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Parental misconceptions about respiratory illnesses, not day care pressure, lead parents to pressure physicians for antibiotics

Physicians often feel pressure from parents to prescribe antibiotics for children with viral upper respiratory tract infections (URIs), sometimes to expedite the parent's return to work and the child to day care. However, day care pressure is a less important factor in parental demand for antibiotics than parents' misconceptions about URIs and antibiotic indications, according to a study supported in part by the Agency for Healthcare Research and Quality (National Research Service Award training grant T32 HS00063).

Grace M. Lee, M.D., M.P.H., of Harvard Medical School, and her colleagues surveyed 36 day care centers in Massachusetts about their policies for excluding children or requiring physician clearance for clear runny nose, green runny nose, and cough without difficulty breathing (all without fever), and how strictly the policies were enforced. Current medical guidelines do not recommend exclusion or physician clearance for any of these URI symptoms. The researchers also surveyed 398 parents (most of whom were well-educated) of children attending the centers about their knowledge and beliefs about URIs, understanding of their child's day care center policies about URIs, and perceived pressure from day care staff.

About one in five parents surveyed incorrectly believed that most colds and flu illnesses are caused by bacteria and get better faster with antibiotics. Day care centers reported at least sometimes excluding children for green nasal discharge (75 percent) and cough without difficulty breathing (88 percent) and requiring a physician visit for these two symptoms (65 and 73 percent, respectively). Although parental beliefs about day care policies often did not match a center's policies, very few parents felt pressured by day care staff to see a doctor (4 percent) or obtain an antibiotic (2 percent) when their child was ill.

See "Acute care and antibiotic seeking for upper respiratory tract infections for children in day care," by Jennifer F. Friedman, M.D., M.P.H., Dr. Lee, Ken P. Kleinman, Sc.D., and others, in the April 2003 Archives of Pediatric and Adolescent Medicine 157, pp. 369-374.

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