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Telemedicine modalities, such as videoconferencing, are used by health care providers to remotely deliver health care to patients. Telemedicine use in pediatrics has increased in recent years. This has resulted in improved health care access, optimized disease management, progress in the monitoring of health conditions, and fewer exposures to patients with illnesses during pandemics (eg, the COVID-19 pandemic).
We aimed to systematically evaluate the most recent evidence on the feasibility and accessibility of telemedicine services, patients’ and care providers’ satisfaction with these services, and treatment outcomes related to telemedicine service use among pediatric populations with different health conditions.
Studies were obtained from the PubMed database on May 10, 2020. We followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. In this review, we included randomized controlled trials from the last 10 years that used a telemedicine approach as a study intervention or assessed telemedicine as a subspecialty of pediatric care. Titles and abstracts were independently screened based on the eligibility criteria. Afterward, full texts were retrieved and independently screened based on the eligibility criteria. A standardized form was used to extract the following data: publication title, first author’s name, publication year, participants’ characteristics, study design, the technology-based approach that was used, intervention characteristics, study goals, and study findings.
In total, 11 articles met the inclusion criteria and were included in this review. All studies were categorized as randomized controlled trials (8/11, 73%) or cluster randomized trials (3/11, 27%). The number of participants in each study ranged from 22 to 400. The health conditions that were assessed included obesity (3/11, 27%), asthma (2/11, 18%), mental health conditions (1/11, 9%), otitis media (1/11, 9%), skin conditions (1/11, 9%), type 1 diabetes (1/11, 9%), attention deficit hyperactivity disorder (1/11, 9%), and cystic fibrosis–related pancreatic insufficiency (1/11). The telemedicine approaches that were used included patient and doctor videoconferencing visits (5/11, 45%), smartphone-based interventions (3/11, 27%), telephone counseling (2/11, 18%), and telemedicine-based screening visits (1/11, 9%). The telemedicine interventions in all included studies resulted in outcomes that were comparable to or better than the outcomes of control groups. These outcomes were related to symptom management, quality of life, satisfaction, medication adherence, visit completion rates, and disease progression.
Although more research is needed, the evidence from this review suggests that telemedicine services for the general public and pediatric care are comparable to or better than in-person services. Patients, health care professionals, and caregivers may benefit from using both telemedicine services and traditional, in-person health care services. To maximize the potential of telemedicine, future research should focus on improving patients’ access to care, increasing the cost-effectiveness of telemedicine services, and eliminating barriers to telemedicine use.
Telemedicine is a broad term that describes the use of technology in health services for patients and families [
Due to the many benefits that telemedicine encounters can provide to patients and physicians, telemedicine services have been used more frequently in recent years [
The future uses of telemedicine technology may include remote patient monitoring, triage, and the implementation of telemedicine services in rural settings or low-income countries [
The unique challenges resulting from the COVID-19 pandemic, limited accessibility of pediatric health care in rural areas, management of childhood chronic illnesses, lack of pediatric specialists (ie, compared to the number adult care specialists), and difficulties in traveling with children have highlighted the usefulness and importance of telemedicine modalities for the pediatric population [
We followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to report on evidence from the studies that were included in this systematic review [
Original randomized controlled trials that were published after 2010 and used telemedicine modalities for different pediatric populations were eligible for this review. No restrictions were placed on the language, condition, setting, or country of a trial. The inclusion criteria included original research papers, randomized controlled trials, pediatric populations (ie, general pediatric care or a subspecialty of pediatric care), and a focus on telemedicine as a study intervention. This review was limited to randomized controlled trials so that we could assess studies with the highest quality of evidence. In order to focus on recent telemedicine advances and the current uses of telemedicine technology, eligible studies were limited to those that were published within the last 10 years.
A standardized form was used for data extraction. The data items in this form included the following: publication title, first author’s name, publication year, participants’ characteristics, study design, the technology-based approach that was used, intervention characteristics, study goals, and main study findings. Synthesized data were qualitatively analyzed. ACS conducted the data extraction and SMB conducted a review of the final data.
