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Remote Paediatrics with Dr Victoria Agunloye

Dane catches up with Dr Victoria Agunloye about tips & tricks for remote paediatric consultations.

Dane catches up with Dr Victoria Agunloye, a Senior Paediatric Registrar who is involved with the paediatrician-designed iPhone app ‘Juno’ - which gives parents direct access to paediatric registrars and consultants. She’s also involved with ‘On-Call Mummy’, a platform used to teach parents and carers first aid and paediatric first aid. In the episode, Dane and Victoria discuss the types of questions to ask during a remote paediatric consultation, tips and tricks for clinicians, how to use images and video to identify types of rashes and how to manage symptoms of COVID-19 in children remotely.

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Produced by Arc Health in collaboration with Doctors.net.uk.

Explore more educational resources for remote consultations at archealth.io/education.

Arc Health helps clinicians save time with remote consultations. Our technology is used in hundreds of NHS GP surgeries, care homes, hospitals and pharmacies. Find out more at archealth.io.

Episode
9
29 mins

Episode preview clip: “I would say, go with your gut. So if you feel that this child needs to either see you face-to-face or be seen in hospital, trust that. Listen to the parent, number two. So if the parent says “I want my child to be seen”, make a big effort to see them if you can accommodate that, and if you can’t accommodate that please send them to A&E. And then also, just have really good red flag advice. Safety netting. So be very clear about what they need to do if X, Y and Z happens. And that’s the safest way I think you can be with regards to remote medicine.

Dr. Dane Vishnubala:

Hi there, Dane here from Arc Health. Welcome to Remote Consultation Masterclass. This is a podcast where we catch up with leading health care professionals to discuss tips and tricks for carrying out remote consultations, as well as bringing you key nuggets of information for your CPD. Now, you can listen to us on Apple Podcast, YouTube, Spotify, or wherever you get your podcast from. So I hope you enjoy the episode.

Dr. Dane Vishnubala:

So my name's Dane, I'm a GP and a Sport and Exercise Medicine Consultant based in Yorkshire. And today I'm joined by Dr. Victoria Agunloye, a general paediatrician with a P to A&E interest who's currently STA and due to finish this year. Thanks for joining us.

Dr. Victoria Agunloye:

Hello. Hi, thanks for having me. My pleasure.

Dr. Dane Vishnubala:

So I guess before we get started, obviously we're going to be talking about remote consultation and paediatrics today, but tell us a bit about your journey today and how you got here.

Dr. Victoria Agunloye:

Sure. So I'm Vicky, I'm a paediatric trainee based in London and I've been working in the NHS here in London since 2011 as a paediatrics trainee. I went to medical school at Southampton and my specialist interest is paediatric A&E and also parent education and empowering parents with information about looking after their children and so forth. So yeah, that's my background.

Dr. Dane Vishnubala:

Perfect. Okay. So, I mean, everyone knows about NHS Paediatric, so I won't focus on here, but just to pick out on some of the other bits that you do at the moment, so there's two things you do, isn't there? There's On-Call Mummy and then there's Juno. So tell us a bit about Juno first of all.

Dr. Victoria Agunloye:

Yeah. So Juno is an app that you can get on your iPhone at the moment, they are working on Android. And the app's called Hello Juno, and basically it gives parents direct access to paediatric registrars and paediatric consultants all over the country. It's a chat-based interface, so the parent can take a picture of a child's rash and then they can contact us between the hours of 08:00 to 08:00 and we will give them advice. We are an advice service and a sign posting service, so we don't prescribe or we don't refer currently. But we will sort of signpost towards a GP, 111, or to A&E, or just say, "We can watch and wait and contact us again."

Dr. Victoria Agunloye:

Parents seem to love it, because actually it's really family focused. It allows parents access to tertiary level care in the comfort of their own homes and on the end of their phone, which is a great thing, particularly in the current climate with lots of parents struggling to get access to healthcare, even having hesitancy and fear to go to hospitals. So it's great.

Dr. Victoria Agunloye:

The other thing I do is the On-Call Mummy, as you mentioned. So this was something I started on my own probably about two or three years ago where I teach parents and carers first aid, pediatric first aid. And then I have an interface on Instagram where I give general advice, sort of common things I see in peds.

