Because of the pandemic, many developmental pediatricians opted to provide online consultation or telemedicine to their patients. If you’re a parent or a caregiver who would like to know whether telemedicine will be right for your child and your family, read this guide so you’ll understand how this can be an option for you. 

This World Health Organization defines Telemedicine as the “delivery of health care services, where distance is a critical factor, by all health care professionals using information and communication technologies for the exchange of valid information for the diagnosis, treatment, and prevention of disease and injuries, research and evaluation, and for the continuing education of health care providers, all in the interests of advancing the health of individuals and their communities”. Telemedicine is a great way for developmental pediatricians to continue supporting their patients during the pandemic. 

What innovations had to be done to provide teleconsultation?

Since telemedicine provides remote clinical services, pediatricians have to innovate different approaches when it comes to diagnostics and providing therapy to their patients. Here are some of the innovations that developmental pediatricians have to do:

1. Improvisations using materials that patients have at home.

In a face-to-face consultation, pediatricians have really big developmental assessment kits with standardized materials available in their clinics. But with telemedicine, they learned to improvise using the materials that patients have at home, instead of using their developmental kits. Since many of the assessment tools that pediatricians use released guidelines, we can be assured that the evaluations can still be as standardized as possible. 

Furthermore, pediatricians have now started using some tests that are specifically designed for telemedicine. For example, for young kids who are suspected to be on the autism spectrum, there’s the TELE-PEDS-ASD, which is an observation tool that is really designed for use in a telemedicine session. 

2. More parental involvement in the assessment process.

Since the assessment process takes place at home, parents are the ones administering many of the tasks. Because of this, parents become very much involved in the process and even in the whole course of their child’s therapy. 

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3. Addition of an asynchronous portion of the evaluation. 

Many developmental pediatricians have now added an asynchronous portion of the evaluation. For example, before the consult, they can ask parents to send a short video of their child playing or talking. Or ask them to complete some of the screening tools. This gives the pediatricians a more comprehensive picture of the child’s development. 

Afterward, some patients, especially those who need a multidisciplinary team, would use Viber or Telegram groups, or even Slack channels.

What are the challenges of using telemedicine?

With telemedicine, healthcare providers and patients are also facing many challenges. Some of the challenges of using telemedicine are the following:

1. Adjustment to a new platform.

At the start, everyone is adjusting to a whole new platform. For pediatricians, choosing the right tech for scheduling, consultation, and sharing of materials has been a real challenge. 

2. Loss of whole-body physical cues.

One of the biggest challenges in telemedicine is the loss of whole-body physical cues since most of the nonverbal cues get lost over Zoom. If you are a parent whose kid is doing online classes, and you see how tiring it is for your kids, it’s basically the same with telemedicine. Pediatricians need to work harder to process the nonverbal cues, especially the body language and eye contact. 

loss of body cues telemedicine in developmental pediatrics telemedicine challenges

This also becomes a challenge especially in disclosing a diagnosis. It’s already hard enough to tell someone their child has autism. Now try doing that – over Zoom! Pediatricians try really hard to make sure it doesn’t sound so impersonal. For some, it becomes difficult if it’s someone they have never seen in person, compared to someone who’s been their patient before. 

3. Technical difficulties.

Because of unreliable internet connection in some areas in our country, technical difficulties are unavoidable. Oftentimes, during a Zoom consultation, a parent or healthcare provider might get disconnected many times, which results in the child getting tired or cranky. That’s why the asynchronous portion is really important. 

4. Lack of access to technology. 

It is recommended that platforms like Zoom should be used during telemedicine consultations. However, not all patients or their families have access to technologies like this. 

What are the opportunities in using telemedicine?

Telemedicine offers many opportunities that’s why a lot of developmental pediatricians are utilizing this, especially during the pandemic. Here are some of the opportunities in using telemedicine:

1. Safe interaction without PPE. 

In which setting do we lose more physical cues? Is it over telemedicine? Or face-to-face consultation, but you’re wearing a mask and PPE? Those who have done face-to-face consultations have observed that many of their patients get upset because they’re wearing a mask. Even their long-time patients don’t recognize them.

With telemedicine, pediatricians can now interact safely without having to don PPE. There may be a barrier to the screen, but at least they’re not covering half of their face. 

2. Home observations.

The second big opportunity is being able to do observations at home, where the patient is more comfortable. For example, the pediatrician noted that the child isn’t talking. The parent feels frustrated because they know that the child can talk at home, but maybe got intimidated by the hospital setting. Telemedicine will help take away the confounding factor, so in many ways, it will help developmental pediatricians get more accurate results. 

3. Inclusion of underserved areas.

Because of telemedicine, developmental pediatricians are now able to include what were underserved areas before. More patients are being seen from provinces with no practicing developmental pediatrician.

What are the characteristics of patients who can be seen by telemedicine?

Everyone can benefit from telemedicine. But not every patient can be catered to by telemedicine. These are the characteristics of patients that can be seen by telemedicine:

1. Medically stable.

As long as the patient is medically stable and is not in an emergency situation, they can avail of the telemedicine. That’s why this is very suitable for developmental pediatricians.

2. With access to video call technology. 

It’s important for patients to have access to video call technology so that the pediatrician will be able to really see their patients and observe their behaviors. 

3. Within the scope of practice as physicians licensed in the Philippines.

There’s an excellent discussion of this in the PPS telemedicine manual. The PPS telemedicine manual is very comprehensive and really walks us through the process of doing telemedicine consult in pediatrics, from what to prepare beforehand, to the actual conduct of the consultation.

Filipino licensed physicians may practice telemedicine beyond national jurisdictional borders subject to applicable laws and regulations of the country of residence of the telemedicine patient-client. In addition, overseas-based Filipino licensed physicians may continue to cater to Philippine-based patients, regardless of other licenses that they possess, provided that they have retained their Philippine citizenship to similarly retain their PRC licenses. 

4. The parent has to be willing to make the effort.

The parent or the caregiver has to be reliable and willing to make the effort and be involved in the process. If your doctor gave you instructions on what toys and materials to prepare, go ahead and prepare them. If you have other kids besides the patient, arrange for someone to look after them so that there are no distractions during the consultation. Most parents actually appreciate and enjoy it if they are involved in the process. 

parent's willingness to make effort during telemedicine

Also – this is really important- gather together those you think will be important decision-makers in your child’s care. It will be much easier to explain the process if everyone is present. 

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Remember that WILLINGNESS is the key for telemedicine to work. Parents and caregivers have to be willing to do what needs to be done for their patients. It has been proven to work even for patients who’ve never had a chance to be seen by a developmental pediatrician before, or those living in areas where technology is difficult. If a parent has the willingness, they will find a way to make telemedicine work. 

What are the positive outcomes of telemedicine?

Telemedicine is a wonderful opportunity to serve patients with developmental disabilities. Whether during the pandemic or even after, telemedicine will be a big part of how these patients are taken care of. 

For developmental pediatricians, it would be wise to include developmental surveillance and screening during telemedicine consultations.

For parents and caregivers, you have learned in this guide that telemedicine is helpful and effective.

So we would like to emphasize this: Do not wait until the pandemic is over before getting a consultation or intervention. We don’t want to miss this window of opportunity to help your child. If you need help at this time, telemedicine is a great way for you to get the support that you need.

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