The quality of evidence from the studies that were analyzed in this review was independently evaluated by using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach [
We conducted a literature search on the PubMed database on May 2020, and this initial literature search yielded a total of 149 references. The “randomized control trial” and “past ten years” filters were applied to all four searches. After excluding duplicates, 74 references remained. The titles and abstracts of all 74 articles were screened, and of these 74 articles, 20 met all the predefined inclusion criteria. Full texts were retrieved from these 20 articles. Afterward, 9 articles were excluded. A total of 11 articles were included in this review [
Flow diagram of the study inclusion and exclusion process.
The characteristics of all included studies are reported in
Characteristics of participants in all included studies.
Source (year, country) | Number of participants | Mean age of participants | Female participants, % |
Cocker et al (2019, United States) [ |
Total: 342 Control: 178 Intervention: 164 |
8.6 years | 38.3 |
Erkkola-Anttinen et al (2019, Finland) [ |
Total: 41 Immediate group: 20 Delayed group: 21 |
21 monthsa | 42 |
Perry et al (2018, United States) [ |
Total: 363 Control group: 183 Intervention group: 180 |
9.6 yearsa | 44 |
Halterman et al (2018, United States) [ |
Total: 400 Control group: 200 Intervention group: 200 |
7.8 years | 38.25 |
O’Connor et al (2017, United States) [ |
Total: 40 Control group: 20 Intervention group: 20 |
6.96 years | 55 |
Di Bartolo et al (2017, Italy) [ |
Total: 182 Control group: 90 Intervention group: 92 |
17.7 years | 48.9 |
Fleischman et al (2016, United States) [ |
Beginning of study: Total: 40 Control group: 21 Intervention group: 19 Total: 33 Control group: 19 Intervention group: 14 |
14.3 years | 77.5 |
Rhodes et al (2017, United States) [ |
Total: 22 Low GLb group: 11 Low-fat group: 11 |
Low GL group: 8.1 years |
Low GL group: 54.5 |
Stoep et al (2017, United States) [ |
Total: 223 Control group: 112 Intervention group: 111 |
9.23 years | 29.9 |
Davis et al (2016, United States) [ |
Total: 103 Control group: 61 Intervention group: 42 |
9.14 years | 55.34 |
Powers et al (2015, United States) [ |
Total: 78 Control group: 42 Intervention group: 36 |
3.8 years | 43 |
aMedian used instead of mean.
bGL: glycemic load.
Summary of study characteristics and the quality of evidence from all included studies.
Source (year, country) | Health condition | Study design | Telemedicine approach | Outcome measures | Follow-up period | Quality of evidencea |
Cocker et al |
Mental health | Cluster RCTb | Video orientations and videoconferencing screening visits with a mental health clinic |
Primary: completion of screening visit Secondary: time from referral to screening visit and completion of intake visit |
6 months | Low |
Erkkola-Anttinen et al (2019, Finland) [ |
Otitis media | RCT | At-home otoscopy videos via smartphone |
Primary: exclusion of otitis media Secondary: diagnostic quality of videos and effects of teaching interventions |
60 days | Moderate |
Perry et al (2018, United States) [ |
Asthma | Cluster RCT | Asthma education and monitoring via a telemedicine approach |
Primary: number of symptom-free days Secondary: peak flow meter use, medication adherence, quality of life, self-efficacy, lung function, and asthma knowledge |
6 months | Low |
Halterman et al (2018, United States) [ |
Asthma | RCT | School-based telemedicine visits |
Primary: number of symptom-free days Secondary: number of days with symptoms, use of rescue medication, and number of days with limited activity |
7-9 months for intervention and up to 5 years after enrollment | Moderate |
O’Connor et al (2017, United States) [ |
Skin condition | RCT | Parents used a smartphone to photograph their child’s skin condition for direct patient-to-physician telemedicine. |
Primary: Concordance between in-person and photograph-based diagnoses Secondary: parents’ willingness, image quality, and effect of photograph instructions |
None | Low |
Di Bartolo et al (2017, Italy) [ |
Type 1 diabetes | RCT | Glucose meters were able to sync with a phone app, which can directly send information to health care workers. Patients were able to contact physicians via email, SMS text messaging, or telephone. |
