Oh, it just broke my heart reading your post.  I'm literally blinking back tears.

Our guidelines in the U.S. are NPO for 4 hrs for breastmilk and 2 hrs for clears (water/apple juice).  This is a standard of care and we really won't put a child to sleep without them unless it's for an emergency -- our concern is the passive regurgitation of stomach contents during the time when the airway is unsecured and protective reflexes are impaired.  My understanding is that most hospitals are now moving towards this, rather than a blanket "NPO after midnight" rule.

One random thought:  I anesthetized an 8-mo-old baby last year who had brain cancer and who also could not tolerate feeds because of some GI complication relating to the chemotherapy.  But who derived great comfort from breastfeeding.  This little guy needed an NG tube anyway to help drain stomach secretions and so mom was able to nurse ad lib since the milk was returned back out immediately.  It was a really nice solution for this sweet baby.

Best of luck to this mom.
-Sarah Reece-Stremtan (pediatric anesthesiologist)

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