Dr. Dane Vishnubala:

Cool, perfect. So we'll pick up on both of those bits in a bit, a couple of questions about Juno itself is, how does it work? So let's say I download this app and I ask a question about my child. What kind of turnaround time would you get it back in? How much do I pay? How does that all work?

Dr. Victoria Agunloye:

Yeah, so we have, there's a short period where the service is free and then after that you do pay and I think it's about £60 for the year, which I think is actually really good value for money considering what you're getting, which is basically tertiary level care at the end of your phone. And it's a really good service because actually the registrar is on call with the consultants. If there's any issues that I can't answer as a registrar, I can speak to the consultant and you're getting that advice, the same sort of service you'd get in a hospital.

Dr. Victoria Agunloye:

So the way it works is that you put a profile of your child and your details and your GP details, so it's the safest, we can sort of make it and you have to be over 18 to have a profile on there now. And you will say, "My child has this rash." You log on, there's a waiting room, a virtual waiting room, and actually between the hours of 08:00 and 08:00, we try and answer your claim in less than five minutes. And actually I think most of them are within a minute, you will get a paediatrician saying, "Hi, I'm Dr. Vicky. How can I help today?" Which is great and we sort of go back and forth for as long as it takes to resolve the issue.

Dr. Victoria Agunloye:

And as I said, most of the time it's us just being able to give advice and say, "You can watch and wait. These are the things you need to look out for." So, really clear signposting, which is important when you do remote consultations. Or we will say, "I think you need to see your GP, either today, next week, or in a month." Or, "I think you need to go to 111," because I think you can't wait to see your GP because it's out of hours or whatever. Or, "Go to A&E." And then we clarify that parents understand what we're saying and then we leave it as that and we close the chat. And that's it really.

Dr. Dane Vishnubala:

Yeah. Okay. Sounds good.

Dr. Victoria Agunloye:

Yeah. I think it's a good service.

Dr. Dane Vishnubala:

I probably need to give it a download and start sending my questions through.

Dr. Victoria Agunloye:

Yeah, have a go.

Dr. Dane Vishnubala:

We've got a 20 week old, so it never hurts to have a paediatrician on the end of a phone.

Dr. Victoria Agunloye:

No, exactly. It's like phone a friend, basically.

Dr. Dane Vishnubala:

Perfect. Okay. So I guess with the On-Call Mummy stuff, with Juno, and obviously with your NHS work at the moment, there's lots of stuff that is essentially remote now. What are the common presentations you may be seeing in this more remote capacity?

Dr. Victoria Agunloye:

So the most common cohort we see are the younger ones. So they're the majority of the patients, the profiles we are getting. And the top three things that I see regularly when I'm on this service are so fussing babies, it's also reflux, funny stool habits, that sort of issue, funny issues with feeding, rashes are really common. "Do I need to be concerned about this rash?" And then obviously fever, which actually also probably reflects, I think, a lot of what primary care sees, those sorts of concerns. And then also some of the phone calls I get from GPs about children they've seen in their clinics and do they need to escalate? Do they need to be worried about? So those are the common things we see.

Dr. Dane Vishnubala:

Yeah. That'd be fair with my out of hours GP shifts that I still do, these kinds of things that come up. So, okay, this will be a really good CPD for me as well. So, let's take some of these points then. So let's start with, I think the first one you mentioned, which is the kind of fussy baby. So if you were a remote clinician that's not a paediatrician, so maybe it's more GP, ED, or similar, what kind of questions and things could you do remotely that either puts your mind at ease or that starts to give you the right answers that you need something more face-to-face.

Dr. Victoria Agunloye:

So it's a tricky one because the fussy baby is such a big topic and the differentials can be huge from, this is just benign colic to actually, this is a baby that perhaps has quite severe calcium protein intolerance or actually a baby that may possibly be septic, that's been masked. So the things that you need to get an understanding of is obviously the age of the child. So, if you've got a six month old that's fussing, you probably can have... And they've been growing and thriving well, you can probably be slightly more relaxed, the fact that there's nothing seriously going on wrong with this baby. If they're thriving, they're growing, there've been no issues until the age of six months. So age is important.

