Five Lessons in Feeding Following Abdominal Surgery in Children: Can We Discontinue Unnecessary Fasting?

Fasting children after gastrointestinal surgery is traditionally thought to reduce complications. However, over the last two decades, there has been increasing interest in feed commencement within 24 h of operation, termed 'early enteral nutrition'. Evidence is now demonstrating that this approach to feeding aligns more closely with value-based healthcare principles than traditional postoperative fasting. This is reflected in the fact that early feeding can be safely offered and is associated with earlier return of bowel function, with shorter time to stool, quicker progression to full feeds and reduced length of stay. There is higher patient satisfaction, and no increase in complications. Because of this, early enteral nutrition is a key component of enhanced recovery after surgery protocols, which are being integrated into paediatric surgical practice.