Respiratory Symptoms in Post-infancy Children. A Dutch Pediatric Cohort Study

Abstract

Aim: To study the pattern of respiratory symptoms in children in the general population.Method: We followed a cohort of children for up to 2 years through parents completing weekly online questionnaires in the Child-Is-Ill study (“Kind-en-Ziekmeting” in Dutch); the study was running 2012–2015. Inclusion criteria were “an ordinary child” (according to the parents) and <18 years old at inclusion. We especially encouraged participation of post-infancy children. Age at inclusion, sex, smoking exposure, allergy in the family, and frequent infections in the family were noted. Pearson's correlation, principal component analysis, latent class analysis, latent profile analysis, linear regression, and linear mixed effects regression were used in the statistical analyses.Results: Data were collected on 55,524 childweeks in 755 children (50% girls; median age, 7 years; interquartile range, 4–11 years, 97% ≥2 years at inclusion), with reported symptom(s) in 8,425 childweeks (15%), leading to school absenteeism in 25%, doctor's visits in 12%, and parental sick leave in 8%; symptoms lasting ≥3 weeks were rare (2% of episodes). Linear mixed effects regression showed significant, but only limited, effects of season on the proportion of “symptom(s) reported” per individual child. Only runny nose showed a significant, but very small, age effect. However, the variability between the children was considerable. There were no obvious subgroups of children with specific symptom combinations.Conclusion: In any randomly chosen week, the vast majority of children (85%) in our—mainly—post-infancy cohort derived from the general population did not have any symptom, even in the younger age group, even in winter. The children showed considerable variability; no clear subgroups of symptom patterns could be identified, underlining the difficult position of healthcare providers. These results support our opinion that post-infancy children in the general population should not be evaluated as if they are infants when they have recurrent respiratory symptoms. If they clearly deviate from the above-described most common pattern, it is wise to keep an eye on potential, maybe even rare, serious underlying causes.

Process Evaluation of the Child and Youth Healthcare Intervention ‘Medical Advice for Sick-Reported Students in Primary School’ (MASS-PS)

“…In contrast, international research and policy makers stress the importance of early childhood education as the basis for success in life [ 20 ]. While increased absenteeism due to adjusting to school life or infectious diseases may be expected at that young age, ESA should not be tolerated as it might be a red flag for underlying problems that had not been noticed before the child attended school [ 21 ]. Awareness of the importance of school attendance in early childhood should be increased among both parents and teachers.…”

Increased rate of respiratory symptoms in children with Down syndrome: a 2-year web-based parent-reported prospective study

“…To identify subgroups of symptom combinations, we performed latent class analysis for binary data (symptom yes/no; R poLCA package) using the Akaiki information criterion (AIC) to select the best model. The latent class analysis was performed for Down syndrome, Down syndrome versus children from the general population [13], and in all data from both cohorts combined. A Pearson's chi-squared test with Yates' continuity correction was performed to identify significant differences in occurrence of symptoms between Down syndrome and children from the general population.…”

“…After the first baseline questionnaire was completed, parents received a weekly questionnaire regarding the presence or absence of respiratory symptoms of the child in the past week. This weekly questionnaire was identical to the survey that was used in a separate study investigating the incidence of respiratory symptoms in children who were deemed healthy by their parents [13]. This population served as a control group for this study (questionnaires used in Supplemental Table 3).…”

“…Here, we describe the incidence and pattern of respiratory symptoms in children with Down syndrome as reported by parents or caregivers in a prospective nationwide web-based 2-year weekly survey and compare these data to a large population-based cohort of children from the general population [13]. The primary aim of this study is to obtain information on the frequency of respiratory symptoms in relation to age and season.…”

Prevalence of Recurrent Hospital Admission in Children with Recurrent Wheezing in Babylon Province

“…1-3 children have at minimum one severe wheezing attack beforehand the age of 3 years [1]. Repeated wheezing can cause a chief financial problematic subsequent from the healthcare cost equivalent with the illness [2], [3]. Whereas the most public reasons of repeated wheezing is "asthma, gastroesophageal reflux disease (GER), foreign body aspiration, bronchopulmonary dysplasia (BPD), bronchiolitis obliterans, an immunodeficiency, primary ciliary dyskinesia, vocal cord dysfunction, cardiac and structural etiologies" [1].…”