BackgroundThe purpose of this study was to determine current practice patterns for preoperative fasting at major pediatric hospitals.MethodsFasting guidelines for children at each of the hospitals listed in the second edition of the Directory of Pediatric Anesthesiology Fellowship Programs were solicited and analyzed.ResultsFifty‐one institutions were surveyed, and 44 responded. In 50%, clear fluids were permitted up to 2 h prior to anesthesia for all children. Breast milk was restricted to 4 h for children younger than 6 months in 61% of hospitals. Institutions were equally divided (39% each) between a 4‐h and 6‐h fast for formula in infants younger than 6 months; for infants older than 6 months, 50% of hospitals restricted formula feeding to 6 h. There was no consensus for solid feeding in children younger than 3 yr, but 50% of hospitals agree that solids should be restricted after midnight in children older than 3 yr.ConclusionsThere is no uniform fasting practice for children before elective surgery in the United States and Canada. However, there is agreement among most institutions that ingestion of clear fluids 2‐3 h prior to general anesthesia is acceptable. Most also accept a 4‐h restriction for breast milk and a 6‐h restriction for nonhuman formula. There is great diversity among institutions regarding fasting for solids in children, with many restricting intake after midnight. There is little agreement about whether infant formula should be treated in the same way as solid food or how to categorize breast milk.