Dr. Victoria Agunloye:

The other thing is getting an understanding of what number baby your child is. If you've got a first-time parent, the things that concern them possibly are likely to be less serious than the parent who's had four or five children. If you've got a mum that says like, "This is my fourth baby and the baby isn't right." I take that much more seriously than... That's a slight red flag.

Dr. Victoria Agunloye:

So that sort of stuff, then you just need to sort of break down to, how is the baby feeding? Is this a breastfed baby? A bottle fed baby? Was there any sort of trauma and drama in the baby's birth? So, it's not unusual to have parents that are anxious if they've had a baby that's been in NICU and they were in NICU for three or four weeks where they've been used to having really strict regimes of feeding and pooing and weeing. And they're now saying, "My baby's not pooing. My baby's not weeing." All that sort of stuff. So just take a really good history and it can take a bit longer remotely.

Dr. Victoria Agunloye:

So on the phone, that's fine because it's a conversation, but if it's a chat basis, then that process can take a while, but you can't really skip it. You need to make sure you've got a good understanding of their background before you can give that sort of advice. Then I feel for me the gold standard is, is your baby growing? Are they gaining weight well? Because a lot of times the fussing issues around feeding, he's not fed well today, he's not fed well for the last couple of weeks. So just sort of go, "Is your baby been gaining weight nicely?"

Dr. Victoria Agunloye:

In this current climate, it's been a bit tricky because lots of parents are struggling to get to health visitors and doing regular weights is tricky, but actually mum's are pretty good at knowing if their baby's gaining weight. So just if they say to you, "I haven't had a chance to weigh them for three weeks." Just say, "Do you think they're gaining weight nicely? Or are you concerned they're losing weight?" So weight gain's important.

Dr. Victoria Agunloye:

Then the basic stuff like wet nappies, how many wet nappies have you had in the last 24 hours? So, a common fussing one is that they've not been feeding very well and the most important thing about reduced feeding is dehydration. So you want to know, is this baby dehydrated? Do they need to be seen today? Or is this just something that's sort of going on grumbling on and off? Because babies do get feed strikes and that's not unusual in itself. Once they're having a good amount of wet nappies and they're otherwise well in themselves. So break it down to, how many wet nappies are they having? And if they're having at least four wet nappies in 24 hours, that baby is getting enough hydration at least in that immediate acute period of time.

Dr. Victoria Agunloye:

Then once again, poos. How many poos are you getting? So it's that sort of basic paediatric history that doesn't sound very exciting, but actually gives you a lot of information about how unwell a child is. Then it's also about then just speaking to the parent about what their understanding of what babies should be doing. So a lot of times, particularly new parents, expect babies to feed every three to four hours, sleep for four hours, wake up, and want a feed. And actually it's quite important to get to them that every baby's different and just because on the back of the formula, it says they should be taking four ounces every however many hours, that may not be the case for their baby.

Dr. Victoria Agunloye:

So it's important to give them that information. And then another common thing we see in the fussing babies, this whole thing about reflux and vomiting. And I think it's important to let parents know and reiterate that actually, reflux is really common and it isn't a pathology unless you've got a baby that's not thriving or the baby's in so much distress and crying and back arching that something needs to be done about it. And I talk about, the sort of simple, keeping them upright, not over feeding, and actually stuff like not overfeeding, you need to be so particular and go, "How much do you actually feed them every feed? How often?" And it's not unusual for babies to be fed 200 mils per kilo per day, which is a huge amount of milk for a formula-fed baby, which is once again where it's important. "Is this formula you're feeding them? Is it breast milk you're feeding them?" And sort of going into that sort of detail can actually make a big difference into what diagnosis you give.

Dr. Victoria Agunloye:

So, yeah. And so I think the times I would say to a parent, "I think you need to see your GP or go to A&E about a fussing baby," if I'm concerned about the baby's fussing so much they can't feed. And I'm going to know this because they haven't had enough wet nappies. So they've had less than four wet nappies in a 24 hour period. Or if you've got a baby that basically just won't feed at all. So babies that are not feeding at all, that isn't a see your GP, that is probably, it'd be good for a paediatrician to see them in the next 24 hours really ideally.

