Before the consultation
Send out any information beforehand
Advise the parent what will be needed for the consultation to give them time to prepare and so they know how to position the child (e.g. so you can assess joint ranges). Photographs or video guides may be helpful.
Plan the timing of the appointment depending on your goals
Decide whether you want to avoid nap, medication or feeding times or if this will be part of your assessment.
Consider two appointments
One for talking and taking history and another for assessing movement (if this is all done at once it can be a lot for families and children to cope with):
"Complete a triage phone call with a subjective assessment prior to a video call - I find you are then able to target objective assessment or treatment better and are able to prepare the parent or school for what to expect before the call. I find this allows for less stress and better engagement from the child, otherwise the child gets bored and loses interest.” Physiotherapist, Paediatrics
Who should be involved?
If possible involve two adults
If only one parent is present, advise them to use hands-free support or position the device somewhere stable so they are able to engage with the child during the assessment.
“One adult can position the camera, another can feed back which position is best and model what the child needs to do, or to help position them.” Occupational Therapist, Generic
Consider having two therapists present
One can engage with the parent(s) and child while the other observes.
Observe the child’s normal routine and play
With the parent’s consent, you could take the opportunity at the beginning or end of the consultation, and/or if the child or parent needs a break. This will allow you to see them in their ‘natural’ environment. “You could ask the parents to turn on their camera at the start and just observe before they ask the child to get involved.” Medic, GP and Emergency Medicine
With younger children
Be led by their play, encourage parents to use a portable device such as a smartphone or tablet so that they can follow the child as they move around the room or house. You could use music or ask the parents to involve siblings to keep the child engaged during the appointment. “You can use a doll to demonstrate on.” Physiotherapist, Paediatrics
Empower the parent to take control
Work with them to decide on specific goals, activities or exercises, and encourage them to work on these in between sessions and feed back on progress.
For a successful video consultation with children
The child needs to be in a good place, not tired or hungry or ill. The parent needs to have time. The therapist needs good communication skills to conduct the session and be able to adapt according to needs of the parent.
Remote consultations with teenagers
There should be negotiation with the teenager and parent about for how much of the session the parent is present. “The aim is for teenagers to self-manage, not be nagged by their parents!” Consultant, Rehabilitation Medicine