How Accurate Are Parents’ Perceptions of Their Children’s Conditions?

Parents in all three areas were not really able to give an accurate history. There were examples where the parents thought the children’s balance skills were better than average, yet they were worse than average. [Parents either] overestimated or underestimated the symptoms of their child, Dr. Friedman said.

The same was true when it came to children who were being seen for hearing problems. In some cases, parents thought the child had hearing loss, yet a significant percent did not have hearing loss. But in some cases the parents were correct about the hearing loss.

With the sleep disturbance one, some of the people thought the children had severe sleep apnea and they didn’t have any apnea at all. And some of them thought the kids had normal sleep but the children had significant sleep apnea, Dr. Friedman said.

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Figure. Parental descriptions are an important part of patient histories–but objective tests must still be performed.

Sometimes, as in the lemon rind case, parents do get it right-so doctors can’t assume that parents either exaggerate or miss problems.

As a physician you use parental history to help guide you toward thinking about the workup and also for the treatment, she said. But it’s the clinical assessment that can pinpoint and clarify what the problem is.

Another case seen by Dr. Friedman was of a child brought in for earache. The parents had dutifully administered ear drops and were so focused on that particular problem that they somehow didn’t pay attention to a mass growing on the auricle, which turned out to be a tumor.

You think, what were they thinking? Too neurotic isn’t good, but too laid back isn’t good either, she said.

Reality Check

The medical literature abounds with studies of parental perceptions and attitudes about the health of their offspring in various specialties such as psychiatry, nutrition, and orthopedics. Many show that parental perceptions simply do not match up with clinical findings.

Several studies looking at how parents perceive their child’s weight and body mass index (BMI) show that many underestimate how heavy their child is, or will rank a child with a heavy BMI as having a healthier BMI than they really have. This could be of interest to otolaryngologists because of the effect of obesity on conditions such as obstructive sleep apnea (OSA).

A recently published study by Belgian researchers found that more than 75% of cases of obesity in preschool-aged children would be missed if only parental reports of weight and height were used. On the other hand, Italian researchers reported (in a study that was part of a large nutritional survey in Tuscany) that mothers had an accurate perception of the nutritional status of their children and were able to accurately choose silhouettes that corresponded to their child’s BMI.