Parental assessment of disease severity in febrile children under 5 years of age: a qualitative study

OBJECTIVE: To explore how parents judge disease severity of their febrile child and to identify symptoms they associate with serious illness, minor illness or health. DESIGN: Semistructured interviews were conducted. Interviews were audio taped, transcribed verbatim and analysed thematically. PARTICIPANTS: Parents of children aged 0–5 years with a febrile illness. SETTING: Participants were recruited at the paediatric ward and the emergency department. RESULTS: Twenty-six interviews were conducted, in which 37 parents participated. Parents described disease severity of their child mainly in terms of changes in their child’s normal characteristics (behaviour and physical features). They found it harder to describe specific disease symptoms such as dyspnoea or dehydration. Their child being active, eating and drinking well, and smiling were perceived as reassuring, whereas high fever, moving very little and uncertainty about the type of infections were mentioned as alarming symptoms. Previous experience with febrile illnesses in their children was of great influence on the number and accuracy of symptoms they reported. CONCLUSION: Parents used the normal behaviour and physical features of their child as a reference frame for judging disease severity. With a larger deviation from the child’s normal characteristics, parents considered the illness more serious. They were less able to describe specific symptoms of disease such as dyspnoea or dehydration. This knowledge is important for clinicians in their communication with parents of children with febrile illness.