Dr. Victoria Agunloye:

And obviously the younger the baby, the lower threshold I have to see them. So, if you've got a baby that's less than three months old, those are the babies that you want to make sure are well-hydrated and you're not missing something significant as sepsis. So once again, these babies that are fussing, I generally ask about their birth history. So how many hours from being born to mum's water been breaking? Any history of group B strep? Any fevers in mum? Was baby ever screened for sepsis? Those babies who are fussing, I have a much lower threshold to say, "Do you know what? I think it makes sense, if you can't see your GP today, speak to 111 or go to A&E." Does that all make sense?

Dr. Dane Vishnubala:

Yeah. Yeah, yeah, definitely. Yeah. Okay. That's really useful to just see, some of this is stuff that many of us will have thought about, but I think knowing that whole spectrum is really useful and some of those detailed extra questions as well. Okay, perfect.

Dr. Dane Vishnubala:

So that's the kind of fussing baby, is that a PC term? Maybe. And then if we go towards, what about rashes? So how do you manage rashes? And I know you said remotely, obviously with Juno and stuff, you are getting those stills and pictures as well.

Dr. Victoria Agunloye:

Yeah. So, it's great. So Juno is great because we can do the stills. We're working on getting the live moving images and that's coming soon, hopefully, but actually for rashes, what you need is a still and that's great. And once again, it's about finding out, when did the rash come? Is the rash bothering the child? So is it an itchy rash or not on itchy rash? Has the child got a cough, cold, or fever with it? Because actually the most common cause of a rash in children is a viral exanthem. And the majority of them will be just that. So finding out, is it associated with any sort of infective symptoms?

Dr. Victoria Agunloye:

Then depending on what the rash looks like, and I think that most of us can distinguish between an eczematous rash to a urticaria type rash to a benign sort of maculopapular rash. And you will get a good idea of that from a video. Once again though, sometimes say if you have an interface where you haven't got video, it's about just trying to use descriptive terms that the parents will understand. So, is it raised? Is it flat? Does it blanche? So a lot of parents don't know about blanching means, so you have to say, the tumbler test. And a lot of them are quite familiar with that tumbler test, and it's really, so every rash I ever see or discuss, I clarify, does it blanche? Does it not blanche? Because actually that does make a slight difference to how seriously I take the rash.

Dr. Victoria Agunloye:

So the maculopapular blanching ones, if the child is otherwise well, I generally say, it's probably going to be a viral exanthem, depending on what they tell me, and most of those are gone within sort of 48 hours to five days. So I say that to them and I say to them, "If the child remains well, it's not spreading much more than we've discussed, and it doesn't change in character, you can afford to watch and wait. If anything does change, then either contact us again or speak to 111 or see your GP." Very rarely would I ever send a child with a maculopapular rash that's well to A&E. So I think you can normally afford to watch and wait.

Dr. Victoria Agunloye:

The other thing that's quite helpful is that sometimes these rashes do cause a bit of an itching on the child. So, a non-sedating antihistamine I often recommend, but in my experience, the viral ones don't really respond to antihistamines, but it's always worth saying to the parent, "Try it to see if it makes a difference."

Dr. Victoria Agunloye:

Then obviously you've got your sort of petechial rashes, which we take much more seriously. So, if the child has a fever and a petechial rash, go to an A & E job, 100%. I don't think it'd be worth sending that child to a GP, because the GP would only send them to us anyway. Once again, so yeah, so any sort of petechial rash, I'd advocate seeing a doctor within 12 to 24 hours. No fever, if you can get to your GP that day, I think that's a sensible option. If you can't get to your GP that day, I think depending on the time of day, urgent care may be a good option in a child that's relatively well.