Primary: changes in hemoglobin A1c levels Secondary: number of patients who self-monitored their blood glucose levels and patients’ quality of life |
12 months | Moderate |
Fleischman et al (2016, United States) [ |
Obesity | RCT | Televisits with obesity specialists and teleconsults between physicians and specialists |
Primary: changes in BMI Secondary: waist circumference, triceps skinfold, blood pressure, dietary glycemic load, and physical activity |
12 months | Low |
Rhodes et al (2017, United States) [ |
Obesity | RCT | Dietary counseling via telephone |
Primary: changes in glycemic load and total number of calories in fat Secondary: total energy intake |
12 months | Moderate |
Stoep et al (2017, United States) [ |
Attention deficit hyperactivity disorder | RCT | Telepsychiatry sessions via video counseling |
Primary: changes in distress, as measured by a variety of questionnaires Secondary: patient health, caregiver strain, parenting stress, and family empowerment |
25 weeks | Moderate |
Davis et al (2016, United States) [ |
Obesity | Cluster RCT | Physicians delivered behavioral group interventions to families via a telemedicine approach. |
Primary: BMI Secondary: feasibility measures, parents’ BMIs, 24-hour dietary recall, behavioral checklist scores, feeding assessment scale scores, and accelerometer data |
8 months | Moderate |
Powers et al (2015, United States) [ |
Cystic fibrosis and pancreatic insufficiency | RCT | Parts of both treatments were delivered via telephone. |
Primary: changes in energy intake Secondary: changes in weight |
18 months | High |
aQuality ratings are based on the Grading of Recommendations, Assessment, Development and Evaluation criteria.
bRCT: randomized controlled trial.
Telemedicine approaches widely varied across all included studies. Several studies (5/11, 45%) involved traditional patient and doctor visits [
This was a study on mental health.
A community mental health clinic conducted an initial screening visit via videoconferencing instead of via telephone.
After receiving a mental health referral from the primary care physician, parents watched an introduction video about the community mental health clinic.
Parents returned to the health center and connected with the community mental health clinic coordinator via videoconferencing to determine their eligibility for a screening visit.
This was a study on otitis media.
Patients were randomized into either the immediate and delayed teaching groups.
The immediate teaching group received instructions on how to use a smartphone otoscope before the study began.
The delayed teaching group received instructions after the first week of the study.
Parents performed a bilateral smartphone otoscopy on their child for a minimum of 5 days during the first week.
After the first week, bilateral otoscopy was performed (1) once per week if the child was not experiencing symptoms; (2) every day if child was experiencing respiratory symptoms; (3) every day for 1 week following a diagnosis of acute otitis media; (4) any day the child was experiencing ear pain; and (5) on days of physician visits.
Bilateral otoscopy videos were sent to the study physician via iMessage, email, or WhatsApp.
This was a study on asthma.
Students participated in five age-appropriate asthma education telemedicine sessions with an allergist, respiratory therapist, or asthma educator.
These sessions involved the use of a standard, prewritten script.
Parents or caregivers participated in two telemedicine asthma education sessions that were conducted at a school.
Nurses participated in two telemedicine asthma education sessions that were conducted at a school.
If 3 or more sessions were missed, education was delivered via telephone, and education materials were mailed ahead of time.
Patients were assessed via telemonitoring on months 0 and 3, and asthma medication information was provided by parents on months 3 and 6.
Caregiver-reported outcomes were measured via telephone interviews on months 0, 3, and 6.
This was a study on asthma.
Initial asthma assessments for patient and caregivers were conducted via a telemedicine approach.
A telemedicine assistant entered baseline patient data into the electronic health record system, and a clinician completed the visit within 3 days (ie, from the office or via real-time videoconferencing).
