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As the world continues living by the rules of COVID-19, stay-at-home orders remain in effect for many areas of the country. Even for places that have opened up somewhat, virtual contact still remains safer than in-person meetings. That goes for doctor’s appointments too.
Luckily, technology has evolved to the point where patients can “visit” their physicians via telehealth virtual visits—live, streaming, audio/video sessions between doctors and patients. And this service isn’t just for grownups: Parents can schedule telehealth appointments for children too.
But how should parents handle a kid’s virtual visit session? How would a virtual visit compare to a child’s in-person visit? And how should parents prepare their children for an exam over the internet?
Dr. Ambreen Syed, a Stanford Children’s Health pediatrician at Peninsula Pediatric Medical Group, Menlo Park, offers some advice below.
When telehealth is a child's best option
There are a few conditions that can be seen via telehealth. Depending on your child’s symptoms, it’s best to call your provider’s office to find out what can be seen in a telehealth session.
“If there’s some sort of behavioral concern—ADHD, school concerns, psychological issues—we’ll see the child on telehealth,” Syed says. “Or, if you brought the child in for a checkup and want to follow up, that’s a great reason for a telehealth visit.”
Rashes, too, can qualify for a virtual diagnosis. “Depending on the resolution and the WiFi connection, a lot of times rashes on video don’t come out as clear," Syed says. “But I usually ask parents to send me a photo ahead of time so I can see the rash in much better resolution before a video session with the patient.”
Seasonal allergies, lice . . . those are among other conditions that work for telehealth. What typically does not work well includes injuries, abdominal pain—pain in general, really. “A child, unlike an adult, can’t vocalize their pain very well, or their symptoms—they may not even be talking at that point,” Syed says. “So we rely heavily on our physical exam because they’re not able to really tell us in as much detail what they’re feeling, what it feels like, what triggers it.”
Preparing children for a telehealth session
“Whether you’re preparing your child for an in-person visit or a virtual visit, I think it’s good to talk to them ahead of time so they’re not caught off guard,” Syed says. “I tell parents to do some pretend play with them: If you have a little play phone, you can play doctor and patient so your child can become familiar with it.” Also, when possible, schedule your telehealth visit for a time where the child tends to be more receptive. That means avoiding naptimes and mealtimes so they’ll be a bit more relaxed and less cranky.
Telehealth sessions give parents the opportunity to talk to the doctor first. If both caregivers are there, one parent can talk and relay concerns while the other plays with the child. Then, toward the end, the parents can bring the child into the picture to be interviewed, to voice their own concerns, and for an exam.
The children aren’t the only ones needing prep. Parents should:
- Have a list of questions.
- Send a photo of anything you’ll want to bring to the doctor’s attention during the virtual visits.
- Make sure you’re in a private location—don’t broadcast from any location where others can hear you.
- Have nice, medium, natural light (not too bright—that may wash you out).
- Have a small flashlight on hand—the doctor may want to examine the inside of the child’s mouth or nose.
- Employ a wearable or any kind of device that can read the child’s heart rate, if you have one handy.
- Have a thermometer ready.
The technology: How to participate in a telehealth session
Many healthcare organizations have their own telehealth platform through the electronic medical record system they use. Stanford Children’s uses Epic, a portal through which patients can initiate virtual visits. “We like to start with our platform because that’s most compliant with patient safety and privacy,” Syed says. “But in this COVID era, we’re allowed to use other systems if we need to, so we can transition to a WebEx, Zoom, or FaceTime visit.”
Just make sure to check your WiFi connection along with your equipment before the visit: You can jump onto the portal and test your sound and video. (Instructions are provided beforehand).
The experience for children
“The most efficient virtual visits give parents time to discuss their concerns with doctors—and they can do all this while the child is playing in their play area,” Syed says. “Then, toward the end of the virtual visit, the child can come over and share their thoughts and we can do a physical exam. I feel like that’s a better experience for the child—they don’t have to sit in the exam room while the parents are talking; they’re in the comfort of their home and they’re on just for the physical exam part. Coming into the office, on the other hand, they’re waiting, they’re getting tired, they’re getting hungry.”
After the session is over, “I think it’s always good to go over it with the child,” Syed says. “Maybe ask, ‘How did you feel about that? Tell me if anything changes. Make sure to tell me if you feel anything new.’” Syed adds, it’s also good to review the plan with your child so they know what’s to come, such as prescriptions or referrals.
“I definitely think kids are really excited and engaged during these televisits,” Syed continues. “And they like that medium too. One of our doctors mentioned that children, because of their technological prowess, are much more engaged in front of a screen than in the office.”
Telehealth virtual visits is just one service offered for kids at Stanford Children’s Health. To learn more about telehealth virtual visits, click here.