Dr. Victoria Agunloye:

Otherwise, I think in paediatrics, we are lucky that we now have vaccinations, so we see much, much less meningococcal sepsis, but it is still there. And I feel like no one's ever going to criticise you for sending in a child with a petechial rash that you can't explain. So I think that's fine. If you feel that you are confident, so if you are a GP and you can see the child in 48 hours, things that you can ask them. So, is there a fever? The answer should be no. If there's a fever, send them to A&E. If there's no fever, the next question will be, whereabouts on the child's body is it? So if it's above the SVC and you can get a good history of coughing, vomiting, straining, and they have no other petechiae anywhere else below the SVC region and you feel the parents are sensible, so if things get worse, if the rash is spreading, the child gets unwell, they go to A&E, that sort of child you can probably wait to see in the next 24 to 48 hours.

Dr. Victoria Agunloye:

But otherwise I think it's just sensible to be on the side of caution when you're being remote to say, "Do you know what? Someone needs to see you so I can clarify," because you want to check their heart rate, you want to check their cap refill, you want to actually see this child. And if you have got an interface where you can do a remote consultation, where you can see a video consultation, I beg your pardon, then once again you may be able to say, "Do you know what? I can see you in 48 hours," but you have to give really good signposting for these children's petechial rashes. And I think that's the safest way to perform remotely for these kids.

Dr. Dane Vishnubala:

Perfect. No, that's really useful. And then the final one to pick your brains on, I guess that you mentioned post rashes will be fever. So obviously there are lots of tools already out there for this, but anything particularly in terms of tips and tricks for the clinicians that are listening?

Dr. Victoria Agunloye:

So the absolute one that I sometimes find surprising not all clinicians know about is the rule for under three month old babies. So any baby who is under the age of three months that has a fever, that has to come to paediatric A&E. So if you ever have that conversation with a parent and they're like, "This is my two month old who has a fever of above 38," even if the child sounds fine, that one always goes to A&E, because a paediatrician needs to cast an eye on them, otherwise it's stuff like just trusting the parents' gut. And if the parent says, "Do you know what? I think it's more than just a cough or cold." And once again, if you can, and they really feel that this child needs to be seen because of the fever, I feel that you just need to do it because actually a big part of knowing how unwell a child with fever is seeing them.

Dr. Victoria Agunloye:

So if you have a remote consultation where you don't have a live moving image, I feel like erring on the side of caution makes sense, particularly in this current climate where we are seeing some post sort of inflammatory conditions, like the PMTS that we are seeing in children, and this normally happens sort of three weeks post COVID infection, the family may not have known that the child had COVID and then they present with fever and they can get sick quite quickly. So once again, I think in this current climate, with a child with fever, if you can't see them and the parents are concerned, err on the side of caution and actually send them in, or if you can somehow get them to see you in the clinic, that'd be great. That'd be much better.

Dr. Victoria Agunloye:

But otherwise I think it's common stuff. The rule of five days for children. So it's not seven days that has been advertised a lot on 111 with regards to COVID. So, a child that's had a fever for more than five days needs to see a doctor. Clarify the source, because that's unusual for a viral infection to last more than five days. But I think lots of people are aware of that. And then also just listening to the parents a lot. And I think that's a problem with the remote consultation, the fact that if a parent says they're concerned, you need to really go for that.

Dr. Dane Vishnubala:

Yeah. Okay. Perfect. Okay. So we talked a bit about fussy babies, rashes, and fever as presentations. So taking on that last point you mentioned about COVID, what's COVID looking like where you are? And if the kids have got COVID, what kind of presentations are you seeing and how are they being managed?

Dr. Victoria Agunloye:

Yeah. So COVID has caused certainly the structure in London, the paediatric structure in London to change slightly in order to accommodate the surge for the adult services. So the things, one thing that we've seen is just reduced number of children presenting to the hospital, which has been of concern to us, but we also probably appreciate that there probably are less children in need of medical services because actually, they're mixing much less with their peers so therefore we're getting much less infective type things, which is generally our bread and butter.

Dr. Victoria Agunloye:

However, the children we are then seeing either are presenting late into their illness course, which then makes them more unwell and harder to manage. So we're seeing a lot of very sick children presenting to A&E once they are finally brought in, which is unfortunate. The other things that we are seeing directly related to COVID is that we're seeing this PIMS-TS. So that's post-inflammatory multi-systemic response basically. And it's seen two to three weeks after a child has been exposed to COVID most likely.

