Which urgent care services do febrile children use and why?

2014

To cite: Jones CHD, Neill S, Lakhanpaul M, et al. Information needs of parents for acute childhood illness: determining 'what, how, where and when' of safety netting using a qualitative exploration with parents and clinicians.

Archives of Disease in Childhood, 2015

ContextFollow-up strategies after emergency department (ED) discharge, alias safety netting, is often based on the gut feeling of the attending physician.ObjectiveTo systematically identify evaluated safety-netting strategies after ED discharge and to describe determinants of paediatric ED revisits.Data sourcesMEDLINE, Embase, CINAHL, Cochrane central, OvidSP, Web of Science, Google Scholar, PubMed.Study selectionStudies of any design reporting on safety netting/follow-up after ED discharge and/or determinants of ED revisits for the total paediatric population or specifically for children with fever, dyspnoea and/or gastroenteritis. Outcomes included complicated course of disease after initial ED visit (eg, revisits, hospitalisation).Data extractionTwo reviewers independently assessed studies for eligibility and study quality. As meta-analysis was not possible due to heterogeneity of studies, we performed a narrative synthesis of study results. A best-evidence synthesis was used to ...

Proceedings of Singapore Healthcare

Introduction: Many paediatric emergency departments face a significant proportion of non-urgent attendances, leading to problems for both patients and healthcare systems. Our primary aim was to compare the effectiveness of pamphlet versus video in educating caregivers regarding fever management in children. Our secondary aim was to assess caregivers’ sentiments towards these methods. Methods: A randomized controlled trial was conducted with 50 participants over a four-week period (May–June 2015) in the KK Hospital Paediatric Emergency Department. The control group was exposed to the standard pamphlet available in the KK Hospital Paediatric Emergency Department, which provided basic information on fever management. The intervention group watched a video produced by our team, containing similar content. The same five-question questionnaire assessing fever management knowledge was issued to participants before and immediately following exposure to intervention. Results: The pamphlet gr...

Journal of Clinical Nursing, 2007

Influences on parents' fever management: beliefs, experiences and information sources Aim. To identify parents' knowledge, beliefs, management and sources of information about fever management. Background. Despite numerous studies exploring parents' management of childhood fever; negative beliefs about fever and overuse of antipyretics and health services for mild fevers and self-limiting viral illnesses continue to be reported. Design. Qualitative design using semi-structured interviews and discussions. Method. Fifteen metropolitan parents whose children were aged six months to five years, volunteered to participate in individual interviews or group discussions. Recruitment was through Playgroup Queensland's online newsletter and letters from two childcare centres to all parents. Verbatim and audio data were collected by an experienced moderator using a semi-structured interview guide. Data analysis: Two transcripts were independently analysed by two researchers; categories, subheadings and codes were independently developed, crosschecked and found comparable. Remaining transcripts were analysed using developed categories and codes. Results. Fever, determined through behavioural changes, was perceived as 'good', a warning that something was wrong. High fever, reported as 38AE0-39AE1°C, was considered harmful; it must be prevented or reduced irrespective of concerns about antipyretics. Positive febrile experiences reduced concern about fever. Negative experiences such as febrile convulsions, media reports of harm, not receiving a definitive diagnosis, inaccessibility to regular doctors and receiving conflicting information about fever management increased the concerns. Parents seek information about fever from multiple sources such as doctors, books and other parents.

BMJ Open

ObjectivesFirst, to explore parents’ views on and experiences of managing their febrile child and to assess their behaviour and needs when in search of information about fever; second, to develop and evaluate a hospital discharge information package about fever in children.DesignMixed methods: (A) qualitative study with semistructured interviews and a focus group discussion (FGD) and (B) quantitative survey.SettingEmergency department, non-acute hospital setting and day nursery in Rotterdam, The Netherlands.ParticipantsParents of children <18 years (interviews, n=22) parents of children under 5 years (FGD (n=14), survey (n=38)).InterventionInformation package about fever in children (leaflet and website including videos).Outcome measures quantitative surveyKnowledge of fever and confidence in caring for a febrile child (Likert scale 0–5).ResultsParents found fever mostly alarming, especially high fever. Help-seeking behaviour was based on either specific symptoms or on an undefin...

BMC Family Practice, 2013

Background: Acute illness is common in childhood, and it is difficult for healthcare professionals to distinguish seriously ill children from the vast majority with minor or self-limiting illnesses. Safety netting provides parents with advice on when and where to return if their child deteriorates, and it is widely recommended that parents of acutely sick young children should be given safety netting advice. Yet little is known about how and when this is given. We aimed to understand what safety netting advice first contact clinicians give parents of acutely sick young children, how, when, and why. Methods: This was a qualitative study. Interviews and focus groups were held with doctors and nurses in a general practice surgery, a District General Hospital emergency department, a paediatric emergency department, and an out-of-hours service. Data were analysed using the method of constant comparison. Results: Sixteen clinicians participated. They described that safety netting advice includes advising parents what to look for, when and where to seek help. How safety netting was delivered and whether it was verbal or written was inconsistent, and no participants described being trained in this area. Safety netting appeared to be rarely documented, and was left to individual preference. Limitations of written materials, and structural barriers to the provision of safety netting, were perceived. Participants described that safety netting was influenced by clinicians' experience, confidence, time and knowledge; and perceived parental anxiety, experience, and competence. Participants noted several limitations to safety netting including not knowing if it has been understood by parents or been effective; parental difficulty interpreting information and desire for face-to-face reassurance; and potential over-reassurance. Conclusion: First contact clinicians employ a range of safety netting techniques, with inconsistencies within and between organisations. Structural changes, clinician training, and documentation in patient notes may improve safety netting provision. Research is needed into the optimal components of safety netting advice so that clinicians can consistently deliver the most effective advice for parents.

