Mothers often express intense stress and uncertainty when their children develop acute childhood illnesses and it is important for healthcare professionals to consider maternal uncertainty when providing support for mothers. This study aimed to examine maternal uncertainty about children's hospitalization due to acute childhood illnesses. We recruited 15 Japanese mothers of children aged 1 -12 months who had been hospitalized for the first time due to acute childhood illnesses, and conducted unstructured interviews with the participants at the time of discharge. Content analysis was used to examine uncertainty in their expression of their psychological state. Mothers' uncertainty was classified into five categories: ambiguity about the severity of the illness, unpredictability of the course of the illness, discrepancy of the judgement with healthcare professionals, lack of information about the causes of the illness, and ambiguous appropriateness of management. The former three categories were reported as uncertainty of mothers of children with chronic diseases, while the latter two categories were particularly characteristic of mothers of children with acute childhood illnesses. It is, therefore, important to explore the causes of children's illnesses and help mothers build confidence in their ability to manage their children's illness before discharge.

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Aims To examine characteristics of parents of children with acute, albeit mild, illnesses who used ambulance transport unnecessarily. Design A cross‐sectional study. Methods From 2016 ‐ 2017, we recruited parents who visited the emergency room of a Japanese paediatric hospital and whose children were discharged without hospitalization. Participants whose children arrived by ambulance were classified as using ambulance services unnecessarily. Participants answered a questionnaire consisting of parents’ characteristics, including health literacy scales and the Parents’ Uncertainty regarding their Children with Acute Illness Scale. We conducted a receiver operating characteristic analysis to convert the Parents’ Uncertainty regarding their Children with Acute Illness Scale results to binary scores. We analysed questionnaire responses using logistic regression analysis. Results Analysed data were from 171 participants. The cut‐off score was 59 for the Parents’ Uncertainty regarding their Children with Acute Illness Scale. Results of the logistic regression indicated that parents who did not use resources to obtain information regarding their child's illness, had low health literacy, were observing presenting symptoms for the first time in their child, or had high uncertainty, were significantly more likely to unnecessarily use ambulances. Conclusion Publicizing available resources regarding child health information, social healthcare activities to raise parents’ health literacy and providing explanations in accordance with parents’ uncertainty, especially when confronting new symptoms in their child, might reduce unnecessary ambulance use. Impact Of patients transported to hospitals by ambulance, the rate of paediatric parents with mild conditions has been found to be high. The study findings could contribute to the appropriateness of using ambulances and have implications for policymakers and healthcare providers, particularly in the Japanese paediatric emergency system. In particular, parental uncertainty, one of four significant characteristics, could be resolved in clinical settings. Generalization for global health services requires further research.

Parents experience uncertainty when their children become sick. The study aimed to develop a Parents' Uncertainty regarding their Child with Acute Illness Scale (PUCAS) and to clarify differences in PUCAS scores between groups that were divided according to participants' demographic characteristics. PUCAS was developed based on interviews, literature review, and a pilot study. We obtained valid responses from 235 parents with children hospitalized due to an acute childhood illness. Exploratory factor analysis narrowed the number of items to 25, divided into the following 5 subscales: unpredictability of the course of the illness, ambiguity about the severity of the illness, ambiguous appropriateness of management, discrepancy of judgement with health care professionals, and lack of information about the causes of the illness. There was satisfactory construct validity and criterion-related validity. Cronbach's alpha was 0.92 for the overall scale. Participants who used ambulances, those who were not given any reliable diagnosis for their children, and fathers scored significantly higher on the PUCAS. PUCAS has high validity and reliability in measuring uncertainty of parents who have children with acute childhood illness and could be a useful screening tool for parents with high uncertainty in a clinical setting.

There is potential for improved understanding of the predictors of maternal state anxiety to aid in the development of materials that would best measure anxiety. The present findings may also suggest some means of providing appropriate information and support to anxious mothers. Our findings cannot demonstrate causation, however, and teaching methods and supportive practices were not investigated; therefore, a qualitative study on the concrete content of maternal anxiety and an intervention study to create support services for anxious mothers is required. In addition, prospective or longitudinal studies are also important for investigating causation.

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