Children's Health Online: When Your Child Needs a Telehealth Doctor

Not every childhood illness requires a hands-on examination. Many of the conditions that parents most frequently bring to a GP can be effectively assessed and managed through a kids telehealth consultation, particularly when parents can describe symptoms clearly and, where relevant, show the affected area on camera.

Ear infections

Middle ear infections (otitis media) are one of the most common childhood illnesses. The Raising Children Network notes that around 75 per cent of children will have at least one ear infection before the age of three. While a GP cannot look inside a child's ear through a screen, the history is often highly informative. A child pulling at their ear, irritability, fever, recent cold symptoms, and disrupted sleep together paint a clear clinical picture. A GP can advise on pain management, whether antibiotics are likely to be needed, and what signs to watch for that would warrant an in-person examination.

Rashes and skin conditions

Many childhood rashes can be assessed visually through a high-quality video consultation. Conditions such as eczema flare-ups, nappy rash, mild impetigo, hives, and viral rashes (like roseola or hand, foot and mouth disease) often present with characteristic patterns that a GP can identify on screen. Parents can be asked to show the rash under good lighting and describe whether it is raised, itchy, spreading, or accompanied by other symptoms. Healthdirect Australia notes that most childhood rashes are not serious, but a GP can help distinguish between those that need treatment and those that will resolve on their own.

Cold, flu, and upper respiratory infections

Coughs, runny noses, sore throats, and fevers are the bread and butter of childhood illness. For most viral upper respiratory infections, the management is supportive: rest, fluids, and age-appropriate pain relief. A telehealth consultation allows a GP to assess the severity of symptoms, rule out red flags, advise on home management, and prescribe medication if clinically appropriate. The GP can also help parents understand when symptoms suggest something more than a simple cold, such as croup, bronchiolitis, or a secondary bacterial infection.

Behavioural and developmental concerns

Parents who have questions or concerns about a child's behaviour, mood, sleep patterns, or developmental milestones can raise these with a GP through telehealth. While a comprehensive developmental assessment may require in-person evaluation, an initial conversation with a GP is an important first step. The GP can take a history, discuss observations, and arrange referrals to paediatricians, psychologists, or allied health professionals as needed. For families in areas where specialist access is limited, this initial telehealth step can significantly speed up the pathway to appropriate support.

Medication reviews

Children with ongoing conditions such as asthma, ADHD, allergies, or eczema often require regular medication reviews. These consultations typically involve discussing how the child is responding to treatment, whether symptoms are well controlled, and whether any adjustments are needed. A telehealth appointment is well suited to this type of review, saving families a trip to the clinic while ensuring the child's care plan stays current.

Allergies

Allergic rhinitis (hay fever), food allergy management, and allergic skin reactions are common in Australian children. The Australasian Society of Clinical Immunology and Allergy reports that around one in ten children has a food allergy. While acute allergic reactions require immediate in-person or emergency care, ongoing allergy management, discussion of allergy action plans, and referrals for allergy testing can all be handled effectively through telehealth.

For parents who have not used telehealth for their child before, knowing what to expect can make the experience smoother and more productive.

Before the appointment

It helps to prepare a few things in advance:

• Write down the symptoms. Note when symptoms started, how they have changed, and anything that seems to make them better or worse.
• Have the child nearby. The GP may want to see the child on camera, particularly for rashes, swelling, or other visible symptoms.
• Gather relevant items. If the child is on medication, have the packaging nearby. If there is a rash, make sure the area can be shown on camera under good lighting.
• Check the technology. Ensure the device has a working camera and microphone, and that the internet connection is stable. A quiet room helps the GP hear clearly, especially if they need to listen to the child's breathing.

During the consultation

The GP will ask questions about the child's symptoms, medical history, and any relevant family history. For younger children, the parent will do most of the talking. For older children and teenagers, the GP may speak directly with the child as well, which can be an important part of building rapport and understanding the concern from the child's perspective.

If the GP needs to see a physical symptom, they may ask the parent to hold the child up to the camera or adjust the lighting. For some presentations, the GP may ask the parent to perform simple checks at home, such as taking the child's temperature, checking for a stiff neck, or pressing on a rash to see if it blanches (fades with pressure).

After the consultation

Depending on the assessment, the GP may:

• Provide advice on home management and what to watch for
• Send an electronic prescription to the parent's phone or email
• Arrange a pathology request or referral for further investigation
• Recommend an in-person follow-up if a physical examination is needed
• Schedule a follow-up telehealth appointment to check progress

The consultation is documented in the patient's medical record, just as it would be for an in-person visit. This means that if the child needs to be seen again, the next GP has access to the full history of what was discussed and recommended.

Telehealth is a powerful tool for paediatric care, but it has clear limits. Some situations require a hands-on physical examination, diagnostic equipment, or emergency intervention that cannot be delivered through a screen. Being honest about these boundaries is an important part of responsible healthcare.

Red flags that require in-person or emergency care

The following signs and symptoms in children should prompt immediate in-person medical attention or a call to 000:

• Difficulty breathing. Rapid breathing, nostrils flaring, chest drawing in with each breath, or lips or skin turning blue are all signs that a child needs urgent assessment. The Royal Children's Hospital Melbourne advises that any child with significant breathing difficulty should be seen in an emergency department.
• High fever in a baby under three months. A temperature of 38 degrees Celsius or above in a baby under three months old is considered a medical emergency and requires immediate in-person assessment, regardless of how well the baby appears.
• Non-blanching rash. A rash that does not fade when pressed with a glass (the "glass test") can be a sign of meningococcal disease or other serious infection. This is a medical emergency.
• Severe dehydration. Signs include sunken eyes, dry mouth, no tears when crying, significantly reduced wet nappies (in infants), and lethargy. Severe dehydration in children can deteriorate quickly.
• Seizures or loss of consciousness. Any seizure in a child, or any episode of unresponsiveness, requires immediate emergency care.
• Severe abdominal pain. Particularly if persistent, worsening, or accompanied by vomiting, fever, or blood in the stool.
• Head injuries. Especially in infants, or any head injury followed by vomiting, drowsiness, confusion, or unusual behaviour.
• Ingestion of a potentially harmful substance. If a child has swallowed medication, a household chemical, or a button battery, call the Poisons Information Centre (13 11 26) or 000 immediately.

Examinations that require physical presence

Some clinical assessments simply cannot be done through a screen. These include:

• Examining the inner ear with an otoscope (for confirming ear infections)
• Listening to the chest with a stethoscope (for suspected pneumonia or wheezing)
• Palpating the abdomen (for abdominal pain assessment)
• Checking joint range of motion (for musculoskeletal injuries)
• Performing growth and developmental assessments that require standardised tools

A good GP will always be transparent about when telehealth is sufficient and when in-person care is the safer option. If a telehealth consultation reveals the need for physical examination, the GP will advise the family on the most appropriate next step.