2014

BMC Pediatrics, 2019

Background: We know that parents require resources which can assist them to improve fever knowledge and management practices. The purpose of this study, using an RCT, was to examine the effectiveness of an information leaflet at increasing parental knowledge of fever, specifically temperature definition. Methods: A prospective, multi-centre, randomised, two-parallel arm, controlled trial with blinded outcome ascertainment was conducted. Parents presenting at purposively selected healthcare facilities who had a child aged ≤5 years of age were invited to participate. An information leaflet for use in the trial was designed based on previous studies with parents. Parents in the intervention arm read an information leaflet on fever and management of fever in children, completed a short questionnaire at Time 1 (T1) and again 2 weeks after randomisation at Time 2 (T2). Parents in the control arm did not receive the fever information leaflet but completed the same questionnaire as the intervention arm at T1 and againat T2. The primary outcome was the correct definition of fever (higher than ≥38 °C). Results: A total of 100 parents participated in the study at T1. A greater proportion of the intervention group (76%) than the control group (28%) selected the correct temperature (≥38 °C) at T1. 76% of the intervention arm correctly identified "higher than ≥38°C" as the temperature at which a fever is said to be present compared to 28% of the control arm. After 2 weeks, there was an increase of 6% of parents in the intervention arm (increase to 82.4%) who gave the correct temperature compared to just a 2.8% increase in the control arm (increase to 30.8%). Univariate logistic regression showed that parents in the intervention arm were significantly more likely to give the correct answer at both time-points (T1: OR 8.1; CI 95% 3.3-19.9: p < 0.01; T2: OR 10.5; CI 95% 3.4-32.0: p < 0.01). Conclusions: Our RCT of this simple educational intervention has been shown to improve parental understanding of fever knowledge and correct management strategies. Education interventions providing simple, clear information is a key step to decreasing parental mismanagement of fever and febrile illness in children. Trial registration: ClinicalTrials.gov NCT02903342, September 16, 2016, Retrospectively registered.

Healthcare, 2022

The COVID-19 pandemic and stay-at-home regulations have increased child home injuries. This study illustrates the type and frequency of child home injuries in Greece during the COVID-19 lockdown. Moreover, the survey reports the results on parents' proposals regarding child injuries at home during the COVID-19 quarantine. A community-based, cross-sectional, descriptive study was conducted from November to December 2021 in Greece. Parents were asked to voluntarily complete an anonymous questionnaire, designed for the needs of the research. A statistical analysis of the data was performed using the Kolmogorov-Smirnov and Shapiro-Wilk tests for a normal distribution, a chi-squared (χ 2 ) test to compare percentages among different groups and a non-parametric Mann-Whitney U test to determine the differences in Likert scale variables between two groups. A total of 130 parents with at least one child were questioned through an online questionnaire survey. Of the parents, 39.3%, stated that the number of accidents in their home increased. The most frequent accidents were injuries (49.3%). Most of the accidents occurred inside the house (75.8%) and were observed among children aged 0-4 years. A high percentage of children's accidents was observed in rural/island areas or in the suburbs. Children who were with either their father or mother had one accident, and a higher number of accidents occurred when the children were with their grandparents, with the nanny or alone. For those parents who had difficulty supervising their child, child accidents increased compared to parents who had the ability to supervise. It was noticed that parents who knew how to provide a safe home stated that the number of accidents remained the same. Parents must organize a safer home. Authorities should educate parents on child injury prevention and provide them with financial facilities to provide a safer house.

Paediatrics & child health, 2011

To assess the influence of prehospital health care contact on triage acuity. One hundred fifteen families were assigned Canadian Triage and Acuity Scale scores by a paediatric emergency department (ED) physician. Scores of children who had or had not seen a health care professional before attending the ED were compared. Sixty-two of 72 (86.1%) children without previous health care professional contact, and 30 of 43 (69.8%) children with contact were triaged as &#39;urgent&#39; (P=0.034). Parents with first aid knowledge (29 of 43 [67.4%]) were more likely to have had contact with a health care professional before visiting the ED compared with those with no such knowledge (27 of 72 [37.5%]; P=0.003). Patients without previous health care professional contact were assigned more acute triage categories. Health care professionals may advise families to visit the ED more frequently than necessary, which could contribute to ED congestion. Incorporating a parental estimate of the degree of...