The natural history of acute upper respiratory tract infections in children.

Aim: To describe the natural history of acute upper respiratory tract infections (AURIs) in primary-school children, by recording their daily symptoms.

Background: AURIs in children are one of the most common reasons for people seeking advice from general practitioners (GPs); however, little is known about the natural history of AURIs in terms of the length and severity of symptoms, because the majority of illnesses are contracted at home.

Method: After an initial pilot study to test the feasibility of parents recording symptoms in a diary based on the Canadian Acute Respiratory Illness and Flu Scale (CARIFS), a random selection of primary schools operating in the region was carried out in order to minimise selection bias. Meetings were arranged at the 20 schools to obtain written consent from parents and to give out diaries with a stamped addressed envelope. The diaries recorded daily symptom severity for one episode of AURI, and the data were analysed using SPSS programmes.

Findings: Diaries were returned from 223 children, of whom 146 had had an AURI. The average age was eight years, and there were almost equal numbers of boys and girls. The most frequent symptoms were runny nose, cough, feeling unwell and sore throat. There was a biphasic distribution with systemic symptoms in the first three days characterised by fever, poor sleep, irritability, not playing and headache. By day four, symptoms localising the infection to the upper respiratory tract appeared with runny nose, cough, sore throat and poor appetite; these continued into the second and occasionally third week. Most symptoms lasted for 5-11 days, with a median length for all symptoms of seven days. Symptoms defined by parents tended to be scored less for severity than symptoms defined by children.