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Is my child seriously ill?

Press release issued: 12 March 2019

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."


'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

Further information

About the Centre for Academic Primary Care
The Centre for Academic Primary Care (CAPC) at the University of Bristol is a leading centre for primary care research in the UK, one of nine forming the NIHR School for Primary Care Research. It sits within Bristol Medical School, an internationally recognised centre of excellence for population health research and teaching. Follow us on Twitter: @capcbristol

About the National Institute for Health Research
The National Institute for Health Research (NIHR) is the nation's largest funder of health and care research. The NIHR:

  • funds, supports and delivers high quality research that benefits the NHS, public health and social care
  • engages and involves patients, carers and the public in order to improve the reach, quality and impact of research
  • attracts, trains and supports the best researchers to tackle the complex health and care challenges of the future
  • invests in world-class infrastructure and a skilled delivery workforce to translate discoveries into improved treatments and services
  • partners with other public funders, charities and industry to maximise the value of research to patients and the economy.

The NIHR was established in 2006 to improve the health and wealth of the nation through research and is funded by the Department of Health and
Social Care. In addition to its national role, the NIHR commissions applied health research to benefit the poorest people in low- and middle-income countries, using Official Development Assistance funding.

This work uses data provided by patients and collected by the NHS as part of their care and support and would not have been possible without access to this data. The NIHR recognises and values the role of patient data, securely accessed and stored, both in underpinning and leading to improvements in research and care.

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