An Overview of Telehealth and Paediatrics

Introduction

With pediatric telehealth, healthcare providers can reach a broad range of pediatric populations, including those with barriers such as physical location or limited resources. Pediatric telemedicine has grown over the past 10 years [1] and has been rapidly adopted by many countries during the COVID-19 pandemic set up. [2][3][4] The authors of a systematic review and meta-analysis[5] found that telemedicine delivered by allied health professionals and nurses was as effective as face-to-face meetings in rural and remote settings. However, practitioner acceptance of telemedicine is low. [5] Different devices are used for Pediatric telemedicine, including desktops, laptops, tablets and smartphones. [1]

Practitioners should understand that telehealth regulations are regularly updated, especially during the coronavirus pandemic. [6] “There is no clear decision or one-size-fits-all solution for telemedicine for pediatric services.” [6] Here is a practitioner’s It is the responsibility to be aware of local state or national regulations for physical therapy/physiotherapy in relation to telehealth. Healthcare practitioners should review the context/situation using clinical reasoning and consider ethics and personal preferences to determine whether Telemedicine will be available for each individual case. It is also important to check any regulations related to the scope of further training and practice for telehealth consultations. Make sure you comply with all laws related to patient privacy, such as GDPR and HIPAA. Medical Assistance/Insurance Companies have different payment structures or agreements for telehealth services that should be considered and discussed with families prior to making an appointment. Prepare all procedures for a telehealth consultation and make sure you have one Emergency situations. [6]

If you’re new to telehealth or would like to learn more about the basics, check out the following pages:

• Introduction to Telehealth
• Fundamentals of Telehealth Technology
• Practical Considerations in Telehealth

Barriers

Barriers to telemedicine for healthcare professionals include low interest due to lack of provider training resources to adequately train healthcare providers in the use of telemedicine. [1] Technical issues were considered less of an issue compared to vendor challenges. [1] Poor network Connectivity, insurance issues, liability uncertainty, inconsistent reimbursement, and negative attitudes or lack of willingness by healthcare professionals and clients to engage in telehealth are also barriers to telehealth. [5][7]

Telehealth is not for all clients. This is evidenced by the varying responses to telemedicine in various studies; participants may be satisfied or consider telemedicine to be acceptable, or dropout rates may be high.

There are also specific limitations when the intervention requires physical interaction. [5] Therapists also often believe that they cannot treat patients effectively if they cannot put their hands on them or take body measurements. In recent years, this belief has changed Technology allows therapists to take real-time measurements. [8]

Disorders specific to the pediatric population are also present compared with adults. Participants in a 2019 qualitative study suggested that children may dislike or be unable to concentrate during telemedicine sessions. [9] Participants also felt that communication via telemedicine may not As effective as face-to-face meetings can be, the quality of the relationship may be compromised, and telemedicine is ill-suited for an area of health that relies on physical contact. [9] Depending on the age of the child, parents may be required to conduct physical supervision or Facilitates instruction for learning and functioning on behalf of the therapist. This barrier can be overcome by educating parents to intervene. [5] Other potential barriers include concerns about privacy, parental consent, child consent, child welfare, and quality issues. [10]

Benefits

• Telemedicine connects children to different types or more diverse healthcare services that may not be available in the area where they live[11][12]
• Telemedicine can be used to replace or supplement face-to-face meetings [11]
• It allows healthcare services to be delivered at times and places that may not be readily available[11]
• Cost, resource and time effective[13]
• No weather conflicts or shipping costs[13]
• Reduce the need for family or healthcare personnel to travel long distances, especially when patients live in remote areas [14]
• No need to struggle finding child care for other children in the family [13]
• Immunocompromised children are not at risk of exposure to disease [13]
• Improves adherence to treatment, especially when both parents are required to work [13]
• Children may feel more comfortable playing with their own toys in their own environment[13]
• Treatment can continue even if the child or parent is unwell
• Telemedicine can also allow multiple children to participate in group therapy without the risk of cross-infection [12]
• Telemedicine can include gamification and social-based activities to increase physical activity through activity trackers [12]
• Multidisciplinary follow-up of patients
• Telemedicine gives the therapist the opportunity to observe and view the entire movement from the outside and take notes[15]

[16]

Uses of Telehealth in Paediatrics

• Monitoring children’s home use of asthma inhalers for compliance and technique [17]
• In children with cystic fibrosis, the therapist can monitor and facilitate airway clearance and the child’s physical activity [17]
• Hybrid model – includes virtual telehealth visits as well as in-person visits. This is a supplemental model where the therapist conducts regular video calls to make sure the child is being treated at home and that the technique is being performed correctly. This improves the [6]
• Children with neurological disorders, cerebral palsy, intellectual disability, and congenital syndromes [18] with developmental delay
• Pediatric orthopedics, including pre-operative and post-operative follow-up pre-treatment assessment [14]
• Monitoring and promoting physical activity in children with different conditions, eg: hemophilia
• Pediatric palliative care at home, providing patient management and care for the family [19]

Practicalities

[20]

