Background: Little is known about the determinants of parental response when children appear to have a respiratory tract infection (RTI). Our objective was to identify what factors predict that parents will seek medical consultation.
Methods: In a prospective cohort study we consecutively recruited 400 children aged 2 months to 12 years from the urban, largely middle-class, primary-care practices of 7 pediatricians in Toronto. Baseline demographic data were collected and the children followed by telephone inquiry until an RTI developed or 6 months elapsed. Data about any medical consultation for the RTI were collected. The parents completed a questionnaire on clinical features and parental interpretations and concerns. Potential predictors of consultation were organized into 4 domains: family factors, principal complaints, functional burden of illness (determined with a validated measure, the Canadian Acute Respiratory Illness and Flu Scale [CARIFS]) and parental interpretation of the illness. Key variables for each domain were derived by endorsement, correlation and combination, and univariate association with the outcome (medical consultation). A model was created to identify independent predictors of consultation.
Results: Of the 383 children (96%) for whom the study was completed, 275 (72%) had symptoms of an RTI within 6 months after recruitment. Medical consultation was sought for 140 (56%) of the 251 for whom further data were available. The questionnaire data and follow up were complete for 197 (78%) of the 251. Children with earaches compared to children without were more likely to be taken to a physician (odds ratio [OR] 10.2; 95% confidence interval [CI] 2.8-37.4), as were children with high fever (temperature > 40 degrees C) compared to children with no fever or fever < or = 40 degrees C (OR 3.2; 95% CI 1.2-8.6). Parents who rated their children as having a complaint that was severe or persisting for more than 24 hours were more likely to see a physician than parents who rated their children as having no complaints (OR 8.5; 95% CI 2.3-32.0). Parental concern that the illness had an unusual course, with prolonged duration or deterioration (OR 5.7; 95% CI 1.3-24.8), that the child had a specific illness (OR 2.9; 95% CI 1.1-7.7) or that specific treatment was needed (OR 5.0; 95% CI 1.1-23.1), compared to children with no illnesses or need for treatment, also predicted consultation with a physician. Parents' postsecondary education (OR 4.0; 95% CI 1.1-14.6), compared to parents with less than postsecondary education, was the only parental factor that independently predicted taking a child to see a physician. Child's age 48 months or less was the only child factor that independently predicted physician consultation (0-6 months, OR 9.2, 95% CI 1.4-58.1; 7-12 months, OR 17.3, 95% CI 2.0-147.2; 13-24 months, OR 9.2, 95% CI 1.3-63.6; 25-48 months, OR 5.2, 95% CI 0.8-34.4). Neither family demographics nor functional burden of illness predicted consultation.
Interpretation: Generally, parents choose reasonable criteria for seeking physician advice. However, their perceptions and interpretations may be based in part on limited understanding of some factors. Further research is necessary to determine how these findings can be used to improve anticipatory guidance to parents and better address parental concerns.