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Understanding telemedicine for children
Most telemedicine visits can be conducted on any electronic device with webcam capabilities, including cell phones, tablets or computers. These visits usually have both video and audio components. - photo by File photo
Dr. Becky Alford
Dr. Bailey Alford - photo by Photo submitted

During the ongoing pandemic, healthcare is evolving. How we care for patients has changed out of necessity. Most of these changes are to continue to provide high-quality healthcare to patients diagnosed with coronavirus while avoiding exposure to others around them. At the same time, protecting healthcare workers who are treating them. As you can imagine, this process can get complicated.

In this new environment, telemedicine plays an important role. Telehealth services allow healthcare providers to "see" patients, assess their symptoms, in some cases perform limited exams, triage them, and either treat them or direct them to a higher level of care. All while avoiding exposure to others and the healthcare providers themselves. Although telemedicine services were available and gaining popularity pre-pandemic, their use is now more accessible and essential.

— Are telemedicine visits appropriate and useful for children?

In response to the pandemic, the American Academy of Pediatrics (AAP) strongly supports telemedicine services for children to ensure continued access to care. Your child's pediatrician or pediatric subspecialist's office will likely be offering telemedicine visits when appropriate. However, there are times where the importance of an in-person, face-to-face visit with your child's pediatric provider cannot be denied. Some diagnoses are difficult to make without a full hands-on exam. However, there are many times when a telemedicine visit with video and audio components can provide enough information to make a diagnosis or triage a patient to determine if they need more urgent care.

It's a good idea to reach out to your child's pediatrician's office first to determine if they offer telemedicine services, as they know your child and their medical history best. When your child must see a provider new to them, it is vital to ensure that that provider is experienced and trained in pediatrics to assure your child is receiving appropriate advice and treatment. If you are not using your child's pediatrician's office for a telemedicine visit, do not hesitate to confirm the provider's credentials, qualifications, and board certifications, which should all be information readily available to you. Make sure the telehealth provider is aware of any chronic medical conditions your child may have in addition to any medication allergies, as this may affect the treatment your child should receive.

— How do telemedicine visits work?

Most telemedicine visits can be conducted on any electronic device with webcam capabilities, including cell phones, tablets or computers. These visits usually have both video and audio components. Your child's provider should be able to see and hear you and your child, and vice versa. It is important to make sure you are in a well-lit, quiet, and private location while conducting the visit and aim to keep distractions at a minimum. Your child's medical provider may ask you to aid them in conducting a limited physical exam, with things that can be assessed over video. They may ask you to use a flashlight to examine your child's throat, focus closer on a rash, press his or her abdomen to assess for pain, or simply lift their shirt so the provider can watch your child breathe to evaluate for signs of increased work while breathing. An experienced pediatric telemedicine provider can gain valuable information about your child and decide further management — even given the limited exam. However, there are times when certain symptoms or exam findings over telemedicine warrant further investigation, and an in-person visit will be recommended for your child.

— How do I know if my child's symptoms are appropriate for a telemedicine visit?

In general, telemedicine visits are designed to be for non-urgent complaints. If you feel your child's symptoms require urgent or emergency medical attention, then a telemedicine visit is not appropriate. Urgent symptoms would include if your child has difficulty breathing, is breathing harder or faster than normal, is lethargic, or is an infant with a high fever (especially one under three months of age), to name a few.

Symptoms that may not be urgent and require an ER visit — but should likely be seen for an in-person, face-to-face visit — include fever with ear pain, fever with a sore throat and white patches on the tonsils, burning with urination, or fever with significant abdominal pain. These symptoms may require an exam and more detailed testing. If you are unsure, discuss with your child's pediatrician as different offices may have different policies regarding what would be appropriate for a telemedicine visit.

The technology of telemedicine is a useful tool for providing quick and easy access to care for your children. However, it is most effective when integrated with your child's pediatrician's office, not as a replacement. Continued well-child visits, updated immunizations, and face-to-face visits with comprehensive physical exams, when conducted safely, remain the standard of care.