By Dr Christie Cabral, Senior Lecturer, Centre for Academic Primary Care, University of Bristol
When a child develops a cough, parents often find themselves in a whirlwind of worry and uncertainty. Is this normal? Should I call the doctor? Could it be something serious? These questions are common and understandable.
Infectious illnesses, like respiratory infections that cause coughs, are among the most frequent reasons for childhood visits to the GP. While the vast majority of coughs in children get better without the need for any medical treatment, a very small number could be serious.
The challenge lies in helping parents distinguish between what’s normal and what needs to be checked by a GP. This is what we set out to do when creating the Caring for children with coughs materials.
Why we needed better information
Parents said they found most of the existing NHS resources on what to do when a child has a cough too vague, illness-focused rather than symptom-focused, and sometimes even increased anxiety by emphasising risks without explaining what’s normal. They wanted clear, practical guidance that could help them decide when to manage at home and when to seek help.
GPs want parents to feel confident to bring their child in for an assessment if they were worried about their health. Sometimes GPs will prescribe antibiotics for their child ‘just in case’. The over-use of antibiotics is a key factor in the development of antimicrobial resistance (AMR), which is a serious global health threat.
In 2021, 4.7 million deaths were linked to AMR. Thanks to efforts to use antibiotics more carefully, antibiotic prescribing rates for children fell steadily in the 2010s to an all-time low during the COVID-19 pandemic, when infection control measures for COVID reduced all infection rates. However, since then, antibiotic prescribing rates for children have been rising again.
What parents said they needed
Through discussion and interviews with parents, we identified parents’ key information needs. Parents wanted to know:
- What is normal for a child with cough, including:
- information about different symptoms and their severity, as well as how long each symptom could be expected to last
- frequency of symptoms & illness – how often they could be expected to occur
- Red flags: which signs and symptoms mean “see a doctor now”?
- Practical care: what can I do at home to help my child feel better?
Parents wanted information organised by symptom, not illness, and presented in clear, accessible language. They also wanted all their concerns addressed – not just those considered clinically relevant.
Co-designing the information
To tackle these gaps, we worked with four parent groups from different communities living in deprived urban areas; a group each of South Asian, Somali, White British, and Eastern European parents. Over nine months, we met regularly to co-design and continually improve the information materials for parents.
We started with the information needs identified by parents, and then gathered the best available clinical and public health evidence, and relevant National Institute for Health and Care Excellence (NICE) guidelines, to address these needs.
What we did differently
With the parents’ key information needs firmly in mind, we:
- Organised the information by symptom: parents told us this was more intuitive than illness-based advice.
- Explained common symptoms: what was normal in terms of characteristics and duration.
- Added red-flag guidance: set out clear information about when to seek help.
- Addressed wider concerns: including the impact on a child’s sleep and eating, what to do at home, and when to attend nursery or school (or not).
The materials were revised repeatedly until parents felt confident they were clear, useful and reassuring.
Outputs and impact
The final resources include:
- A leaflet: Caring for Children with Cough with key information
- A website: Caring for Babies and Children with Cough with detailed information
The leaflet was integrated into the TARGET toolkit – a collection of free resources for primary care clinicians to support the responsible use of antibiotics – and has been widely used in UK primary care.
The leaflet also formed part of the CHICO intervention, which showed that the leaflet was highly regarded by clinicians and supported better conversations with parents.
Looking ahead
This project demonstrates the power of co-design. When parents help shape health information, it becomes more relevant, more trusted, and more effective. As healthcare systems face rising demand and the ongoing threat – and reality – of antimicrobial resistance, supporting parents with clear, evidence-based guidance is essential.
What you can do
Parents: Visit the Caring for Babies and Children with Cough website for practical, trustworthy advice on managing common symptoms at home.
Clinicians: Use these resources in consultations to support shared decision-making and reduce unnecessary antibiotic prescribing.
This week (18-24 November 2025) is World AMR Awareness Week, a global campaign that is celebrated annually to improve awareness and understanding of AMR and encourage best practices among the public, One Health stakeholders and policymakers, who all play a critical role in reducing the further emergence and spread of AMR. Find out more and how you can support the campaign: World AMR Awareness Week.