Last updated: 11/24/2009

The physician should be informed of any medication the patient is using and any heart surgery that the patient may have undergone.

Adults require no special preparation for this test. As for infants and children, they need physical and psychological...

preparation depending on the child's age, previous medical experiences, and level of trust.

Infant preparation

Before the test, parents should know that their child will most probably cry, and that restraints may be used. To provide comfort, and help their child through this procedure, parents are commonly asked to be present during the procedure. Crying is a normal infant response to an unfamiliar environment, strangers, restraints, and separation from the parent. Infants cry more for these reasons than because they hurt. An infant will be restrained by hand or with devices because they have not yet developed the physical control, coordination, and ability to follow commands as adults have. The restraints used thus aim to ensure the infant's safety.

Toddler preparation

Parents should prepare a toddler for bone marrow aspiration directly before the procedure, because toddlers have a very short attention span. Some general guidelines for parents include the following:

• Explain the procedure in a simple language, using concrete terms and avoiding abstract terminology.
• Make sure that the child understands where on his body the procedure will be performed and that it will be limited to that area.
• Allow the child to yell, cry, or express anything, especially pain, verbally.
• Describe how the test will feel.
• Stress the benefits of the procedure and anything that the child may find enjoyable afterwards, such as feeling better or going home.

Preschooler preparation

Parents should prepare a preschooler for bone marrow aspiration directly before the procedure, so that the child does not worry about it for days in advance. Explanations should be limited to 10 or 15 minutes, because preschoolers also have a limited attention span. Parents should also ensure that the child understands that the procedure is not a punishment. Some general guidelines for parents include the following:

• Explain the procedure in a simple language, using concrete terms and avoiding abstract terminology.
• Make sure that the child understands where on his or her body the procedure will be performed and that it will be limited to that area.
• Allow the child to yell, cry, or express anything, especially pain, verbally.
• Describe how the test will feel and be honest about any pain that may be felt.
• Allow the child to practice different positions or movements that will be required for the procedure.
• Stress the benefits of the procedure and anything that the child may find enjoyable afterwards, such as feeling better or going for a treat on the way home.
• Practice deep breathing and other relaxing exercises. Practice also to have the child hold your hand and tell him or her to squeeze it when he or she feels pain during the procedure.

School-age child preparation

Explanations should be limited to 20 minutes, and repeated if required. School-age children have a good concept of time, allowing for preparation in advance of the procedure. The older the child, the earlier a parent can start preparation. Guidelines for parents include the ones provided for preschoolers as well as the following:

• Suggest ways for maintaining control during the procedure. For example, counting, deep breathing, and relaxation (thinking of pleasant thoughts).
• Include the child in the decision-making process, for example, the time of day or the body site where the procedure will be performed. These of course depend on the scheduling constraints of your physician and the type of procedure being performed, but where possible, involve the child in the decisions.
• Encourage the child to participate in the procedure, for example by holding an instrument, if allowed by the attending hospital staff.
• Encourage the child to hold your hand or the hand of a nurse. Physical contact does help reduce pain and anxiety.

Adolescent preparation

An adolescent is best prepared by being provided with detailed information and reasons for the procedure. Adolescents should be encouraged to make as many decisions as possible. An adolescent may or may not wish a parent to be present during the procedure, and such wishes should be respected, since privacy is important during adolescence. Other guidelines include the following:

• Explain the procedure in correct medical terminology, and provide the reason for it. Ask the physician about the specific reason if you are not sure.
• To the best of your ability, describe the equipment that will be involved in concrete terms.
• Discuss potential risks because adolescents are usually quite concerned about any effects on appearance, mental function, and sexuality. These concerns should be addressed honestly and openly.