By: S. David McSwain, MD, MPH, FAAP
While the American Academy of Pediatrics (AAP) believes the best place for children to receive medical care is at a pediatrician's office, telehealth services integrated into a child's medical home have many benefits.
What is Telehealth?
Telehealth is a tool that can help connect your child to many different types of healthcare services using various types of technology, such as live, interactive audio and video and special diagnostic tools. These services can be used in place of, or in addition to, a traditional face-to-face visit with a pediatrician or pediatric specialist.
Telehealth also provides healthcare services at times and places where children 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.
Frequently Asked Questions About Telehealth Services for Children:
While telehealth is a great tool to help children get the care they need, parents should understand what makes for a good telehealth service.
What makes a good telehealth service for children?
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.
Telehealth does NOT replace your pediatrician. Good telehealth services work WITH your pediatrician. Your pediatrician may be the one seeing your child using telehealth, or he or she may have referred your child for a telehealth service. But, no telehealth service can take the place of your pediatrician—your medical home—who truly knows your child.
The telehealth visit has to be SECURE and PRIVATE. When connecting with your provider, the connection must be secure. Both the patient and the telehealth provider should be in a private area, so that people who aren't supposed to be a part of the visit cannot see or hear anything that they shouldn't.
A responsible adult should be present with your child during the telehealth visit. Except in special situations where your child can legally consent to his or her own care, a responsible adult such as a parent, legal guardian, school nurse, pediatrician, or other healthcare provider should always be with your child during the telehealth service.
Telehealth providers should follow up with you AND your pediatrician. After the telehealth visit is over, the telehealth provider should send your pediatrician information about the visit, including any necessary follow-up. If you are unsure whether the telehealth provider has your pediatrician's fax number or other contact information, you should have that information available and request that documentation about the visit be sent promptly to your pediatrician.
The tools used should work for children. Some telehealth services use special cameras and other devices, like blood pressure cuffs, stethoscopes, and pulse oximeters, to help examine your child. These tools should be the correct size for your child and should be proven effective for examining children.
Telehealth providers should perform needed tests and examinations. Many telehealth tools are available to allow for a detailed examination of your child from a distance. These tools, such as otoscopes to look in your child's ear, blood pressure cuffs, and pulse oximeters, can be used in a variety of settings—including the home—but their appropriate use requires training and practice.
Before a telehealth provider who has never examined your child before gives your child antibiotics for an ear infection, he or she should use an otoscope to look in your child's ear—just as the provider would in an in-person visit.
Before the telehealth provider treats your child for a urinary tract infection, your child's urine should be tested—as it would be in person.
Using telehealth is not an excuse for not doing all the right tests and examinations before treatment.
AAP-endorsed Operating Procedures for Pediatric Telehealth for more information.
Telehealth providers should have clear guidance on when a virtual visit should be converted to a face-to-face visit. Sometimes a telehealth provider may determine that your child needs a more thorough examination, or is too sick to be cared for through telehealth, after the telehealth visit has already started. In that case, telehealth providers 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?
Always talk to your pediatrician about any telehealth service you use. If the interaction is only through telephone, your first phone call should be to your pediatrician's office, or during off hours, to their on-call service.
See the AAP policy statement,
Nonemergency Acute Care: When It's Not the Medical Home, for more information.
Make sure you get information about how the telehealth visit works before it happens. Except in certain emergencies, the telehealth provider should get your consent for the telehealth service before the visit.
Be very careful about using a smartphone or mobile device for telehealth. These devices can be lost or stolen, and keeping private health information secure is harder.
Talk to your pediatrician about any prescriptions that you get through telehealth, to make sure the medication is appropriate, necessary, and safe for your child.
What do I need to know about my child's telehealth provider?
If you don't already know the telehealth provider, the next best thing is to be referred or presented for a telehealth service by a healthcare provider who already knows your child. This helps to make sure your whole
healthcare team is working together!
Here's the information that you should have about a telehealth provider BEFORE the telehealth visit:
What is his or her specialty? Is he or she board certified in that specialty? Is he or she certified to care for children?
Where is the provider located? Is he or she in your town or your state? Is he or she in another country? Is the provider licensed to care for your child in your state?
What is his or her contact information? How can you or your pediatrician reach the telehealth provider after the visit for follow-up and/or questions?
Telehealth providers should freely provide you with this information prior to the visit and make it easy to find on their website.
Have More Questions?
If you have any questions about appropriate care for your child, please discuss them with your pediatrician (your medical home) and/or with the examining provider.
Note: The AAP does not recommend retail-based clinics, telehealth services outside of the medical home, or acute care services without pediatric expertise for children younger than 2 years.
Urgent Care: Is It Worth the No Wait? for more information.
Additional Information & Resources:
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).