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UNIVERSITE DE NANTES Thomas Gelineau UNIVERSITE DE NANTES __________ FACULTE DE MEDECINE __________ Année 2011 N° 139 THESE pour le DIPLÔME D’ÉTAT DE DOCTEUR EN MÉDECINE DES de médecine générale par Thomas Gelineau né le 29 janvier 1983 à Cholet __________ Présentée et soutenue publiquement le 06/12/2011 __________ LE RHUME DE L'ENFANT ET SON TRAITEMENT: DECISION PARTAGEE AVEC LES PARENTS D'APRES UN QUESTIONNAIRE __________ Président : Monsieur le Professeur Olivier MALARD Directeur de thèse : Madame le Professeur Jacqueline LACAILLE 1 Table des matières IIntroduction................................................................................................................ 7 IIDéfinition, état des connaissances...........................................................................8 1Le rhume.......................................................................................................................................8 APhysiopathologie............................................................................................................................. 8 aL'origine virale.................................................................................................................................... 8 bLa saisonnalité................................................................................................................................... 8 cL'âge de survenue.............................................................................................................................. 9 dLe sexe................................................................................................................................................... 9 eLe mode de contagion.....................................................................................................................9 fL'influence de facteurs génétiques.............................................................................................10 BSymptomatologie.......................................................................................................................... 10 aL'incubation...................................................................................................................................... 10 bLa durée des symptômes..............................................................................................................10 cLes symptômes................................................................................................................................. 10 dLes complications............................................................................................................................11 eQuand consulter?............................................................................................................................12 2Les médicaments de la toux et du rhume.....................................................................12 ADéfinition......................................................................................................................................... 12 BUtilisation......................................................................................................................................... 14 CCoût................................................................................................................................................... 15 DEfficacité........................................................................................................................................... 15 EEffets indésirables.......................................................................................................................... 17 FRecommandations de diverses institutions...........................................................................18 GAutres traitements........................................................................................................................ 19 3Les règles hygiéno-diététiques.........................................................................................20 APour limiter la contagion........................................................................................................... 20 BMesures générales......................................................................................................................... 20 CLavage des fosses nasales au sérum physiologique..........................................................21 4La relation médecin-malade et la prise de décision médicale..............................21 AContexte historique et sociologique........................................................................................22 BQuels moyens pour une relation optimale?.........................................................................22 CPartager la décision..................................................................................................................... 23 DLes outils de la décision médicale partagée........................................................................24 IIIPopulation et méthode..........................................................................................25 1Population.................................................................................................................................25 2Enquêteurs................................................................................................................................25 3Déroulement de la consultation.......................................................................................26 2 IVRésultats..................................................................................................................28 1Nombre de cas........................................................................................................................28 2Caractéristiques des parents interrogés........................................................................28 3Caractéristiques des enfants..............................................................................................30 4Diagnostic évoqué en début de consultation.............................................................31 5Motifs de consultation..........................................................................................................33 6Attente des parents vis-à-vis de la consultation :......................................................33 ASouhait de médicament.............................................................................................................. 33 BSouhait de conseils....................................................................................................................... 36 CSouhait de traitement antibiotique.........................................................................................38 7Représentation des parents vis à vis des infections virales des voies aériennes supérieures..................................................................................................................................39 8Attente d'un médicament par les parents après information ..............................41 AEn fonction du sexe de l'enfant................................................................................................45 BEn fonction de la catégorie socio-professionnelle..............................................................46 CEn fonction des conseils attendus............................................................................................46 DEn fonction de l'âge des enfants..............................................................................................47 VAnalyse..................................................................................................................... 49 1Méthode.....................................................................................................................................49 2Population.................................................................................................................................49 3Motif de consultation............................................................................................................50 ASymptômes...................................................................................................................................... 50 BDésir de traitement....................................................................................................................... 50 CRéassurance.................................................................................................................................... 51 DInterférence avec le rôle social.................................................................................................51 4Traitement symptomatique.................................................................................................51 ANiveau d'étude............................................................................................................................... 51 BReprésentations des parents vis à vis des traitements symptomatiques....................52 aConnaissance des effets indésirables.......................................................................................52 bCroyance en l'efficacité.................................................................................................................53 CSouhait de traitement symptomatique de la toux et du rhume...................................53 aAvant information.........................................................................................................................
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