Influence of Life Events and Family Routines on Childhood Respiratory Tract Illness

Respiratory illnesses account for nearly two thirds of the total illness in a community,1 account for as much as 40% of the problems seen in a pediatric practice,2,3 and are responsible for over one third of school absences.4 Despite major advances in the microbiology of respiratory disease, why and how a child becomes ill remain poorly understood. In over half of respiratory illnesses, complete cultures fail to yield an etiologic agent.5 Conversely, 30% of a school-age population can harbor group A streptococci without developing symptoms,6 three quarters of preschool children infected with Mycoplasma pneumoniae remain asymptomatic,7 and as many as 42% of upper respiratory tract cultures from well children yield pneumococci.8 Furthermore, there is no satisfactory explanation for the observation that certain children are predisposed to more frequent or more severe respiratory illnesses.9 The limited ability of microbiologic data to account for clinical experience has increased interest in studying the influence of social factors upon childhood disease. The family is undoubtedly the most important social context in which illness occurs, and many studies have documented the link between pediatric disease and family dynamics.10-18 Meyer and Haggerty reported a strong relationship between patterns of streptococcal illness and the degree of chronic family stress.19 Another group of observers found an accumulation of major family life events in the year preceding general pediatric hospitalizations.20 Others have demonstrated the prevalence of psychosocial problems in the families of children with repeated accidents and ingestions of poisons.21,22 There has, however, been little study of the general relationship between social environment and respiratory illness in children.