid Fasting Practice in the United Kingdom & Ireland
Sip til Send Survey
Complete Survey
https://forms.cloud.microsoft/e/eAMTZyq7a1
The APA is conducting a national survey to map current practice regarding preoperative clear fluid fasting in children and young people - your help is needed to build a National picture of practice.
Access the survey using the above link, or alternatively, scan the QR code
Completion typically requires 10 to 15 minutes. Participation is voluntary. Responses are collected anonymously.
Please do circulate the link within your department and regional networks to support broad and representative participation across tertiary paediatric centres and mixed practice hospitals.
The APA will use the survey results to inform its update of the National Position Statement on Clear Fluid Fasting to ensure that the update is both evidence-based and pragmatic.
Thank you for your time and for contributing to this essential piece of national policy work.
Sip til Send Project Outline
Johnny Kenth, Karen Bartholomew
1. Purpose and Overview
Prolonged preoperative fasting exposes children to unnecessary thirst, irritability, hypoglycaemia and avoidable intravenous fluid therapy, yet it persists because United Kingdom guidance still mandates that clear fluids stop one hours before anaesthesia. The evidence base has now shifted. The 2025 European Preoperative Fasting Audit (EuroFAST, 18 531 paediatric cases in 271 centres) demonstrated that healthy elective patients who were allowed clear fluids until transfer to theatre had no increase in pulmonary aspiration or airway complications. Parallel Sip Til Send (STS) pilot programmes in the United Kingdom, Ireland and Australia reproduced this safety record while halving median fasting times and improving parental comfort scores.
Current practice across the United Kingdom remains heterogeneous: some centres are early adopters of STS, others permit clear fluids until one hour before induction, and some still enforce a two‑hour restriction. The 2018 APAGBI statement endorsed a one hour interval; however, recent rigorous evidence from EuroFAST now justifies adoption of STS, whereby children may continue to drink clear fluids until they are summoned to theatre. To translate this evidence into a uniform national standard, APAGBI will deliver three interlocking work packages that provide the requisite data, narrative and consensus.
WP 1 Hot Topic
WP1 will produce a concise, peer reviewed synthesis of the EuroFAST data set and related wider literature, giving clinicians an accessible rationale for STS adoption and caveats.
https://www.apagbi.org.uk/downloads/hottopic/40hot-topic-sts-final-nov25.pdf
WP 2 National Survey
WP2 will map current fasting policy, identify barriers to implementation and provide a baseline against which change can be measured. A second survey six-twelve months after publication of the new guidance will quantify progress.
WP3 Updated APA Position Statement on Clear Fluids Fasting
WP3 will use the survey insights and Hot Topic synthesis to craft and publish the updated APAGBI guidance, supported by coordinated dissemination through the APAGBI network and publication in Anaesthesia journal.
Completion of all three work packages by September 2026 will enable evidence informed roll out of STS and provide a framework for ongoing audit.
2. Governance
Leads
1. Johnny Kenth (JK) – Consultant Clinical Academic, Royal Manchester Children’s Hospital; Chair, APAGBI Scientific Committee
2. Karen Bartholomew (KB) – Consultant Anaesthetist, Calderdale and Huddersfield FT; President, APAGBI
Working Members
Toni Brunning (TB) – Consultant Anaesthetist, Worcestershire Acute Hospitals NHS Trust; Vice President | Royal College of Anaesthetists; APAGBI Council.
Vimmi Oshan (VO) – Consultant in Paediatric Anaesthesia, RMCH; APAGBI Neonatal Anaesthesia Network; Co-author EuroFAST
Zoë Burton (ZB) – Consultant Anaesthetist, Sheffield Children’s FT; APAGBI Link Network Lead
Catalina Stendall (CS) – Consultant Anaesthetist, Birmingham Children’s Hospital; Chair, APAGBI Education CommitteeTrainee Members- TBC