Afterward, the clinician contacted patients’ caregivers by phone or videoconference to discuss initial patient symptoms, treatment plans, and asthma education.
If a patient’s primary care physician did not conduct telemedicine visits, another physician was assigned as the patients’ primary physician during the study. Information was forwarded to the original primary care physician.
Follow-up assessments were conducted via a telemedicine approach every 4-6 weeks.
All telemedicine visits were reviewed by a nurse to ensure that proper guidelines were followed.
This was a study on skin conditions.
Parents took photographs of their child’s skin condition with their smartphone in the examination room.
In this study, 50% of parents received photography instructions and the other 50% did not.
Photographs were uploaded to electronic medical records.
This was a study on type 1 diabetes.
Patients who were allocated to the IBGStar (Sanofi US) group received training on how to use the IBGStar machine.
These patients were able to measure their blood glucose levels with the IBGStar machine at home and sync the readings to an app on their smartphone.
Data on the app could be directly shared with health care providers.
All participants in this study were able to contact their physician via email, SMS text messaging, or telephone.
This was a study on obesity.
All participants attended in-person visits with their primary care physician every 3 months.
All participants’ primary care physicians conducted a teleconsultation with an obesity specialist 1 week before the visit to discuss obesity treatment.
Group 1 attended obesity specialist televisits and primary care physician visits for the first 6 months of the study. In the following 6 months, participants only visited their primary care physician in person.
Group 2 only visited their primary care physician in person for the first 6 months of the study. In the following 6 months, primary care physician visits were supplemented with obesity specialist televisits.
This was a study on obesity.
All participants received weekly dietician telephone consultations for 5 consecutive weeks.
Consultation sessions were recorded, and several sessions were screened to ensure that they adhered to the study protocol.
This study had a standardized procedure for addressing any missed consultations.
This was a study on attention deficit hyperactivity disorder.
Families in the telemedicine group underwent a total of 6 combined telemedicine and in-person treatment sessions.
Videoconferencing was used to deliver child psychiatry treatment and therapy.
Therapists provided parents with education on attention hyperactivity disorder at the end of each telepsychiatry session.
All of the sessions were recorded, and a subset of sessions was reviewed to ensure that they were accurate and guideline compliant.
Therapists were provided with asynchronous telehealth training modules on how to most effectively deliver attention deficit hyper activity education to caregivers.
These telehealth modules involved viewing recordings of interventions on an asynchronous website.
Recordings were obtained from volunteer families.
The control group received 1 telepsychiatry session at the beginning of the study.
The telepsychiatrist recommended treatment to patients’ primary care physicians based on this visit.
Primary care physicians recommend this treatment, along with any other treatment that they felt would be beneficial, to their patients.
This was a study on obesity.
The schools in this study were randomly allocated into either the telephone or telemedicine groups.
Telephone and telemedicine sessions were held at schools and focused on family-based cognitive behavioral therapy.
The telephone group sat around a speakerphone, which was used to connect with the research team during the sessions.
Speakerphones were provided if the school did not already have one.
The telemedicine group used the audio and video functions of a television screen to communicate with the research team.
This was a study on cystic fibrosis and pancreatic insufficiency.
The behavioral and nutritional treatment group received individualized nutritional counseling and parent education on child behavioral management.
Treatment/education sessions and data collection were conducted via an in-person approach or a telehealth approach (ie, telephone).
If a family did not consistently report on their child’s dietary data, a nurse would contact the family via telephone in order to retrieve data.
The education and attention control group were given educational resources that were related to cystic fibrosis and pancreatic insufficiency. Individualized counseling was not provided to this group. In-person visits and telehealth (ie, telephone) techniques were used to conduct appointments and collect data.
Descriptions of study outcomes are reported in
This was a study on mental health.
The initial screening visit was completed by a greater proportion of patients in the telemedicine group (132/164, 80.49%) than in the control group (114/178, 64.04%).
Patients in the telemedicine referral group required more days to complete the initial screening visit (mean 23.6 days) than patients in the control group (mean 17.1 days).
