Respiratory infections in children: an appropriateness study of when parents should home care or seek medical help

Abstract Background: Children with respiratory tract infections (RTIs) use more primary care appointments than any other group, but many parents are unsure when to seek medical help, and report existing guidance is unclear. Aim: To develop symptom-based criteria to support parental medical help seeking for children with RTIs. Design and setting: A RAND/UCLA appropriateness study to obtain consensus on children’s RTI symptoms appropriate for home, primary or secondary health care. Methods: A multidisciplinary panel of 12 healthcare professionals (six general practitioners (GPs), two pharmacists, two NHS 111 nurses and two emergency paediatric consultants) rated the appropriateness of care setting for 1,134 scenarios in children aged >12 months. Results: Panellists agreed that home care would be appropriate for children with up to one week of ‘normal’ infection symptoms (cough, sore throat, ear pain and/or runny nose, with or without eating adequately and normal conscious level). The presence of two or more additional symptoms generally indicated the need for a same-day GP consultation, as did the presence of shortness of breath. Assessment in the Emergency Department (ED) was considered appropriate when three symptoms were present and included shortness of breath or wheeze. Conclusions: We have defined the respiratory tract infection symptoms that parents might regard as ‘normal’ and therefore suitable for care at home. These results could help parents decide when to home care and when to seek medical help for children with RTIs.