Your 5-year-old has a fever. It's 7 PM. Your pediatrician's office is closed.
Do you:
- Drive to urgent care (30-minute wait, $150 copay)
- Start a telehealth visit ($25, 10 minutes)
- Wait until tomorrow and call the pediatrician
Here's how to decide.
When Telehealth Works for Kids
Telehealth is great for common, non-emergency issues that don't require a physical exam.
Good for telehealth:
- Fever (if your child is acting normal otherwise)
- Cough and cold symptoms
- Sore throat (possible strep - doctor can call in antibiotics if symptoms match)
- Rash (doctor can see it on video)
- Vomiting or diarrhea (without severe dehydration)
- Pink eye
- Ear pain (possible ear infection - doctor can prescribe if symptoms are clear)
- Minor injuries (small cuts, scrapes, bruises)
- Behavioral or sleep issues
- Prescription refills
What the doctor can do on video:
- Assess symptoms
- Ask detailed questions about behavior, eating, drinking, energy level
- Look at rashes, eyes, throat (if you have a flashlight and your child cooperates)
- Prescribe medication if appropriate
- Give you a plan (watch at home, go to urgent care, call back in 24 hours)
When Your Child Needs an In-Person Visit
Some conditions require a physical exam or testing that telehealth can't provide.
Go to the doctor or urgent care if:
- High fever in babies under 3 months (100.4°F or higher - this is always urgent)
- Difficulty breathing (wheezing, fast breathing, retractions)
- Severe dehydration (no wet diapers for 8+ hours, dry mouth, no tears when crying)
- Severe pain (abdominal pain, ear pain that won't respond to ibuprofen)
- Head injury with vomiting, confusion, or loss of consciousness
- Rash with fever and stiff neck (possible meningitis)
- Unusual lethargy (won't wake up, can't stay awake, unresponsive)
- Suspected broken bone
- Deep cuts that might need stitches
- Allergic reaction (swelling, hives, trouble breathing)
Why? These need hands-on assessment, lab tests, or immediate intervention.
When to Go to the ER (Not Urgent Care or Telehealth)
Some symptoms require emergency care. Don't waste time with telehealth or urgent care.
Go to the ER if:
- Difficulty breathing or turning blue
- Seizure (first-time or lasting more than 5 minutes)
- Loss of consciousness
- Severe allergic reaction (throat swelling, can't breathe)
- Major trauma (car accident, fall from height, severe bleeding)
- Uncontrollable bleeding
- Signs of severe dehydration in babies (sunken fontanelle, extreme lethargy)
Call 911 if you're unsure or if your child is in immediate danger.
How to Describe Symptoms on a Telehealth Visit
Telehealth doctors can't see or touch your child. You're their eyes and hands.
Be ready to answer:
- When did symptoms start?
- Has your child had a fever? (Take their temperature before the call)
- Is your child eating, drinking, peeing normally?
- Energy level: Acting normal? Lethargic? Irritable?
- Any recent sick contacts (daycare, school, siblings)?
- Any rashes, vomiting, diarrhea, cough?
Helpful to have ready:
- Thermometer (take temp before the visit)
- Flashlight (to show throat or rash on video)
- List of current medications
- Your child's weight (for dosing medication)
The more details you provide, the better the doctor can assess.
Common Scenarios and What to Do
Scenario 1: Fever with No Other Symptoms
Age under 3 months: Go to the doctor or ER (fevers in newborns are always serious).
Age 3 months - 3 years: Start with telehealth if your child is eating, drinking, and acting fairly normal. Doctor can assess and tell you if you need to go in.
Age 3+: Telehealth is fine. Most fevers are viral and just need rest and fluids.
Scenario 2: Sore Throat
Telehealth works if:
- Your child is over 3 years old
- Symptoms suggest strep (sore throat, fever, headache, no cough)
- Doctor can prescribe antibiotics if symptoms match
Go in person if:
- Severe throat pain (can't swallow, drooling)
- Difficulty breathing
- Your child is under 3 (strep is rare, might be something else)
Scenario 3: Cough and Cold
Telehealth is great for this. Most coughs and colds are viral (no treatment needed, just rest and fluids).
Doctor can:
- Rule out anything serious
- Recommend over-the-counter treatments
- Prescribe cough medicine if appropriate
- Tell you when to follow up
Go in person if:
- Difficulty breathing
- Cough lasting more than 2 weeks
- High fever with cough (possible pneumonia)
Scenario 4: Ear Pain
Telehealth can work if:
- Your child is over 6 months old
- Symptoms are classic ear infection (ear pain, fever, fussiness)
- Doctor can prescribe antibiotics based on symptoms
Go in person if:
- Baby under 6 months
- Severe pain that won't respond to ibuprofen
- Fluid draining from ear
Doctors can't look in ears on video. But they can assess based on symptoms and prescribe if appropriate.
Scenario 5: Vomiting or Diarrhea
Telehealth works if:
- Your child is keeping down small sips of water
- Peeing normally
- Acting fairly normal between episodes
Go in person if:
- Signs of dehydration (no wet diapers, dry mouth, extreme lethargy)
- Blood in vomit or stool
- Severe abdominal pain
- Vomiting after a head injury
Scenario 6: Rash
Telehealth is perfect for rashes. Doctor can see it on video.
Be ready to show:
- Where is the rash? (face, arms, trunk, legs)
- Does it itch? Hurt? Spread?
- Any fever or other symptoms?
Go in person if:
- Rash with fever and stiff neck (possible meningitis)
- Rash with severe swelling or trouble breathing (allergic reaction)
What Telehealth Doctors Can and Can't Do for Kids
Can do:
- Diagnose common illnesses based on symptoms and video assessment
- Prescribe antibiotics, pain relievers, cough medicine, creams
- Refer to specialist if needed
- Give guidance on home care (fluids, rest, fever management)
- Write a sick note for school
Can't do:
- Physical exams (listen to lungs, feel abdomen, check ears with otoscope)
- Lab tests (strep test, flu test, urinalysis)
- X-rays or imaging
- Stitches or wound closure
- IV fluids for dehydration
If the doctor thinks your child needs any of those, they'll tell you to go to urgent care or the ER.
How Much It Costs
Typical costs:
- Telehealth visit: $25-$75 (Bivvy Health: $25)
- Urgent care: $100-$200
- ER: $500-$2,000+
Telehealth is the cheapest option. If it doesn't work, you can still go to urgent care. But most of the time, telehealth is enough.
When to Follow Up
After a telehealth visit, follow up if:
- Symptoms get worse
- Fever lasts more than 3 days
- Your child isn't improving after 48 hours
- New symptoms develop
- You're worried (trust your instincts)
You can do another telehealth visit or schedule an in-person appointment.
The Bottom Line
Telehealth works for most common childhood illnesses: fever, cough, sore throat, rash, ear pain, vomiting, diarrhea.
Go to the doctor or urgent care if your child needs a physical exam, lab tests, or has severe symptoms.
Go to the ER if your child is in distress: difficulty breathing, seizure, loss of consciousness, severe dehydration.
Start with telehealth. It's fast, affordable, and works for 70-80% of sick kid situations. If the doctor says you need to go in, you can still do that.
Bivvy Health offers $25 telehealth visits for kids and families. Available 7 days a week, no insurance required. Worth checking out if your kid is sick and you don't want to sit in urgent care for 2 hours.