THE VIRTUAL DOCTOR IS IN

HOUSE CALL Make the most of your pediatric telemedicine visit.

By Dina El Nabli

As the COVID-19 pandemic has pushed most of us to work from home, much of what we do—from learning to gathering with family—has gone virtual. While hospitals struggle to keep up with coronavirus cases and New Jersey’s stay-at-home orders continue in an effort to prevent the virus from spreading, your child’s non-urgent doctor’s visits have also gone virtual.

“COVID-19 has rapidly made telemedicine an essential element of care delivery,” says Marnie Dardanello, MD, chair of the Department of Pediatrics at Summit Medical Group. “Even in the midst of the pandemic, pediatric providers are available for patients by several telemedicine options, including telephone check-in and virtual video visit.”

IN-PERSON VS. VIRTUAL

How do you determine whether your child needs to be seen in person? Start with a video visit and if that leads to a same day office visit, the telemedicine visit is not charged, Dardanello says. Serious symptoms or a need to be immunized are two examples of visits that need to happen in person, says Andy Anderson, MD, president and CEO of RWJBarnabas Health Medical Group.

“Depending on the presence of any underlying conditions and the severity and type of symptoms (such as difficulty breathing or confusion are more concerning), the provider will make the decision on whether an in-person or telemedicine visit is the most appropriate care,” Anderson says. “We also want to ensure our children and adolescents are staying up-to-date with vaccinations, so that is an example of a patient who we would bring to the office site.”

Be prepared to list your child’s symptoms in detail. “For example, if your throat hurts, can you look in the mirror and see if your tonsils are enlarged or if there are white spots that can be seen?” Anderson says. “If you have stomach pain, the doctor may ask you to press on certain areas of your belly and describe the feeling.”

Dardanello says pediatricians are having a lot of success with virtual appointments “including those for rashes, pink eye, motor tic, stomach issues such as constipation, fever in older children, allergy symptoms, and cough,” Dardanello says. “Behavioral concerns such as toilet training questions, ADHD concerns or mental health concerns with stress and anxiety related to remote schooling and isolation have also been addressed. For the teenagers, virtual visits are a wonderful way to connect to discuss any physical or mental health complaint.”

Most practices are putting off well visits for now, except for newborn care. Questions about immunizations should be directed to your child’s pediatrician. The good news is that telemedicine visits are covered by insurance and most plans are waiving copays for telemedicine visits during the pandemic, Dardanello says.

Dardanello shared these tips to help you prepare for your

child’s virtual visit: Pick a time that works for your child. For a younger child, in the morning after breakfast might be best. For a schoolage child, after the remote school day may be ideal. Find a quiet spot away from other distractions to sit for the visits, preferably a spot with a good wireless connection. Clothing should be comfortable and loose in case it needs to be moved or removed for the exam. Have a pen and paper to review questions and take notes. Make sure you have a flashlight handy, which can help for examining the eyes, mouth, skin. Having a favorite doll or stuffed animal at hand can help younger kids feel more comfortable.

HOW TO HANDLE EMERGENCIES

A video visit with your child’s pediatrician will determine whether your child’s illness or injury is serious enough to require a trip to a comprehensive urgent care facility or a hospital emergency room. “Many parents may be hesitant to seek emergency care at a hospital during the pandemic, but emergency departments that treat children are prepared to

treat illness and injury in a safe manner,” Dardanello says.

If you or a member of your family has symptoms of COVID-19, call your doctor who will then follow screening guidelines. “If you experience any of the emergency warning signs of COVID-19, including difficulty breathing, persistent pain or pressure in the chest, confusion, bluish lips/face and/ or difficulty waking up, call 911 and advise medical personnel you are experiencing symptoms of and/or have been exposed to COVID-19,” Anderson says.

After assessing whether the patient has a temperature, cough or shortness of breath and/or other respiratory symptoms and whether he or she has been in contact with someone who has tested positive for COVID-19 in the last 14 days, a doctor will decide if a COVID-19 test should be administered. “There will also be a discussion about any pre-existing conditions the individual may have and the doctor will observe the patient to take note of his or her rate of respiration and if he or she can carry on a conversation without becoming short of breath,” Anderson says.

For an updated list of COVID-19 symptoms, a self-checker and the latest guidance, go to cdc.gov/coronavirus.