When preparing a child for a thoracentesis, in which of the following positions should the neonatal/pediatric specialist place the patient?

• A. Lying flat on his back
• B. Sitting up and leaning forward
• C. Semi-Fowlers
• D. Lateral Decubitus

Answer: (B)

Positioning for a pediatric thoracentesis focuses on exposure of the pleural space and stability of the child. Having the child sit up and lean forward onto a table or supported surface best exposes the posterior lateral chest, where effusions pool, and widens the intercostal spaces, making it easier to identify landmarks and insert the needle safely above the superior border of the lower rib to avoid the neurovascular bundle. This upright, forward-leaning posture also helps keep the patient still and reduces the risk of injury by aligning the needle trajectory with the pleural space. Other positions provide less optimal access: lying flat hampers access to the posterior pleural space, semi-Fowler offers only partial exposure, and lateral decubitus is used mainly when a child cannot sit up.