High Parental Concern in Children With Medical Complexity: An Early Indicator of Illness

Abstract

OBJECTIVESHigh concern about child’s health is a common reason parents of children with medical complexity (CMC) seek care in emergency departments and hospitals. Factors driving parental concern are unknown. This study explores associations of parent’s sociodemographic and child’s clinical factors with high parental concern.PATIENT AND METHODSSecondary analysis of a pilot study of CMC and parents who used daily for 3 months MyChildCMC, a home monitoring app. Parents recorded their child’s vital signs (temperature, heart rate, respiratory rate, oximetry), symptoms (pain, seizures, fluid intake/feeding, mental status), and oxygen use, and received immediate feedback. Parents rated their child’s health concern on a 4-point Likert scale. Concern scores were dichotomized (3–4 = high, 1–2 = low) and modeled in a mixed-effects logistic regression to explore important associations.RESULTSWe analyzed 1223 measurements from 24 CMC/parents, with 113 (9.24%) instances of high concern. Child factors associated with high parental concern were increased pain (odds ratio [OR], 5.10; 95% confidence interval [CI], 2.53–10.29; P < .01), increased oxygen requirement (OR, 28.91; 95% CI, 10.07–82.96; P < .01), reduced nutrition/fluid intake (OR, 71.58; 95% CI, 13.01–393.80; P < .01), and worsened mental status (OR, 2.15; 95% CI, 1.10–4.17, P = .02). No other associations existed.CONCLUSIONSChanges in CMC’s clinical parameters were associated with high concern, which may be an early indicator of acute illness in CMC when it is the primary complaint. Monitoring and responding to high parental concerns may support CMC care at home.