Table 4. Condensed data extraction summary.

Author, Year, Country	Study Design	No in Sample	Child age, Socioeconomic Status (SES), Disease Characteristics, Parent age/gender	Help-seeking behaviours, Organisational factors, Environmental factors, SES, Other findings.
Crocker (2013) UK [7]	Design: Mixed methods sequential sub sample design.	N = 151	Child age: 6 months-16yrs (mean 5yrs)	Help-seeking behaviours: Late/non-consulters significantly less likely to have taken antibiotics before presenting to hospital, & significantly more likely to have obtained advice (e.g., NHS Direct Telephone helpline) and had significantly more rapid onset of illness. Various parent factors reported (e.g., did not think earlier symptoms were serious/unusual due to child initially improving). Organisational: Various factors for no GP presentation (e.g. GP surgery closed). Environmental: Various factors for late/no GP presentation (e.g. unable to travel to GP surgery). SES: Late/non-consultation associated with lack of home ownership, WIMD quintile and higher ratio of children: adults in household.
			SES: All quintiles represented.
			Disease: Community acquired pneumonia or empyema.
			Parent: Carer gender not recorded
Emery (2015), New Zealand [19]	Design: Mixed methods.	N = 856	Child age: <5yrs (mean 19mths).	Help-seeking behaviours: Various factors were associated with likelihood of ED presentation: increased (e.g. lower parental satisfaction scores for communication); decreased (e.g. children whose caregivers would take them back to the same doctor if still unwell). Various factors were associated with likelihood of ED admission: increased (children who had made more health professional visits before presentation); decreased (e.g., children whose caregivers would take them to a hospital ED if they had been seen the previous day by their GP and were still unwell). Organisational: Various factors associated with increased likelihood of presenting (e.g. GP worked ⩽20hr week) and increased likelihood of hospital admission with pneumonia (e.g., antibiotics prescribed by GP before ED presentation).
			SES: Measured by household deprivation score.
			Disease: Pneumonia.
Francis (2011), UK [6]	Design: Qualitative study.	N = 22	Child age: 16 months-13yrs (median 4yrs).	Help-seeking behaviours: All parents described potentially serious symptoms. Although most regarded these symptoms as unusual/worrying, nearly half described delay of 24h or more between first identifying the symptom(s) and consulting. Parents not consulting earlier because of a fear of ‘overreacting’, not wanting to ‘bother’ service or past experience. Organisational (parent reported): Delays included difficulties with GP appointment system (e.g., prolonged waits for emergency appointments), failures/problems of appropriate triage, and failures of HCPs to respond appropriately after child had developed one or more serious symptoms.
			SES: Not reported.
			Disease: Empyema, pneumonia, peritonsillar abscess, mastoiditis, lateral sinus thrombosis.
			Parent: Mothers (n = 22), father (n = 1)
Grant (2012), New Zealand [9]	Design: Case series.	N = 280	Child age: <5yrs (median 17mths).	Other findings: Receipt of antibiotic more likely if child seen by own General Practitioner (GP), less likely if the primary care clinician failed to make a diagnosis of LRTI. Mild pneumonia associated with increased likelihood of being prescribed antibiotics. Children with no opportunity to receive antibiotics had more rapidly evolving illness than those with opportunity to receive antibiotics. Various reasons for missed opportunity to receive antibiotics.
			SES: NZ Index of Social Deprivation.
			Disease: Pneumonia.
Kilpi (1991), Finland [20]	Design: Prospective cases series.	N = 286	Child age: 3 months-15yrs (mean 2.9yrs).	Other findings: Level of consciousness significantly poorer in children with short history of illness than those with long history. Seizures before or on admission were more common in the short history than the intermediate or long history groups. Children with long history of illness significantly younger than those ill for up to 48hr.
			SES: Not reported.
			Disease: Included bacterial meningitis, haemophilus influenzae type b.
McIntyre (2005), Australia [21]	Design: Case series.	N = 122	Child age: 1.78-179mths (median 13mths).	Other findings: Significant diagnostic and prognostic predictors of outcome were not having a lumbar puncture done, intensive care admission, intubation, any neurological abnormality, seizures within 48 hours, and higher temperature. The only significant therapeutic factor was administration of corticosteroids with or before antibiotics.
			SES: Not reported.
