Telemedicine in pediatrics: a critical narrative review of innovations, limitations, and future priorities

Clinical Snapshot

Key Findings

• P Value: Not reported

• Effect Size: Not reported — no quantitative pooling performed

• Primary Outcome: Narrative synthesis suggesting telemedicine can support follow-up, access to specialist care, and family engagement in pediatric chronic-care pathways, particularly diabetes and asthma. Evidence is less mature for acute assessment, neonatal care, rehabilitation, wearables, and AI-enabled tools.

• Nnt Or Sensitivity: Not applicable — no meta-analytic data available from this review. Clinicians seeking effect size estimates should consult primary systematic reviews and RCTs in specific pediatric subspecialties.

• Confidence Interval: Not reported

Clinical Application

Feasibility is context-dependent. The review highlights that successful implementation requires structured hybrid care models, digital literacy support for families, equitable access to devices and connectivity, EHR integration, and clinician training. Organisational and regulatory infrastructure is a prerequisite for safe deployment. Pediatric telemedicine is directly relevant to Australian practice given the country's geographic dispersal, significant rural and remote populations, and existing telehealth infrastructure expanded under Medicare during and after the COVID-19 pandemic. The Royal Australian College of General Practitioners (RACGP) supports telehealth as a complement to in-person care. The Australian Digital Health Agency's national digital health strategy aligns with the hybrid model advocated in this review. Key Australian considerations include: (1) Medicare Benefits Schedule (MBS) telehealth item numbers for pediatric consultations, which remain subject to ongoing policy review; (2) equity of access for Aboriginal and Torres Strait Islander children in remote communities, where connectivity and device access remain barriers; (3) TGA regulatory oversight of AI-enabled diagnostic tools and wearable medical devices used in pediatric remote monitoring; (4) state-based children's hospital telehealth programs (e.g., Queensland Children's Hospital Virtual Care, Sydney Children's Hospitals Network) that already operationalise many of the hybrid models described. The review's conclusions regarding structured, equitable, and clinically appropriate pathways are consistent with RACGP and Australian Commission on Safety and Quality in Health Care guidance on telehealth governance. Children and adolescents with chronic conditions (particularly diabetes and asthma) who require ongoing specialist follow-up, remote monitoring, or care coordination. Application to acute presentations, neonates, and rehabilitation populations requires further evidence before routine implementation.

Abstract

UNLABELLED: This narrative review synthesizes recent technological and organizational developments in pediatric telemedicine, maps their principal clinical applications, and critically discusses implementation, safety, equity, and future priorities. This narrative review used a transparent, non-systematic literature-search approach in PubMed/MEDLINE, Scopus, and Google Scholar, considering publications available through April 2026. Searches were intended to identify and contextualize relevant literature across pediatric settings rather than to provide an exhaustive, reproducible systematic evidence synthesis. No formal risk-of-bias assessment, meta-analysis, or certainty-of-evidence grading was undertaken; therefore, findings are interpreted cautiously and according to the maturity and consistency of the available evidence. Evidence suggests that telemedicine can support follow-up, access to specialist care, and family engagement in several pediatric chronic-care pathways, particularly diabetes and asthma. However, the evidence base is heterogeneous across specialties, frequently relies on observational or implementation studies, and is less mature for acute assessment, neonatal and rehabilitation uses, wearables, and AI-enabled tools. CONCLUSION: Telemedicine should be considered a complementary component of pediatric healthcare rather than a replacement for in-person assessment. Hybrid models may support accessibility, continuity, and sustainability when embedded in structured, patient-centered, equitable, and clinically appropriate pathways. WHAT IS KNOWN: • Telemedicine expanded rapidly in pediatrics during the COVID-19 pandemic and is now used across many specialties. • It can improve access, continuity of care, remote monitoring, and family engagement, especially in chronic and complex conditions. WHAT IS NEW: • This review summarizes recent technological and organizational innovations, including wearables, mHealth, EHR integration, AI, and hybrid care models. • It highlights current limits and future requirements for safe, equitable, and sustainable integration into routine pediatric care.

References

1. 1.Zuccotti, G., Scavone, I. A. M., Cordaro, E., Rossi, V., & Calcaterra, V. (2026). Telemedicine in pediatrics: a critical narrative review of innovations, limitations, and future priorities. European Journal of Pediatrics. https://doi.org/10.1016/j.acap.2025.102791