Dr. Victoria Agunloye:

The evidence isn't... Not every single child has been proven to have had COVID, but the indication is that they've probably been exposed to at some point and these children are getting fevers for more than five days, they're getting vomiting, diarrhoea, and they're getting rashes. And actually a lot of the symptoms cross between Kawasaki and a sort of streptococcal infection. So it can be quite hard to distinguish, but they come in shocked. Lots of them need fluids. A couple of them will need inotropes. Most of these children make a full recovery, but that's one of the things that within paediatrics, we've been seeing a higher number of.

Dr. Victoria Agunloye:

We've also had a handful of children that have had chest COVID. The ones that I've seen personally luckily haven't been intubated or ventilated for their chest COVID, but they've needed some oxygen and a bit of supplementary, non-invasive support. But once again, they make really good recoveries. Yeah.

Dr. Dane Vishnubala:

Okay. So okay, good to know they all make good recoveries.

Dr. Victoria Agunloye:

Yeah, they do.

Dr. Dane Vishnubala:

But I think with, I guess, the stuff coming out around the systemic issues that some of the children, the hospitals are seeing with some of the children, I think everyone's on high alert to make sure we don't miss stuff and just pass it off as a viral infection, I guess.

Dr. Victoria Agunloye:

Yeah. And I think, if you are in the position where you have the child who is... So, these are the children who, as I said, even before COVID, if you had a child that had had a fever for more than five days who was getting a widespread maculopapular rash, vomiting and diarrhoea, that's the sort of child you probably would have sent to A&E anyway to see a paediatrician. So I think, don't let COVID change that. If this was a child you would have sent in in the first place, send them in.

Dr. Victoria Agunloye:

Equally, if you're like, "Do you know what? I'm not sure if this child needs to go in, am I overthinking it?" Speak to us on the phone. We can give advice on the phone and if we feel that actually this child needs to be seen, they'll be seen again. So don't hesitate to call us just for advice, because we may well say, "Yes, you're right. Actually this sounds pretty straightforward. You've given tight red flag advice. Parents will know where to go if things change."

Dr. Victoria Agunloye:

The other thing that we're seeing is the vasculitis type rash in children that are actually relatively well. And there's evidence that actually these children, that's how the COVID is presented in them. So it's like a vasculitic rash mainly on the lower limbs, so once again, if you were to see this in a child and it's because it's unusual, that's a sort of child I wouldn't be surprised for you to call me about in hospital and say, "I've got this child with an unusual vasculitic rash, petechiae basically, or purpura," and I would want to see that child anyway.

Dr. Victoria Agunloye:

So I think don't overthink the situation. If you think you want secondary advice on it, please call us and we are happy to either see the child or just give you advice on the phone about it.

Dr. Dane Vishnubala:

Perfect. I think it's always where remote consultation is that limit to what you can do remotely and knowing, and I think you've mentioned that time and time again, so far is knowing that limitation and knowing when it does need a face to face or that referral. And some things haven't changed from before.

Dr. Victoria Agunloye:

No, they haven't. They haven't, and I think with remote medicine, the most important thing is there's only certain things you can say and you almost have to give them advice for the different options that may happen. If this happens, do this, this and this. If this happens, do this and this. If you're sure about it, then call us back, or actually the safest thing to do is just to go in. Because no one in A&E is going to be, "You're wasting my time." That doesn't happen.

Dr. Dane Vishnubala:

Yeah. No. Perfect. Yeah. And definitely, I've never noticed someone ever say that for a child, so yeah. Okay. And I guess the other kind of point that always comes up is, we talk a lot about remote consultation in adults and a lot of our podcasts have been around that, but how do you make remote consultation child-friendly? What's the way of doing that?

Dr. Victoria Agunloye:

We're lucky that actually lots of parents, as a parent yourself, take countless videos and pictures of their children anyway. So a lot of children these days are used to being videoed and filmed. I think if a parent wants to send you a video of their child, don't necessarily push the child to do something out of the ordinary. You just want to see the child in their normal state.