No significant difference was observed in the proportion of patients who completed the recommended intake visit after the screening visit between the two groups (telemedicine group: 93/116, 80.2%; control group: 81/97, 83.5%;
Based on the adjusted analysis, no significant difference was observed in the time from referral to the screening visit between the two groups (
Compared to parents in the control group, those in the telemedicine group reported higher satisfaction with the referral system and the care that they received.
No significant differences were observed in patients’ quality of life (ie, after 6 months) between both groups (
This was a study on otitis media.
A video or image was obtained during 98% (1472/1500) of all parent-performed examinations (median video length=18 seconds).
In total, 67% (867/1293) of all videos were of sufficient diagnostic quality.
Diagnoses could be made for 56% (486/867) of videos that were of sufficient diagnostic quality.
Diagnoses could only be made for 8% (35/426) of the videos that were of insufficient diagnostic quality.
Diagnoses could be made for 40% (521/1293) of all videos.
Acute otitis media diagnoses could be confirmed or excluded for 87% (609/699) of all videos that were obtained during respiratory infection.
In total, diagnoses could be confirmed or excluded with 99% (495/501) of the videos that were of sufficient diagnostic quality.
In total, diagnoses could be confirmed or excluded with 58% (114/198) of the videos that were of insufficient diagnostic quality.
During week 1 of the intervention, the immediate teaching group was taught how to perform otoscopy and the delayed teaching group was not. There were significantly more videos that were of sufficient diagnostic quality in the immediate teaching group (95/152, 62%) than in the delayed teaching group (39/179, 22%) (
One week after the delayed teaching group received their education session, 64% (85/133) of their videos were of sufficient diagnostic quality.
In total, 24% (10/41) of families believed that smartphone otoscopy was a burden.
In total, 83% (34/41) of families considered conducting smartphone otoscopies on a daily basis.
This was a study on asthma.
No significant difference was observed in the number posttreatment symptom-free days between the intervention and usual care groups (
Patients in both groups still had uncontrolled asthma at the end of treatment.
Compared to the intervention group, the usual care group had significantly higher scores in the family activity domain of the Child Health Survey for Asthma (
Compared to the usual care group, the intervention group had a significantly greater percentage of patients that used a peak flow meter (
Compared to the usual care group, the intervention group had a significantly greater percentage of patients who were compliant with posttreatment asthma medication (
There was no significant difference in the baseline quality-of-life scores between both treatment groups (
This was a study on asthma.
Children in the telemedicine group had significantly more postintervention symptom-free days (mean 11.6 days) than children in the control group (mean 10.97 days) (
The intervention group had fewer symptom days, symptom nights, and limited activity days than the control group.
Compared to the control group, the telemedicine group had a greater proportion of patients who were prescribed preventive medication (control group: 132/196, 67%; telemedicine group: 181/199, 91%).
In the final follow-up longitudinal visit, the telemedicine group had 0.85 more symptoms than the control group, and a significant correlation was observed between treatment efficacy and time (
Decreases in exhaled nitric oxide levels were greater in the telemedicine group than in the control group (mean difference=−5.54).
Caregivers’ quality of life improved in both groups; there was no significant difference in caregivers’ quality of life between both groups (95% CI −0.08 to 0.37).
In total, 95.7% (361/377) of patients reported that the program was helpful, and 96.5% (365/367) reported that they would partake in another similar program.
This was a study on skin conditions.
The median photograph quality rating score was 9.
The concordance between photograph diagnosis and in-person diagnosis for all photographs was 83% (33/40).
The mean quality rating score for photographs with a diagnosis was 8.9, whereas the mean quality rating score for photographs with no diagnosis was 7.0.
The group that received photography instructions had a higher average image quality score and a higher mean number of images than the group that did not receive instructions, but this was not statistically significant.
No significant difference was observed in the concordance of diagnosis between the group that received photograph instructions and the group that did not receive instructions (
Parents’ willingness to use teledermatology services was measured on a scale of 1 (ie, not willing) to 10 (ie, very willing). The median response score was 8.
