A child is scheduled for treatment under sedation. The parents state she has had nothing to eat since the previous night, but the child says she ate a bowl of cereal with milk this morning. What do you do?

Correct answer: A. Cancel and reschedule the appointment

• A. CORRECT. Always take the more conservative history. A bowl of cereal with milk is a light meal requiring roughly 6 hours of fasting, and milk is treated as a solid rather than a clear liquid. Proceeding risks aspiration of gastric contents under sedation, which is a catastrophic and entirely preventable complication.
• B. Reducing the concentration does not restore protective airway reflexes to a level that makes aspiration acceptable. It manages the wrong variable.
• C. Children frequently eat without their parents knowing. The child's own account of eating is the safety-relevant one, and it must be believed.
• D. One hour falls far short of the required fasting interval for a light meal with milk.

Note: ASA fasting intervals: clear liquids 2 h, breast milk 4 h, infant formula and light meal 6 h, fatty or heavy meal 8 h. When accounts conflict, the interval starts from the later reported intake.