In this section
Lumbar puncture may be performed as part of the initial work up
of a sick child, or later in the course of an illness once the
child has stabilised if there were initial contraindications. It is
preferable to obtain a CSF specimen prior to antibiotic
administration, however this should not be unduly delayed in a
child with signs of meningitis or sepsis.
You must always discuss with a
senior registrar or consultant before doing a lumbar
You must always discuss with a senior
registrar or consultant before doing a lumbar
puncture.Do not do a lumbar puncture if the child is so sick that
you will give antibiotics for meningitis even if the CSF
is normal on microscopy. The clinical findings that suggest you should
give dexamethasoneand antibiotics immediately, and delay lumbar puncture for 1-2 days
until the child is improving are:
Informed verbal consent should be obtained. This should
include a discussion of the benefits of the procedure in terms of
possible diagnoses and potential complications. Complications of LP
The LP Parent Information Sheet may be useful in talking to
parents about the procedure. (See
The most important determinant of a successful lumbar puncture
is a strong, calm, experienced assistant to hold the patient.
Position of the patient is critical.
Cover the puncture site with a band-aid or occlusive dressing
Bed-rest following lumbar puncture is of no benefit in preventing
headache in children.
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