Philadelphia, August 5, 2026 — Telemedicine has become a durable part of pediatric primary care, with its strongest foothold appearing in conditions that often require repeated monitoring rather than a physical examination at every visit. A large observational study led by researchers at Children’s Hospital of Philadelphia (CHOP) found that virtual appointments were used most frequently for behavioral health and endocrine problems between 2019 and 2024. The analysis also suggests that, in the most recent phase of the study, telemedicine may have helped practices accommodate more problem-based visits overall.
The findings, published in Pediatrics, provide one of the broadest examinations to date of how pediatric primary care practices used telemedicine across specific clinical areas. Researchers analyzed electronic health records from 1,088 participating practices and identified 19,633,472 problem-based visits involving patients younger than 18. These were appointments focused on a particular symptom, diagnosis, chronic condition, or health concern, rather than routine preventive care.
Telemedicine use changed dramatically during the study period. In 2019, virtual care accounted for less than 1% of problem-based pediatric visits. As the COVID-19 pandemic disrupted in-person medical services, that share climbed rapidly, reaching 55% in April 2020. Although virtual care declined as offices reopened, it remained embedded in pediatric practice: by 2024, approximately 6% of problem-based visits were conducted through telemedicine.
The study found that behavioral health had the highest proportion of telemedicine visits, at 20%, followed closely by endocrinology at 19%. Dermatology and infectious disease each accounted for 11%, while digestive health represented 10% and respiratory health 9%. These patterns reflect the types of care that can often be delivered through conversation, visual assessment, home measurements, or review of patient-generated data, even when periodic in-person examinations remain essential.
Behavioral health visits may be particularly compatible with telemedicine because diagnosis and follow-up frequently depend on interviews, symptom questionnaires, family observations, and assessments of mood or behavior. Endocrine care may also lend itself to virtual monitoring when clinicians can review laboratory results, medication schedules, growth trends, glucose readings, or other measurements collected outside the clinic. In both areas, a virtual visit can reduce travel and missed work or school while preserving regular contact between families and clinicians.
The researchers also examined whether telemedicine expanded the total number of problem-based visits or merely substituted for appointments that would otherwise have occurred in person. From 2019 through May 2023, each additional telemedicine visit was associated with a statistically nonsignificant net change in total visit volume. After May 2023, however, each additional virtual visit was associated with an increase in overall visit volume. The result does not prove that telemedicine caused the increase, but it raises the possibility that practices became more capable of serving additional patients once virtual care was incorporated into routine workflows.
That distinction is important. During the earliest pandemic months, telemedicine often functioned as an emergency replacement for face-to-face care. Later, it became one component of a hybrid system in which clinicians could choose the format most appropriate for a child’s condition. A virtual appointment may be sufficient for medication follow-up or behavioral health counseling, while a physical examination, diagnostic testing, vaccination, or procedure still requires an in-person visit. By separating these functions, practices may be able to use clinic space and clinician time more flexibly.
The researchers caution that telemedicine access is not evenly distributed. Families may lack reliable broadband, smartphones, computers, private spaces, or devices capable of collecting clinical measurements. Clinicians also face challenges involving scheduling, documentation, privacy, reimbursement, and integration with electronic health records. These barriers can make virtual care less useful for families who might benefit from it most, potentially widening existing disparities unless practices provide technical support and alternative options.
Because the study was retrospective and observational, it cannot determine whether telemedicine improves health outcomes or whether the apparent rise in visit volume reflects other changes in pediatric care. The analysis also did not establish that virtual visits were clinically equivalent to in-person appointments for every condition. Future studies will need to examine missed diagnoses, follow-up completion, treatment response, family burden, equity, and long-term outcomes. Even so, the findings show that telemedicine has moved beyond its pandemic-era emergency role and is becoming a targeted tool for delivering continuing care to children.
Subject of Research: People
Article Title: “Telemedicine use in primary care for children: 2019-2024”
News Publication Date: August 5, 2026
Web References: https://doi.org/10.1542/peds.2025.075498
References: Fiks et al., “Telemedicine use in primary care for children: 2019-2024.” Pediatrics. Published online August 5, 2026. DOI: 10.1542/peds.2025.075498.
Keywords: telemedicine, telehealth, pediatrics, pediatric primary care, behavioral health, endocrinology, chronic conditions, electronic health records, virtual care, healthcare access