This was a study on type 1 diabetes.
The telemedicine and control groups exhibited reduced hemoglobin A1c levels after treatment; there was no significant difference between the two groups (
Patients who self-monitored their blood glucose levels exhibited reduced hemoglobin A1c levels at 6 months posttreatment.
Patients who did not self-monitor their blood glucose levels only exhibited minor changes in hemoglobin A1c levels at 6 months posttreatment.
Patients in the telemedicine group exhibited greater decreases in hemoglobin A1c levels at 6 months posttreatment than the control group (
The control group started using the experimental telemedicine meter at 6 months posttreatment. At 12 months posttreatment, the control group exhibited decreases in hemoglobin A1c levels (
At 12 months posttreatment, the experimental group’s hemoglobin A1c levels remained stable (ie, compared to their hemoglobin A1c levels at 6 months posttreatment).
There were no significant differences in quality-of-life measures between both groups at 6 months and 12 months posttreatment (
This was a study on obesity.
Group 1 (ie, patients who attended primary care physician visits and specialist televisits) exhibited greater decreases in BMI
The BMIs in group 1 significantly decreased after 6 months (
After 6 months, group 1 only attended primary care physician visits and Group 2 attended primary care physician visits and specialist televisits.
The baseline BMIs in group 1 were significantly different from those after 9 months (
The baseline BMIs in group 2 were significantly lower than those after 12 months (
If given the opportunity to choose between obesity specialist televisits or in-person visits, 14 patients would choose televisits and 7 had no preference.
This was a study on obesity.
There were no significant differences in dietary fat content (ie, before and after treatment) between or within the two groups (
After treatment, the low glycemic load group had lower glycemic loads than the low-fat group (
There were no significant differences in posttreatment glycemic loads between both groups (
The low glycemic load group exhibited a significant decrease in total energy intake levels after treatment (
The low glycemic load group had significantly lower posttreatment total energy intake levels than the low-fat group (
There were no significant differences in changes in total energy intake levels (ie, from baseline to after treatment) between both groups (
This was a study on attention deficit hyperactivity disorder.
Caregivers in both the Children’s Attention Deficit Hyperactivity Disorder Telemental Health Treatment Study (CATTS) and augmented primary care groups showed improvements in caregiver distress by the end of the study.
Caregivers in the CATTS group had significantly lower Parenting Stress Index (
Caregivers in the CATTS group also had significantly higher Falls Efficacy Scale scores after 25 weeks of treatment (
This was a study on obesity.
The satisfaction scores between the telemedicine and telephone groups were not considerably different.
There were no significant differences in changes in patients’ BMIs (ie, pretreatment to posttreatment) between the telemedicine and telephone groups (
There were no significant differences in changes in parents’ BMIs (ie, pretreatment to posttreatment) between the telemedicine and telephone groups (
This was a study on cystic fibrosis and pancreatic insufficiency.
After treatment, the control group had significantly lower energy intake levels than the behavioral and nutritional treatment group (
After treatment, there were no significant differences in weight
After treatment, the control group exhibited greater decreases in height
During the follow-up, the behavioral and nutritional treatment group had greater average energy intake levels than the control group (
At follow-up, there were no significant differences in weight
Perry et al [
Fleischman et al [
Di Bartolo et al [
Cocker et al [
Stoep et al [
Erkkola-Anttinen et al [
The evidence from this review suggests that telemedicine visits for pediatric care may be comparable to and occasionally more beneficial than in-person visits. In this review, 11 studies that met all listed inclusion criteria were identified. All included studies were randomized controlled trials that assessed the use of telemedicine in pediatrics. The following eight health conditions were assessed: asthma, obesity, otitis media, mental health conditions, skin conditions, ADHD, type 1 diabetes, and cystic fibrosis–related pancreatic insufficiency. According to the GRADE criteria, the quality of evidence from almost all studies (10/11, 91%) was either low or moderate. Most low or moderate ratings were due to limitations in study design and implementation and the indirectness of evidence. The quality of evidence from one study was high. Most studies conducted videoconferencing visits instead of traditional, in-person physician visits. Other telemedicine interventions that were used included smartphone-based apps, telephone counseling, and web-based screening visits.
