Background Paediatric Emergency Department (ED) attendances have been increasing dramatically in the UK with stark inequalities. Febrile illness accounts for around 10%-20% of these attendances. Reasons for this may relate to parental attitudes and knowledge around the management of fever. However, little research has been done to further explore parental and health care provider (HCP) concerns and experiences along the whole patient journey. This study aims to understand perceptions of the reasons for ED presentation for children with paediatric febrile illness in the UK, including decisions to perform further diagnostic tests or prescribe antibiotics.

Methods Semi-structured interviews were conducted between June 2022 and January 2023 with 15 parents/carers who had taken their febrile child to hospital in England between 2015–2022, and 5 HCPs with experience of treating a febrile child in the Emergency Department. Visual maps were developed of parent’s decision making and experiences of their journey through different services to hospital with their febrile child. Qualitative data were recorded, transcribed, and coded using NVIVO. Thematic analysis identified common themes which were mapped to a theoretical health inequalities framework.

Results Thematic analysis uncovered parental knowledge and concerns regarding fever, and perceptions of decision making that led to emergency hospital attendance. Major themes related to parental anxiety and seeking reassurance; delays in accessing primary care; and uncertainty around the severity of fever. Interviews with HCPs reflected this, and further uncovered potential factors undermining the effectiveness of our healthcare system including differing medical thresholds for fever, parental education surrounding fever, and barriers to primary care.

Discussion Here, in this small study, it appears that parental uncertainty around the severity of fever and seeking medical reassurance are two of the main causes for presentation to the ED for paediatric febrile illness. This study provides unique insight into the complete care pathway for a febrile child and the factors affecting parental decision making in the UK and helps to consider and identify policy entry points to better support parents. There is potential to further investigate parental perceptions on a larger and more diverse population to help narrow the gap in inequalities relevant to ED attendances for paediatric febrile illness in the UK.