References for Dorothy Rae Collier regarding length of time for breastfed
infants to be NPO before surgery:

Litman RS, Wu CL, Quinlivan JK. Gastric volume and pH in infants fed clear
liquids and breast milk prior to surgery. Anesth Analg 1994; 79:482-5.

In a prospective, blinded study, 24 breastfed infants nursed as usual 2
hours prior to surgery (feeding ended by 1 1/2 hours before anesthesia
induction). After induction of general anesthesia and tracheal intubation,
gastric fluid samples were aspirated and volume and pH were measured.
Sufficient gastric fluid for analysis was obtained from 8 (33 %) of the
infants.
The volumes were great enough that the authors do not recommend
breastfeeding less than 3 hours before surgery.  The majority of the
infants had residual gastric contents which were alkaline.  Animal studies
suggest that this higher pH may confer an advantage in case of pumonary
aspiration. The formula fed infants in the study were safely able to
receive 2 - 8 ounces of clear liquids up to 2 hours prior to surgery.

Schreiner MS.  preoperative and postoperative fasting in children.
Pediatric Clinics of North America 1994; 41(1):111-119.

"Until early 1990 perioperative oral fluid management for children could be
summarized as 'Starve Preop: Feed Postop.'  Recent advances have reversed
the conventional wisdom and now allow children to drink clear liquids up
until 2 hours prior to surgery and to fast after surgery until they want to
eat.  The pattern of gastric emptying of milk, formula and breast milk
needs further investigation..."  The author's recommendations are for clear
liquids to be stopped 2-3 hours before arrival at the hospital for day
surgery anesthesia, and breast milk 3 hours before.  He refers to a 1987
study by Tomomosa (Gastroduodenal motility in neonates: response to human
milk compared with cow's milk formula. Pediatrics 1987; 80:434) that showed
that 3 hours after a test meal, 75% of breastfed infants but only 17% of
formula fed infants had entered a fasting state.  "Breast milk clearly
empties faster than formula but slower than clear liquids."

Dr. Schreiner is with the Dept. of Anesthesia at Children's Hospital of
Philadelphia, with a very high volume of patients.

Both of these articles are worth getting to show those who are still
advocating prolonged fasting for infants and young children. Also see
Correspondence columns in the British Journal of Anesthesia for March 1995
Vol. 74 (no 3) p. 349 and September 1995 Vol 75 (no 3) p. 375 for more
support for the 2 hour clear liquid timing (no mention there of breast
milk).

Anne Altshuler, RN, MS, IBCLC and LLL leader in Madison, WI