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Duration of symptoms of respiratory tract infections in children: systematic review

BMJ 2013; 347 doi: (Published 11 December 2013) Cite this as: BMJ 2013;347:f7027
  1. Matthew Thompson, Helen D Cohen endowed professor of family medicine1,
  2. Talley A Vodicka, consultant2,
  3. Peter S Blair, senior research fellow3,
  4. David I Buckley, assistant professor2,
  5. Carl Heneghan, professor4,
  6. Alastair D Hay, professor of primary care and NIHR research professor5
  7. on behalf of the TARGET Programme Team
  1. 1Department of Family Medicine, Box 354696, University of Washington, Seattle, WA 98195-4696, USA
  2. 2Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
  3. 3School of Social and Community Medicine, Level D, St Michael’s Hospital, University of Bristol, Bristol, UK
  4. 4Departments of Family Medicine, Medical Informatics and Clinical Epidemiology, Public Health and Preventive Medicine, Oregon Health and Science University, Portland, OR, USA
  5. 5Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
  1. Correspondence to: M Thompson mjt{at}
  • Accepted 8 November 2013


Objective To determine the expected duration of symptoms of common respiratory tract infections in children in primary and emergency care.

Design Systematic review of existing literature to determine durations of symptoms of earache, sore throat, cough (including acute cough, bronchiolitis, and croup), and common cold in children.

Data sources PubMed, DARE, and CINAHL (all to July 2012).

Eligibility criteria for selecting studies Randomised controlled trials or observational studies of children with acute respiratory tract infections in primary care or emergency settings in high income countries who received either a control treatment or a placebo or over-the-counter treatment. Study quality was assessed with the Cochrane risk of bias framework for randomised controlled trials, and the critical appraisal skills programme framework for observational studies.

Main outcome measures Individual study data and, when possible, pooled daily mean proportions and 95% confidence intervals for symptom duration. Symptom duration (in days) at which each symptom had resolved in 50% and 90% of children.

Results Of 22 182 identified references, 23 trials and 25 observational studies met inclusion criteria. Study populations varied in age and duration of symptoms before study onset. In 90% of children, earache was resolved by seven to eight days, sore throat between two and seven days, croup by two days, bronchiolitis by 21 days, acute cough by 25 days, common cold by 15 days, and non-specific respiratory tract infections symptoms by 16 days.

Conclusions The durations of earache and common colds are considerably longer than current guidance given to parents in the United Kingdom and the United States; for other symptoms such as sore throat, acute cough, bronchiolitis, and croup the current guidance is consistent with our findings. Updating current guidelines with new evidence will help support parents and clinicians in evidence based decision making for children with respiratory tract infections.


  • TARGET team: Alastair D Hay, Andrew Lovering, Brendan Delaney, Christie Cabral, Hannah Christensen, Hannah Thornton, Jenny Ingram, Jeremy Horwood, John Leeming, Margaret Fletcher, Matthew Thompson, Niamh Redmond, Patricia J Lucas, Paul Little, Peter S Blair, Peter Brindle, Peter Muir, Sandra Hollinghurst, Sue Mulvenna, Talley A Vodicka, and Tim Peters.

  • c Crown Copyright 2013

  • Contributors: MT and ADH were responsible for the concept of this research study. MT, ADH, CH, DIB, and PSB were responsible for the methods used for the systematic review. MT, TAV, DIB, and CH were responsible for the searches and identification of included studies, for assessing quality, and extracting data from included studies. TAV, MT, and PSB were responsible for data analyses and presentation of results. All authors were involved in reviewing, commenting, and editing drafts of the manuscript and all approved of the final manuscript. MT is guarantor.

  • Funding: This study was funded by the National Institute for Health Research (NIHR) under its programme grants for applied research funding scheme (RP-PG-0608-10018) and from a career development fellowship (for MT) supported by the National Institute for Health Research. The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. The funding agency had no involvement in the study design, data collection, analysis, writing of the manuscript, or decision to submit it for publication.

  • Competing interests: All authors have completed the ICMJE uniform disclosure form at and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

  • Ethical approval: Not required.

  • Data sharing: No additional data available.

  • Transparency: MT affirms that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

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