Self-reporting versus parental reporting of acute respiratory symptoms of children and their relation to pulmonary function and air pollution

Background Studies of acute effects of outdoor air pollution on acute respi ratory symptoms in children generally rely on reports by parents. Little is known about the validity of parental reporting of symptoms of their childr en. We therefore compared symptoms reported by the parents with self-report ed symptoms and measured pulmonary function of 741 7-11-year-old Dutch chil dren. We also analysed the association of symptoms reported by the child or parent and outdoor air pollution. Methods The parents of the children completed a daily diary of symptoms of their children for about 3 months. The children reported presence of acute respiratory symptoms in the preceding week before a pulmonary function test was conducted (6-10 test days). Results Children reported between 80% and 220% more acute respiratory sympt oms than their parents for them in the same period. The agreement between s ymptom reports by the parent and the child was low to moderate (Kappa betwe en 0.22 for eye irritation and 0.43 for fever). Presence of cough reported by child or parent was associated with similar small decrements in forced v ital capacity (FVC), forced expiratory volume in one second (FEV1.0) and es pecially peak expiratory now (PEF) and maximal mid-expiratory flow (FEF25-7 5). The largest pulmonary function decrements were found when symptoms were reported by both parent and child. Symptoms reported by either child or pa rent were not associated with air pollution. Conclusions Symptom reports of the children were more prevalent but did not agree well with parental reports. The similar association with pulmonary f unction suggested that self-reported symptoms were neither superior nor inf erior to symptoms reported by the parents.