Dr. Victoria Agunloye:

So if the parent is saying, "My child is breathing funny," it should be enough to just have a video of a child sat there, watching television, watching their breathing. You don't need much more than that. That gives you a huge amount of information. Also, if you've got a child, a parent says, "I'm concerned my child is not right," and the video is a child running around like a maniac, that gives you tons of information. Actually, this child is probably quite well.

Dr. Victoria Agunloye:

As paediatricians, from a very early age in our training, we are told just be opportunistic. So just a video of a child being a child is generally enough information. One of the things that's quite helpful is the funny movements that sometimes parents complain about. So babies that have funny movements, is this a seizure? Is this not a seizure? I always say to parents, if you're concerned that your child has a funny movement, obviously A, B, C, safety, is the child safe? Are they breathing? All that sort of stuff, and generally they are, and just say to them, "Video it. And then when you get a chance to see your GP, show your GP that video." Just those tiny little snapshots are great, but I feel like it's not about getting the child to perform, just get the video of a child doing whatever they normally do and that will give you plenty of information about how sick this child is or how well they are.

Dr. Dane Vishnubala:

Perfect. No, that's really useful. Okay. Yeah, because there's always the bit with adult medicine where you're trying to get them to do what you want them to do, versus just observe, particularly remotely on a video.

Dr. Victoria Agunloye:

Yeah. Yeah. I mean the older the kids, obviously that would be easier to do, but generally just let the child be themselves and you'll get plenty of information that way.

Dr. Dane Vishnubala:

Perfect. So I guess finally, and not to put you on the spot I guess, as we close up this podcast, it'd be good to know what your take home points are, the things that you want to get across to listeners as a kind of summary in terms of remote consultation in paediatrics, any key tips before we close?

Dr. Victoria Agunloye:

Yeah. So I would say, go with your gut. So if you feel that this child needs to either see you face to face or be seen in hospital, trust that. Listen to the parent, number two. So if the parent says, "I want my child to be seen," make a big effort to see them if you can accommodate that. And if you can't accommodate that, please send them to A&E. And then also just have really good red flag advice, safety netting. So be very clear about what they need to do if X, Y, and Z happens. And that's the safest way I think you can be with regards to remote medicine.

Dr. Dane Vishnubala:

Perfect. And I think I've typed down a few bits. I think, for me, the things you set across, just really remembering that if they're under three months and they've got a fever, really that should be escalated.

Dr. Victoria Agunloye:

Yeah. 100%.

Dr. Dane Vishnubala:

If it's a child with a fever for more than five days, then really start to think about seeing a healthcare professional, not just another remote option. Again, remember the limitations of remote and then the strong safety netting, I think that you've already mentioned time and time again. So Vicky, thanks for joining us. It's been great to have you on and there's been some really interesting points that you've raised as well that I think a lot of people will go away and look at.

Dr. Dane Vishnubala:

So hopefully you guys found this really useful. So, do have a look at some of the topic areas discussed in more detail if you wish. And we've got lots more interesting topics coming up and we'll pick on some of these and maybe, you never know, we might get Vicky back for something else to do. Let us know if there's something you want paediatric-spaced. Get in touch with us. But otherwise, we'll see you on the next episode. And remember, you can find our podcast on Apple Podcasts and on Spotify. So see you on the next one.

Dr. Dane Vishnubala:

As always, do keep in touch with us for future episodes by clicking the subscribe button on Apple Podcast, YouTube, or Spotify. See you on the next one.

(00:39) Episode introduction
(01:00) Introduction to Dr Victoria Agunloye
(01:38) Introduction to the iPhone app, Juno
(02:32) Introduction to On-Call Mummy
(02:54) Dr Agunloye explains how Juno works in more detail
(05:09) Most frequently seen cohort during the rise of remote consultations
(06:19) Types of questions that are asked during a remote paediatric consultation
(12:30) How to use pictures/stills to identify types of rashes using Juno
(17:00) Remote paediatrics tips and tricks for clinicians
(19:18) How to manage symptoms of COVID-19 in children remotely
(26:15) Summary of the main points covering remote paediatrics


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