Before the session

• Screening the right telemedicine patients is important. Telemedicine should be used only if it is a viable tool to improve patient outcomes. [21] You must be able to bring the same standard of care you would bring to a face-to-face meeting. [twenty two]
• Share your enrollment form with parents ahead of time so you have the necessary information about your child to help you plan the session and what you and the parents will need. [twenty two]
• Make sure you have other methods of contacting parents/carers if technology fails. [twenty two]
• It is important to consider when the parent/carer/advocate should be present during the telehealth consultation with the child. [twenty three]
• The therapist should have different toys to demonstrate what is needed, such as building blocks, bubbles, etc. Have music ready to grab your child’s attention or for a musical activity. [twenty four]
• Organize an orthopedic visit to a patient’s home to use an AFO or adaptive device, and you can even video call while they measure a child.
• Check in with family members a day or two before the meeting. Start by finding out what they want to do, or what part of the day works best for them. Sell the idea of parent coaching where parents are with their children for the rest of the week and should attend sessions. [15]
• Plan meeting times based on goals. Do you want to avoid nap times for feedings or medication, or do you specifically want to help with positioning etc during these times? [twenty two]
• Prepare a rough outline for your meeting. [twenty two]
• Prepare in advance what the family will need for the meeting, such as blocks, toys, blankets or which room to use. [15]
• Educate parents about developmental progress, then break down activities to achieve those developmental goals and explain to parents why you are doing it. [15]

Evaluation

• Utilize past medical history and subjective medical history. [twenty two]
• Screen patients for any red flags and refer if necessary. [twenty two]
• In telehealth it is difficult to apply standardized tests and measurements, so use your clinical observation skills. [twenty two]
• Invite parents to play spontaneously with their children for a few minutes and use this as an assessment. [twenty four]
• Assess the child through different functional movements and different postures, including transitions. [twenty two]
• Functional outcome measures to consider:
  • Alberta Infant Motor Scale (AIMS)
  • Hawaii Early Learning Profile (HELP)
  • Gross Motor Function Classification System (GMFCS)
  • Timed “wake up” for children (TUG-IC)
  • Timed Floor to Stand

During the session

• Be calm and confident.[22]
• Don’t overthink it – keep it simple. [twenty two]
• Rely on your observational skills as a physical therapist/physical therapist. [twenty two]
• Be a good communicator by telling parents what to expect and walking them through each step. This will prevent them from feeling overwhelmed. Explain the focus of the session and why exercising or moving can help achieve that goal. [twenty two]
• Allow time throughout the meeting to ask questions or concerns. [twenty two]
• Educate parents about their child’s level of conditional functioning performance. [twenty two]
• Empowering educates and trains parents to spend the rest of the week independent of therapy. [25]
• Train parents/caregivers in body mechanics to prevent physical injury. [twenty two]
• Spread a blanket or yoga mat on the patient’s floor so the child has a video “safe” area where they are in range of the camera and you can see them on the blanket. [22][24]
• Use props, such as chairs, so your child can stand up on their own or balance while standing. [25]
• Use dolls to show parents techniques or handling. [25] [22]
• Use the nook to sit on a corner sofa or against a wall for sitting exercises. [26]
• An assistant can be present with the patient (if permitted in your state or country) when manual techniques need to be performed. [8]
• Remember to instruct the parent or caregiver. Communicate effectively. Empowers families to offload tasks to everyday tasks, such as carrying arm weights during other activities. [twenty four]
• If the child is running around and needs a break, tell the parents that you will guide them on what to do next so they will be ready when the child is ready. [24] Parents may also need to take a break while you’re talking about education or wrap-up sessions. [twenty two]
• If the child keeps moving off the camera screen, you can ask the parent to move the device (if this is difficult) and ask the parent to describe the movement. You can also invite other siblings to join the meeting and get involved, which can sometimes help keep your child engaged. [twenty four]
• If you’re nervous and starting out with telehealth for the first time, you can start by observing their day-to-day activities and then play a game to see what it’s like. This will help you and your family get used to the concept of telehealth. You can even turn off the video and sound for 10 minutes and watch. Ask parents for their input on their experience and where they need more guidance. Give positive feedback before constructive feedback. [15]
• Provide families with a number of possible activities to choose from to achieve specific developmental goals. This will give parents and children the right to choose. Just asking what you want to do is helpful, but may be too broad for some parents. [15]
• Summarize what was done at the end of the session and just give them 1-2 home exercises. They will be more compliant if these exercises can become part of their daily routine. [twenty two]
• Create a moment of reflection at the end of the session so that you can find out what the child and parent/caregiver liked or disliked or would like to work on in the next session. [twenty two]

After the session

• You can supplement your telehealth sessions with video or handouts to support parents conducting at home. [25]
• Send a summary of what was covered during the meeting. [twenty four]
• Do self-reflection on the session.[22]

[27]

Additional Resources

• Recovery Essentials. Telehealth Education Spotlight: A Question and Answer Session on Pediatric Telehealth. May 2, 2020.
• Sweet Pea Pediatric Health. Getting Started with Telehealth (Live Video Visits) for Early Intervention Providers – Tips and Tricks. March 16, 2020.