Infectious illness is the biggest cause of death in children due to a physical illness, particularly in children under five years. If mortality is to be reduced for this group of children, it is important to understand factors affecting their pathways to hospital. The aim of this study was to retrospectively identify organisational and environmental factors, and individual child, family, and professional factors affecting timing of admission to hospital for children under five years of age with a serious infectious illness (SII). Methods An explanatory modified grounded theory mixed methods design was used in collaboration with parents. Two stages of data collection were conducted: Stage 1, interviews with 22 parents whose child had recently been hospitalised with a SII and 14 health professionals (HPs) involved in their pre-admission trajectories; Stage 2, focus groups with 18 parents and 16 HPs with past experience of SII in young children. Constant comparative analysis generated the explanatory theory. Findings The core category was Navigating uncertain illness trajectories for young children with serious infectious illness. Uncertainty was prevalent throughout the parents and HPs stories about their experiences of navigating social rules and overburdened health services for these children. The complexity of and lack of continuity within services, family lives, social expectations and hierarchies provided the context and conditions for childrens, often complex, illness trajectories. Parents reported powerlessness and perceived criticism leading to delayed help-seeking. Importantly, parents and professionals missed symptoms of serious illness. Risk averse services were found to refer more children to emergency departments. Conclusions Parents and professionals have difficulties recognising signs of SII in young children and can feel socially constrained from seeking help. The increased burden on services has made it more difficult for professionals to spot the seriously ill child.

中文翻译：

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为患有严重传染病的幼儿导航不确定的疾病轨迹：混合方法修改的扎根理论研究。

传染病是儿童因身体疾病而死亡的最大原因，尤其是五岁以下儿童。如果要降低这组儿童的死亡率，了解影响他们入院途径的因素很重要。本研究的目的是回顾性确定组织和环境因素，以及影响 5 岁以下严重传染病 (SII) 儿童入院时间的个体儿童、家庭和专业因素。方法 与家长合作使用解释性修正扎根理论混合方法设计。进行了两个阶段的数据收集：第一阶段，对孩子最近因 SII 住院的 22 名父母和 14 名参与入院前轨迹的健康专业人员 (HP) 进行访谈；第 2 阶段，焦点小组由 18 位父母和 16 位具有幼儿 SII 经验的 HP 组成。不断的比较分析产生了解释性理论。结果 核心类别是为患有严重传染病的幼儿导航不确定的疾病轨迹。不确定性在父母和 HP 的故事中普遍存在，这些故事讲述了他们为这些孩子处理社会规则和负担过重的医疗服务的经历。服务、家庭生活、社会期望和等级制度的复杂性和连续性的缺乏为儿童（通常是复杂的）疾病轨迹提供了背景和条件。父母报告说他们无能为力，并认为批评导致延迟寻求帮助。重要的是，父母和专业人士错过了严重疾病的症状。发现风险规避服务将更多儿童转诊至急诊科。结论 父母和专业人士难以识别幼儿的 SII 迹象，并且可能会因寻求帮助而受到社交限制。服务负担的增加使得专业人员更难发现重病儿童。