Food and liquid intake is restricted before a person has general anesthesia because of the risk of vomiting and then having the vomitus get into the lungs. In adults, "nothing by mouth" orders often mean no food or drink after midnight on the night before surgery. However, an eight-hour (or longer) fast can be very stressful for infants and small children, and eight hours without nursing is unimaginable for most breastfeeding pairs.

Hospitals and anesthesiologists are beginning to recognize that babies and children require different fasting guidelines. A recent survey of pediatric anesthesiologist found that practices differed from one hospital to the next, but that the majority of hospitals followed the 2-4-6-8 rule for intake of food and liquids before surgery:

• up to 2 hours before surgery: clear fluids (for example, water, apple juice, plain gelatin)
• up to 4 hours before surgery: human milk
• up to 6 hours before surgery: infant formal
• up to 8 hours before surgery: solid foods
• some anesthieologist classify human milk as a clear fluid because it is so rapidly digested and so allow babies to breastfeed two to three hours before surgery.

Keeping a breastfed baby happy and comfortable during the three or four hours before surgery when he is not allowed to nurse can be a challenge. This might be a time for dad to take over the baby comforting. Or use your baby sling and walk the halls with baby held in an upright position. Sitting down may frustrate both of you, since baby may interpret this as a sign that you're going to nurse him.

Once baby goes into surgery (and in some hospitals, you may be able to stay with him until he is asleep), you will need to pump your breast. Continue to pump every two or three hours if baby is not nursing well in the hours and days after surgery. Ask the nurses if there is a hospital-grade pump and a special room for pumping somewhere in the hospital (probably near the neonatal unit). Ideally you should have your own pump at baby's bedside, so that you don't have to choose between being there when your little one wakes up and pumping your breasts.