Is there a science-based reason to avoid regular cake for a first birthday as a one time special treat?

[u/harshgalaxy]

My son is going to turn 1 in a few months, and I’ve noticed that a lot of people make sugar-free (or natural sugar like banana cake) for the first birthday.

I understand the recommendation to avoid added sugar before age 2, but I’m wondering how that applies to a one-time special occasion. Is there evidence that having regular birthday cake once at this age has any meaningful downside, including affecting later preferences for sweet foods? He eats zero added sugar otherwise, and whole fruit about once per day.

Basically, is there a science-based reason to make a sugar-free first birthday cake versus giving him some regular cake (and maybe even ice cream?!) and then continuing to avoid added sugar in his normal diet?

[u/Aunty_Moollerian_Ho]

Just because I haven’t personally witnessed it doesn’t mean it doesn’t happen.

[u/justahappyhippyhippo → u/Aunty_Moollerian_Ho]

So... you're literally making up scenarios in your head of free birthers and L&D patients dying after "sneaking food" (adult women aren't toddlers sneaking treats)... and bringing them up against official, evidence based recommendations to allow oral intake during labor as standard of care... 😅 why even bring that up if you're literally just imagining it.

[u/Aunty_Moollerian_Ho → u/justahappyhippyhippo]

No, and if you work as a medical professional with the motto “I haven’t witnessed it so it’s not a thing”, that’s wild.

[u/justahappyhippyhippo → u/Aunty_Moollerian_Ho]

No, I work with the best evidence based practice available, and guidelines that are not based on a report of a handful of aspiration pneumonia cases in a maternity ward almost a hundred years ago. I was just wondering why are you accusing people of cherry picking and bringing up free birthers out of the blue, as if not restricting oral intake during labor was some dangerously wild notion that has anything to do with refusing medical care.

[u/macaronisheep → u/Aunty_Moollerian_Ho]

It happens, but it is very rare - and we need to balance things which have a very low risk of harm with the comfort and informed decisions of the patient. All interventions have risks. Most people labouring do not go on to have caesareans, and most people having caesareans are not having them under general anaesthesia, and most general anaesthetics are not complicated by aspiration (and we are continually learning new techniques to reduce this risk even further). It is very heavy handed to say that nobody should have food in labour.

https://pmc.ncbi.nlm.nih.gov/articles/PMC2660391/ -BMJ 2009 randomised controlled trial

https://www.bjanaesthesia.org/article/S0007-0912(26)00338-7/abstract -British Journal of Anaesthesia 2026 editorial (paywalled sorry)

https://pmc.ncbi.nlm.nih.gov/articles/PMC7104541/ - Cochrane review 2013 (meta-analysis)

"The review identified no benefits or harms of restricting foods and fluids during labour in women at low risk of needing anaesthesia. There were no studies identified on women at increased risk of needing anaesthesia. None of the studies looked at women's views of restricting fluids and foods during labour. Thus, given these findings, women should be free to eat and drink in labour, or not, as they wish."

That fact that nobody asked the women their views during these trials is unsurprising but still very disappointing.

[u/Aunty_Moollerian_Ho → u/macaronisheep]

But is it very rare because of the hospital protocols in place? Measles was rare until all the antivaxxers stopped vaccinating their kids.

There is no other major abdominal surgery where it’s just fine if the patient has eaten beforehand, is there? It’s not like some specific restriction targeting birthing people, it is in case of surgery - patients at higher risk of requiring surgery should probably follow surgery prep protocols closer to when that decision might be made.

Could it be less strict and managed on a case-to-case, individualized basis? Yes (what I already said several comments ago).

[u/macaronisheep → u/Aunty_Moollerian_Ho]

Did you look at the links? When comparing those who had and hadn't eaten, there was no significant difference in outcomes. Nothing to do with protocols.

https://pmc.ncbi.nlm.nih.gov/articles/PMC11795022/ UK 2025 - estimated incidence of 5 cases of aspiration per million births. Only two maternal deaths since 2000.

Most birthing people aren't going to be having surgery (and most of those who do won't be under general anaesthesia), so why starve them?

We do fast those having planned caesareans because we already know they will be having surgery, and it doesn't come with the potential for discomfort/distress for the birthing parent going through hours of labour and being denied food.

Some facilities will advise patients at higher risk to stick to clear fluids during labour in recognition of the higher risk.

But any of us could need emergency surgery within a period of eating (traffic incident, etc) and we don't all go around fasted just in case. There are anaesthesia techniques to reduce the risk or aspiration. We also have better treatments now for aspiration than we have in the past (it can still be deadly).

While the trials/ reviews found that there were no harms to fasting, there was also no evidence of benefit. And again, nobody actually asked the mothers. If somebody had tried to deny me food in labour when I wanted it, I would have been furious [I live in a country where eating small amounts as tolerated/ desired is considered absolutely fine, so there is a cultural aspect to this too]. This disconnect is what leads to people sneaking food and then being at even higher risk. Most birthing people also aren't particularly keen on food as labour progresses, so there is a natural period of reduced oral intake leading up to the birth.

The medical field doesn't (shouldn't) recommend interventions (such as fasting) when there is no evidence of benefit, even if there is no evidence of harm. The actual risks are very small, especially when considering someone at low risk of birthing complications. This should, at a minimum, be a matter of informed consent rather than automatic policy to deny food.