Sara Khan, MD
Pediatric Resident, Seattle Children’s
Muslims are an extremely diverse faith group, comprising the second largest religious group in the world and the third largest religious group in the US. Each year, Muslims partake in the spiritual practice of fasting during the holy month of Ramadan. Here are some tips to navigate taking care of your patients this month:
1. Why do Muslims fast? Fasting is a joyous month of spiritual engagement, worship and community. Many of your patients will be eager to fast. It is best to broach the topic of fasting for patients who may require medical counseling before fasting or unique changes to their medication regimen.
Tip: Consider having special treats in the office for fasting patients as a way to show support and celebrate Ramadan and the culminating day of celebration at the end of the month, Eid-al-Fitr.
2. Who fasts? Muslims who are healthy, physically able to endure a fast, past the age of puberty and are not menstruating are required to fast.
Tip: Many children will partake in fasts some days or part of a day so they can share in the practice with their families, so be sure to talk to families about who is fasting regardless of the age of the patient.
3. When is the fast? Each fast lasts from sunrise to sunset, thus the length of the fast will depend on where someone lives. The month of fasting lasts for an entire lunar month, about 30 days. This year, Ramadan is expected to start on the evening of April 1, 2022 and last until the evening of May 2, 2022.
4. What is abstained from during a fast? Aside from no food and no water, all enteral medications, TPN, blood products, and IV fluids also break the fast, because they either enter the GI tract or provide non-enteral nutrition. Insulin, vaccines, IV/IM antibiotics, eye/ear drops, inhalers, nasal sprays, topicals and patches do not break the fast. Thus, vaccinations should not be delayed.
Tip: Work with your patients to safely move any scheduled medications to a pre-dawn and post-sunset schedule.
5. What if it isn’t safe for my patient to fast? Fasting is forbidden if it can jeopardize health. Thus, your job as a physician is to medically recommend against fasting if it is unsafe or could potentially worsen a patient’s medical condition (gastroenteritis, migraines, transplant or epilepsy patients with time-sensitive medications, etc.).
Tip: Consider a patient’s risk for hypoglycemia if they have diabetes. Some may be safe for fasting, while some may not. Consult a specialist if unsure about your particular patient.
6. What else should I do? Fasting is a deeply personal and spiritual practice for Muslims. Shared decision-making is the best way to ensure Muslim patients are able to safely practice this form of worship.
Tip: If a Muslim patient is eager to fast despite a strong medical recommendation to not fast, consider engaging the patient’s local Imam (religious leader at a mosque) for further discussion.