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Children's Health

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Parents may not always want antibiotics for their child's illness, sometimes they may just want reassurance

Doctors are more likely to prescribe an antibiotic for a child's condition if they believe the parent expects an antibiotic. They usually believe a parent wants an antibiotic for their child if the parent suggests a candidate diagnosis, such as a strep infection that would warrant an antibiotic, or resists the doctor's diagnosis of a viral infection that is not treatable by antibiotics. However, a new study found that these parental communication behaviors were not associated with parental reports of their expectation for antibiotics. Doctors may be too quick to perceive pressure for antibiotics when parents may simply want reassurance that their child is not seriously ill or that they were correct to obtain medical care, concludes the study supported by the Agency for Healthcare Research and Quality (HS10577).

Tanya Stivers, Ph.D., of the University of California, Los Angeles, and her colleagues surveyed 306 parents prior to an audiotaped visit to one of ten physicians in two private pediatric practices for their child's symptoms of upper respiratory tract infection (e.g., sore throat, ear pain) about their expectations of the visit. They then asked doctors after the visits what they believed the parents expected. Finally, they analyzed communication behaviors used by parents and physicians' perceptions of parents' expectations.

When parents simply discussed symptoms, such as a runny nose and sore throat, it did not affect the doctor's perception that they wanted antibiotics. However parents' use of candidate diagnoses when they discussed their child's problem or parents' resistance to a viral diagnosis—for example, of a simple cold—increased by five and nearly three times, respectively, the odds that a doctor would perceive a parental expectation of antibiotics. Yet, there was no association between these communication behaviors and parent's reports of expectations for antibiotics.

See "Why do physicians think parents expect antibiotics? What parents report vs. what physicians believe," by Dr. Stivers, Rita Mangione-Smith, M.D., M.P.H., Marc N. Elliott, Ph.D., and others, in the February 2003 Journal of Family Practice 52(2), pp. 140-148.

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