By Dr Christie Cabral
Research Associate
Centre for Academic Primary Care
When I first started researching infectious cough in children, lots of clinicians told me they couldn’t understand why so many parents brought in children who were well enough to turn the consulting room upside down before they even started the examination. As a parent of two young children myself, I had some idea, but as a qualitative researcher, I was keen to get a balanced view.
In the TARGET Programme* we wanted to answer two questions. Given that most coughs will get better on their own:
1) Why do so many parents consult when their child has a cough?
2) Why do so many clinicians prescribe antibiotics for children with coughs?
We conducted five qualitative studies and began to notice common themes, not just across the studies but also shared by parents and clinicians. We found normative beliefs about the vulnerability of children, the role of adults in protecting them and the risk of being perceived as failing to protect a child . This meant that parents took their child to the doctor, even when they didn’t think they were particularly sick, both to be on the safe side and to demonstrate that they were responsible parents. Similarly clinicians prescribed antibiotics ‘just in case’ when they couldn’t rule out a need for them and to ensure they didn’t ‘miss a sick child’ and the possible medico-legal consequences.
When the problems of high health care use and over prescription of antibiotics are discussed in the press, there is often a lot of patient/parent/GP bashing. Parents are portrayed as having poor knowledge or understanding, going to their GP or A&E to demand care and treatment unnecessarily. GPs are depicted as not taking time to educate and just prescribing to shorten a consultation. But what we found was that often parents and clinicians are just trying to do the best they can for a child and to adhere to social norms around the imperative to protect children from risk of harm.
As a parent, I’m familiar with the pressure to conform to socially acceptable parenting, including socially determined norms of what it means to keep a child safe. It can feel quite disempowering. It’s not just about what I judge to be safe, but whether society would agree were something to go wrong. Am I risking the horror of being labelled a ‘bad mother’?
This is a well-recognised phenomenon in parenting studies. Frank Furedi, among others, has written extensively about how rising concern for child safety has contributed, for example, to the curtailing of children’s outside play. Parents who attempt to allow their child more freedom encounter criticism or even prosecution. In the debates about over-stretched health services and over-prescription of antibiotics it’s easy to point the finger at particular groups and focus on lack of knowledge or ‘incorrect’ behaviours. But the social norms that have a powerful influence on all of us are created and reinforced by our society. Parents and clinicians correctly judge that they would receive far greater social disapprobation for a child suffering avoidable harm than for an unnecessary consultation or prescription.
The challenge lies in finding safe ways of reducing consulting and prescribing that meet the requirements of our current social norms.
Our paper:
“It’s safer to …” parent consulting and clinician antibiotic prescribing decisions for children with respiratory tract infections: An analysis across four qualitative studies” by Christie Cabral, Patricia J Lucas, Jenny Ingram, Alastair D Hay, Jeremy Horwood in Social Science & Medicine.
What parents want from a GP consultation for their child’s cough – a short animation
An animation that summarises the conflicting priorities that parents and GPs have during a consultation for a child’s respiratory tract infection. Based on research with parents funded by the NIHR and on real consultations recorded as part of the CONKER project funded by the RCGP.
https://www.youtube.com/watch?v=GgapMUN222Q
*The TARGET Programme is funded by the National Institute for Health Research’s Programme Grant for Applied Research Programme. This blog post summarises independent research funded by the National Institute for Health Research (NIHR) under its Programme Grant for Applied Research (Grant Reference Number RP-PG-0608-10018). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.