Telemedicine finds lasting role in pediatric chronic care

Clinical takeaway: Telemedicine appears to be most valuable for ongoing management of pediatric behavioral health and endocrine conditions, where frequent follow-up is often needed and physical examination is less critical at every visit.

Telemedicine use has fallen sharply since its pandemic peak, but a large national study suggests it has settled into an important role for selected pediatric conditions rather than disappearing altogether. The findings help clarify where virtual care may provide the greatest clinical value in primary care.

Researchers analyzed nearly 19.6 million problem-based visits for children younger than 18 years across 1,088 U.S. primary care practices between 2019 and 2024. Telemedicine accounted for fewer than 1% of visits before the COVID-19 pandemic, peaked at 55% of visits in April 2020, and stabilized at approximately 6% by 2024.

Behavioral health (20% of visits) and endocrine disorders (19%) had the highest use of telemedicine, followed by dermatologic (11%), infectious disease (11%), digestive (10%), and respiratory (9%) conditions. The results suggest virtual care may be particularly well suited for chronic conditions requiring regular follow-up but only intermittent physical examination.

The study also suggests telemedicine may improve practice capacity. Before mid-2023, adding telemedicine visits had little effect on overall visit volume. After May 2023, however, each additional telemedicine visit was associated with an increase in total problem-based visits, suggesting practices may be using virtual care to expand access rather than simply replacing in-person appointments.

“This study has helped us clarify the role of telemedicine and its impact on problem-based care. We still need studies to investigate how these increased telemedicine visits impact child health outcomes while also reducing the burdens and access barriers families may face when seeking quality care for their children,” said lead author Alexander Fiks, MD, Director of Clinical Futures and the Possibilities Project: Innovation in Pediatric Primary Care at Children's Hospital of Philadelphia and Director of the American Academy of Pediatrics Pediatric Research in Office Settings (PROS) network.

Source: Fiks A, et al. (2026 Aug 5) Pediatrics. Telemedicine use in primary care for children: 2019-2024