By: S. David McSwain, MD, MPH, FAAP
The American Academy of Pediatrics (AAP) believes the best place for children to receive medical care is at a pediatrician's office. Telehealth services or "virtual visits" with your pediatrician and pediatric specialists may be an option to make sure your child continues to get the care they need. Especially during the COVID-19 pandemic, when you are staying home and straying from regular routines, seeing your pediatrician is essential to keep up good physical and mental health.
Here are some common questions parents may have about telehealth, and tips on working with your pediatrician to make sure your child receives the best care.
What is telehealth?
Telehealth is a tool with many benefits that can help connect your child to many different types of health care services. It may use various technologies such as live, interactive audio and video, and special diagnostic tools. These services can be used in addition to in-person visits with a pediatrician or pediatric specialist.
Telehealth can provide health care services at times and places where families and caregivers may not usually be able to get those services. For example, pediatric specialists practicing in large cities can use telehealth to see children who live hundreds of miles away in small community emergency departments. Some pediatricians can also examine your child through your home computer or a computer in your child's school or child-care setting.
What makes a good telehealth service for children?
Families and caregivers should understand what makes for a good telehealth service when deciding if it is right for their child. For example:
Telehealth should not replace your pediatrician. Good telehealth services work WITH your pediatrician. Your pediatrician may be the one seeing your child using telehealth, or they may have referred your child for a telehealth service with a pediatric specialist. But no telehealth service can take the place of your pediatrician—your medical home—who truly knows your child.
Telehealth providers should be trained to treat children. Children are not small adults. Telehealth providers should have the experience and training needed to know how to safely and correctly diagnose and treat your child's condition. It is a good idea to start with your pediatrician's office, where they are already familiar with your child and can easily review their health records.
The telehealth visit should be secure and private. When connecting with your pediatrician and pediatric specialist, the connection must be secure. Both the patient and the provider seeing your child should be in as private an area as possible so that people who aren't supposed to be a part of the visit cannot see or hear it.
An adult should be present during the telehealth visit. Except in special situations when your child can legally consent to their own care, a responsible adult such as a parent, caregiver, school nurse, pediatrician, or other health care provider should be with your child during the telehealth service. During visits with adolescents or young adults, though, it is still a good idea to step out of the room when the doctor suggests so your child can practice taking more responsibility for their health care.
Telehealth providers should follow up with you AND your pediatrician. If the visit was with someone other than your pediatrician, the telehealth provider should send the pediatrician information about the visit. This includes any necessary follow-up. If you're not sure the telehealth provider has your pediatrician's contact information, have that information handy and request that a record of the visit be sent promptly.
Telehealth tools should work well for children. Some telehealth visits involve special cameras and other devices, like blood pressure cuffs, stethoscopes, and pulse oximeters. These allow a detailed examination of your child from a variety of settings--including the home—with proper training and practice. These tools should be shown to work for children and be the correct size. Talk with your pediatrician about these tools, if they will be needed, and how they will get them to your home.
Telehealth care should include needed tests and examinations. Before a provider prescribes medications or other treatments, needed tests and exams should take place. For example, a provider who has never examined your child before will need to use an otoscope to look in your child's ear before prescribing antibiotics for an ear infection—just as would happen during an in-person visit. Likewise, before a telehealth provider provides treatment for a urinary tract infection, your child should get a urine test.
The providers should know when to convert virtual services to face-to-face visits. Sometimes during a virtual visit, your pediatrician or pediatric specialist may determine you're your child needs a more thorough examination. Or, after the telehealth service has started, it may become clear that your child is too sick to be cared for through telehealth. In these cases, your provider should know when and how to refer your child to the most appropriate healthcare facility.
How can I make sure I'm using telehealth wisely for my child?
Call your pediatrician first. Check with your pediatrician's office to ask if a telehealth visit is an option. Even if it's late at night, on a weekend or a holiday, someone will answer your call. They can advise you when you can visit with the pediatrician or can guide you to other services if they are not available.
Get information on how the visit will work before it happens. Except in certain emergencies, the telehealth provider should get your consent for the telehealth service before the visit.
Check with your pediatrician about the telehealth software and app, which must comply with privacy laws. Take care using smartphone or mobile device for telehealth. These devices can be lost or stolen, so keeping private health information secure takes extra attention.
Talk to your pediatrician about any prescriptions received through telehealth to make sure the medication is appropriate, necessary, and safe for your child.
What if my pediatrician's office doesn't offer telehealth services?
The next best thing is to be referred to a telehealth service by your pediatrician, who already knows your child. This helps to make sure your whole
healthcare team is working together!
What do I need to know about my child's telehealth provider?
Here's some information you should have about a telehealth provider before the telehealth visit:
What is their specialty? Are they board certified in that specialty? Are they certified to care for children?
Where is the provider located? Are they in your town or your state? Are they in another country? Are they licensed to care for your child in your state?
What is their contact information? How can you or your pediatrician reach the telehealth provider after the visit for follow-up and questions?
Telehealth providers should freely provide you with this information before the visit and make it easy to find on their website.
If you have any questions about telehealth care for your child, talk with your pediatrician.
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About Dr. McSwain
S. David McSwain, MD, MPH, FAAP, is an Associate Professor of Pediatric Critical Care Medicine and Medical Director of Telehealth Optimization at the Medical University of South Carolina (MUSC) in Charleston, SC. Within the American Academy of Pediatrics (AAP), he is a member of the Section on Telehealth Care Executive Committee, the Section on Advances in Therapeutics and Technology, and the Section on Critical Care. Dr. McSwain is also Chair of the ATA Pediatric Special Interest Group Section on Best Practices and Guidelines and a founder of the SPROUT (Supporting Pediatric Research on Outcomes and Utilization of Telehealth) national pediatric telehealth research collaborative. He previously chaired the American Telemedicine Association (ATA) national workgroup that created the ATA Pediatric Telehealth Operating Procedures, which have been endorsed by the AAP, American Association of Respiratory Care (AARC), and the National Nurse Practitioners Association (NAPNAP).