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

Newbould et al’s review of respiratory infections in children is highly relevant during the COVID-19 pandemic when many GP consultations are conducted by phone. The study explores when to care for a child at home, or seek medical input. The findings could potentially be converted into a calculator (as clinicians use the FeverPain clinical score for children from 3 years old) or a leaflet for families (like the resources available at www.WhenShouldIWorry.com (WSIW)). However, comparing these resources reveals apparently conflicting criteria if the context is not understood.

One parent dismissed my explanation of why antibiotics were not required for her child’s sore throat after watching me typing details into the FeverPain website (https://ctu1.phc.ox.ac.uk/feverpain/index.php) to estimate risk of streptococcal infection. She bundled up her child and bustled out of the surgery, complaining that she would just check Google. WSIW resources, commonly used in GP surgeries and emergency departments, are useful in explaining to parents why their child does not require antibiotics, and to provide safety netting advice. Parents may find either the FeverPain, and WSIW websites when exploring options for a child with respiratory symptoms. The abstract to Newbould et al’s study will also no doubt appear in future Google searches.

There are important differences between these three evidence-based approaches that could be confusing to parents, particularly if not clear about intended purpose. FeverPain scores for the child presenting before 3 days, while WSIW advises GP/ nurse assessment after 3 days, and Newbould et al suggest that common respiratory symptoms including sore throat lasting for a week or less can be managed at home. FeverPain includes physician examination of throat while WSIW suggests that parents do not examine the throat and Newbould et al do not mention examination. Cough is also handled differently between approaches. At a time when patients may choose to stay away from healthcare settings, we need to provide access to straightforward information that parents can follow easily, and should clarify when resources are for professionals (e.g. FeverPain). Materials based on Newbould et al’s study should be developed and tested.