Is my child seriously ill?

Parents generally tend to consider their child more unwell than GPs and use different factors to judge symptom severity, according to researchers at the University of Bristol’s Centre for Academic Primary Care in a study published in the British Journal of General Practice today [Tuesday 12 March].

Respiratory infections are the commonest reason parents take children to see their GP. Disagreement between parents and doctors about the severity of illness can cause problems, so that understanding how parents assess the severity of illness and how this compares with a clinical assessment by a GP is important.

As part of a large National Institute for Health Research (NIHR) funded study to improve the targeting of antibiotics in children with respiratory infections, Dr Esther van der Werf and colleagues carefully studied the symptoms reported by the parents of 8,390 children from 224 GP practices, and their severity assessment, alongside those of GPs.

Parents generally tended to consider their child more unwell than the GPs. Some symptoms that were important to parents, such as severe dry cough, going off food and disturbed sleep, have not been shown to be related to clinicians’ severity assessment, and it may be important for GPs to provide reassurance specifically about these symptoms. However, high fever and rapid breathing were accurately recognised by parents as being indicative of illness severity.

Doctors also considered severity greater in children with intercostal recession, chest signs, drowsiness or irritability and nasal flaring.

These are important findings, and not only emphasise the need for GPs to recognise that parents may reach different conclusions and use different factors when making judgements about illness severity, but also provide guidance to patients on which symptoms to be really concerned about.

Dr Van der Werf, lead author of the study in the Bristol Medical School: Population Health Sciences (PHS ) and Centre for Academic Primary Care , said: "Understanding parents’ concerns and educating them about clinicians’ concerns need to be part of day-to-day practice. Balancing the two is essential to successful management of parents of children with infections."

Paper:

’Parental and clinician agreement of illness severity in children with RTIs: secondary analysis of data from a prospective cohort study’ by Esther Van der Werf et al. in British Journal of General Practice