Nadel (1998), UK [22]	Design: Prospective case note review.	N = 54	Child age: 1 week-15.7yrs (median 2.95yrs)	Help-seeking behaviours: Various reasons for some parents delaying presentation (e.g., hesitation to call GP, inappropriately reassured by advice over phone). In all cases, parents were unaware of signs of serious illness in their child. Other findings: Among children with septicaemia delay from onset until treatment initiation was longer for those who died compared with survivors.
			SES: Not reported.
			Disease: Meningococcal septicaemia, meningococcal meningitis.
Okike (2017), UK [23]	Design: Retrospective medical case note review.	N = 97	Child age: <90 days	Help-seeking behaviour: 20 parents took infants straight to the hospital, remainder phoned GP or 24-hour telephone service or contacted community midwife. Majority of parents presented to hospital within 24 hours of onset of symptoms. Organisational: Uncertainty in recognition, over-reliance on the presence of fever, waiting for urine samples before giving antibiotics and waiting for handover between shifts. Other findings: 55% infants triaged in Emergency Department during normal working hours.
			SES: Addressed by parental accommodation.
			Disease: Included Group B strep, E Coli, other gram-negative/positive bacteria.
			Parent age: (median) mothers 29yrs; fathers 32yrs.
Thompson (2006), UK [24]	Design: Observational study.	N = 448	Child age: ≤16yrs.	Help-seeking behaviour: 51% of children seen by GP were sent to hospital from the 1st consultation. In most children, disease progressed very rapidly. 25% children had symptoms in the two weeks before the onset of meningococcal disease. Only 7% children had seen a doctor in the week before the onset of disease. 76.1% parents had noticed 1/more of early symptoms before hospital admission. Other findings: Fever was 1st symptom to be noticed in children <5yrs; headache 1st to be seen in those >5yrs. First specific clinical signs of sepsis: leg pain, abnormal skin colour, cold hands and feet, and, in older children, thirst. 1st classic symptom of meningococcal disease to emerge was rash.
			SES: Not reported.
			Disease: Meningococcal disease
Urbane (2019), Latvia [25)	Design: Prospective observational study.	N = 162	Age: 2mths-17.8yrs (median 43.5mths).	Help-seeking behaviour: 59.9% parents stated belief that fever itself is indicative of serious illness, some parents believed that other symptoms must be considered as well when evaluating the severity of illness, few parents did not believe that fever is indicative of serious illness. No association was found between the belief that fever is indicative of serious illness and parental concern. Other findings: The presence of clinician’s “gut feeling” was significantly more common in children who developed serious bacterial infection than in those who did not, as was “sense of reassurance” in the cases with no serious bacterial infection.
			SES: Not reported.
			Disease: Included UTI, sepsis, pneumonia, acute osteomyelitis with bacteraemia
			Parent age: Median: mothers 34yrs; fathers 33yrs.
Van den Bruel (2012), Belgium [11]	Design: Observational study.	N = 3890	Age: 0-16yrs (mean 5.05yrs).	Other findings: Gut feeling that something was wrong despite clinical assessment of a non-serious illness increased risk of serious illness & acting on this feeling had potential to prevent cases being missed at cost of 44 false alarms. Compared with clinical impression that the children were seriously ill, gut feeling was consistently more specific, irrespective of the children’s age or diagnosis or the seniority of the doctor.
			SES: Not reported.
			Disease: Pneumonia, pyelonephritis, sepsis, meningitis, cellulitis & bacterial lymphangitis.
Young (2001), New Zealand [26]	Design: Qualitative.	N = 12	Age: <2yrs.	Help-seeking behaviour: Caregivers perceived themselves to be competent (e.g., prompt taking them to doctor, knew instinctively the child was unwell) but felt these subjective feelings dismissed by the doctor leading to mistrust. All parents sent home after the initial consultation but quick to return to doctor if they felt their child was not improving. Personal barriers to accessing GP existed (e.g. lack of knowledge about services, feeling dismissed as unimportant by HCPs). Organisational: Most caregivers visited 2 or more doctors in the community before being referred/self-referring. Environmental: Non-financial barriers for attending accident/medical setting rather than GP reported (e.g., GP fully booked, limited transport to GP).
			SES: Not reported.
			Disease: Viral or bacterial pneumonia.