Objective To explore the effects of implementing relatively relaxed fasting time for pediatric emergency patients. Method A retrospective cohort study was conducted, involving 76 pediatric patients who underwent emergency surgery at Wujiang Children's Hospital in Suzhou from October 2023 to August 2024. Based on preoperative fasting durations, the patients were divided into Group A (fasting duration ≥8 hours, 39 cases) and Group B (fasting duration between 6 and 8 hours, 37 cases). Upon entering the operating room, gastric ultrasound was performed on all children to assess gastric contents. Those with an empty stomach received conventional anesthesia induction, while those with a full stomach underwent rapid sequence induction. General patient data, rates of full stomach and reflux/aspiration, preoperative anxiety scores, and parental satisfaction scores were compared between the two groups. Results No statistically significant differences were observed in the general characteristics between the two groups (P 0.05). After shortening the fasting duration, Group B exhibited a significantly higher rate of full stomach compared to Group A (P 0.05). Neither group experienced complications related to reflux or aspiration. Group B demonstrated significantly lower preoperative anxiety scores and higher parental satisfaction scores than Group A (P 0.05). Conclusion For pediatric emergency patients, implementing a more relaxed fasting protocol after qualitative and quantitative gastric ultrasound assessment does not increase the risk of reflux or aspiration. However, it significantly improves patient comfort and parental satisfaction, contributing to better perioperative recovery.