{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T17:40:09Z","timestamp":1773337209697,"version":"3.50.1"},"reference-count":61,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T00:00:00Z","timestamp":1773273600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Caregiver recognition of pediatric respiratory red-flag signs remains suboptimal despite established international guidelines. The purpose of this study was to investigate caregiver awareness of pediatric respiratory red-flag signs and their intended emergency activation behaviors in China.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a cross-sectional, mixed-mode survey involving 2,702 caregiver\u2013child dyads across pediatric outpatient departments, emergency departments, and wards in Hubei Province, China. Data were collected using a validated questionnaire that measured awareness of 12 red-flag respiratory signs and emergency activation intentions across 5 clinical vignettes. Primary outcomes were adequate awareness (Awareness Index \u22650.70) and high emergency activation intention (Emergency Activation Intention Score (EAIS)\u202f\u2265\u202f20). Data were analyzed using multivariable logistic regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Adequate awareness was achieved by only 22.9% (\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f618) of the caregivers. Notably, symptom recognition varied substantially: identification rates were relatively high for cyanosis (71.0%) and severe chest indrawing (68.4%), but markedly lower for very low oxygen saturation (36.6%) and apnea (40.7%). Conversely, a majority of the cohort (\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f1,756, 65.0%) demonstrated appropriate emergency activation intentions. Caregivers exhibited a high propensity to contact emergency services during urgent scenarios (86\u201389%) while exercising suitable restraint during non-urgent presentations (12.3%). Multivariable analysis identified college education as the most robust predictor of adequate awareness (aOR\u202f=\u202f3.41, 95% CI: 2.75\u20134.23,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001), followed by knowledge of the emergency number 120 (aOR\u202f=\u202f1.67,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.004) and a history of prior respiratory hospitalization (aOR\u202f=\u202f1.34,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.015). Furthermore, a distinct dose\u2013response relationship regarding health literacy was observed, with adequate awareness being significantly more prevalent among caregivers with high health literacy compared to those with low health literacy (29.8% vs. 15.1%,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001). Finally, emergency activation rates were influenced by the clinical setting, as caregivers in the emergency department demonstrated significantly higher rates than those in outpatient environments (70.7% vs. 62.8%,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Despite appropriate emergency activation intentions, caregivers\u2019 limited recognition of red-flag symptoms highlights a critical knowledge\u2013behavior gap. Targeted educational interventions addressing these specific deficits are essential to improving pediatric respiratory emergency outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1702865","type":"journal-article","created":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T06:48:18Z","timestamp":1773298098000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Caregiver awareness of pediatric respiratory red-flag signs and emergency activation intentions: a province-wide cross-sectional study in China"],"prefix":"10.3389","volume":"13","author":[{"given":"Ling","family":"Li","sequence":"first","affiliation":[{"name":"Pediatric Neurology and Respiratory Medicine, The Central Hospital of Enshi Tujia and MiaoAutonomous Prefecture","place":["Enshi, Hubei, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhengtao","family":"Li","sequence":"additional","affiliation":[{"name":"Pediatric Neurology and Respiratory Medicine, The Central Hospital of Enshi Tujia and MiaoAutonomous Prefecture","place":["Enshi, Hubei, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,12]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1147","DOI":"10.1007\/s00112-020-00993-x","article-title":"Acute viral bronchiolitis and wheezy bronchitis in children","volume":"168","author":"Schorlemer","year":"2020","journal-title":"Monatsschrift Kinderheilkunde"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1016\/j.prrv.2009.10.001","article-title":"Acute viral bronchiolitis in children- a very common condition with few therapeutic options","volume":"11","author":"Wainwright","year":"2010","journal-title":"Paediatr Respir Rev"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"139","DOI":"10.2174\/1573396318666220810161945","article-title":"Respiratory syncytial virus is the Most common causative agent of viral bronchiolitis in young children: an updated review","volume":"19","author":"Hon","year":"2023","journal-title":"Curr Pediatr Rev"},{"key":"ref4","first-page":"1535","article-title":"COVID-19 and non-COVID-19 pneumonia: Alarming synergism for Pakistan\u2019s overwhelmed healthcare system","volume-title":"J Formos Med Assoc","author":"Khattak","year":"2021"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"398","DOI":"10.5694\/j.1326-5377.2006.tb00290.x","article-title":"Cough in children: definitions and clinical evaluation","volume":"184","author":"Chang","year":"2006","journal-title":"Med J Aust"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"iii1","DOI":"10.1136\/thx.2007.077370","article-title":"BTS guidelines: recommendations for the assessment and management of cough in children","author":"Shields","year":"2008","journal-title":"Thorax"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"415","DOI":"10.1517\/14656566.8.4.415","article-title":"The management of acute bronchitis in children","volume":"8","author":"Fleming","year":"2007","journal-title":"Expert Opin Pharmacother"},{"key":"ref8","first-page":"315","article-title":"Acute cough in children","volume":"57","author":"Worrall","year":"2011","journal-title":"Can Fam Physician"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"66","DOI":"10.5455\/medarh.2017.71.66-68","article-title":"Productive cough in children and adolescents - 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