Q: Parental presence and lumbar punctures

Scar from LPDoes having the a worried mum or fretful dad in the room with you make a lumbar puncture less likely to succeed? It’s an interesting question, and one that has been posed following an evening on call in Yorkshire. What’s the opinions of folk out there – and any evidence that you can quote to substantiate them?

Acknowledgement: Photo from Got Jenna, CreativeCommons

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  • vipin tyagi

    More often than not, Junior doctors feel under pressure while performing L.P. in prescence of parents and it does affect the success of procedure negatively. Its not a good site for parents as well to see their young one in that awkward posture.

  • Victoria Hemming

    I asked this question as well during my first year of training and decided to look for an article about it to discuss in the journal club at the hospital where I was working. The reference is Nigrovic, L.E. Lumbar Puncture Success Rate Is Not Influenced by Family-Member Presence, Pediatrics, 120 (4) 777-782. The conclusion of the article is obvious from it’s title! There are limitations to the study as there was no randomisation to observation or no observation and numbers were not equal between the groups.

  • Doctors may feel under more pressure, but a child may be calmer if a parent is present. I interviewed parents of babies in our neonatal unit to ask how they felt about being present or being excluded from procedures. I then asked doctors the same question.

    In general –

    Parents hate being excluded from procedures, unless they themselves find it frightening or stressful, in which case they leave. Doctors on the other hand think they’re doing parents a favour.

    Parents don’t want to be present because they want to spectate on the procedure, they want to be able to comfort the child, and they don’t want something bad to happen while they’re not there. Doctors on the other hand worry that parents will be looking over their shoulder.

    Doctors worry that their performance will be impaired by parents being present. Parents understand that a doctor may feel under pressure, and will willingly stay outside if that makes it easier.

    My conclusion is that doctors have a poor understanding of what parents would prefer and how they act; I would encourage doctors (and nurses too, who often express non-verbally to parents that their presence is not welcome) to allow parents to be present if they so wish, and not to worry too much about their abilities being somehow judged. On the other hand, if a doctor feels stressed, they should politely ask the parents to step outside for 10 minutes – to help the doctor relax, though, not the parent.