Overall, although the impact of telemedicine on pediatric health care was modest, telemedicine interventions showed promise. Studies on school-based telemedicine interventions for asthma had contradictory results for the effects of telemedicine on asthma SFDs [
Recently published literature has suggested that telemedicine approaches in general pediatric practice can be used to provide alternatives to traditional patient visits, increase people’s access to health care, and reduce the number of existing disparities [
Health care has been rapidly evolving to adapt to the ongoing COVID-19 pandemic, and telemedicine has become an important mechanism of health care delivery [
The timely management of pediatric chronic illnesses, such as obesity, allergies, and genetic diseases, is paramount to providing patients and their families with the best care, especially during the COVID-19 pandemic [
Telemedicine is also being used in specific pediatric subspecialty settings. In surgery, telemedicine modalities have been used to preoperatively diagnose patients, perform surgery (ie, with robotic devices), or postoperatively monitor patients [
Pediatric patients in rural communities face distinct challenges, such as limited access to subspecialty care and long commutes to clinics. However, these challenges can be overcome with telemedicine interventions [
The use of telemedicine in adult medical care is similar to that in pediatric care. Web-based patient monitoring via telemedicine modalities allows intensive care unit physicians to check the status of multiple patients at any time and place [
This systematic review has multiple strengths. First, we followed recommendations for rigorous systematic review methodologies [
The potential methodological limitations of this systematic review should also be discussed. First, this review used a single database (ie, PubMed) to conduct the literature search. However, PubMed is the most comprehensive medical database. Most studies in other databases are also likely to be found in PubMed. Therefore, it is likely that we did not miss any studies that were relevant to our review. However, the possibility of missing a study cannot be excluded. Second, even though our search criteria allowed for the inclusion of studies from all countries, all included studies were conducted in high-income countries. Telemedicine use in high-income and low-income countries may be different, and the results of this review should be viewed as results from high-income countries. Third, this review included studies with different follow-up periods and patient populations (ie, various health conditions and age groups). Therefore, there may have been several inconsistencies between the results of each study. Furthermore, these limitations did not allow us to perform a meta-analysis [
In recent years, telemedicine use among the pediatric population has become more common. Although a clear consensus on the benefits of telemedicine approaches in pediatrics has not been reached, recent literature has shown that telemedicine services are comparable to or better than in-person services. Patients and caregivers have also consistently reported that they are more satisfied with telemedicine visits than with in-person visits. This shows promise for telemedicine in pediatric settings, especially during times when social distancing is a requirement, such as the COVID-19 pandemic. Future studies should focus on improving telemedicine delivery services, people’s access to health care, the quality of telemedicine approaches, and the integration of telemedicine into in-person physician visits. Furthermore, future studies that emphasize the cost-effectiveness of telemedicine, the use of telemedicine services in rural settings, and barriers to telemedicine technology implementation are needed to analyze the true potential of telemedicine approaches for improving children’s and adolescents’ health outcomes.
PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist.
Detailed descriptions of study outcomes.
attention deficit hyperactivity disorder
Grading of Recommendations, Assessment, Development and Evaluation
hemoglobin A1c
Preferred Reporting Items for Systematic Reviews and Meta-Analyses
symptom-free day
This project was supported by a grant from the National Heart, Lung, and Blood Institute of the National Institutes of Health (grant number: K23HL150232; principal investigator: SMB). The content of this review is solely the responsibility of the authors and does not necessarily represent the official views of the National Heart, Lung, and Blood Institute or the National Institutes of Health.
ACS conceptualized and designed the study, collected the data, analyzed the data, drafted the initial manuscript, and reviewed and revised the manuscript. SMB conceptualized and designed the study, coordinated and supervised the data collection process, and critically reviewed and revised the manuscript. Both authors reviewed and approved the final version of the manuscript.
None declared.