The call usually comes in after dinner. Sometimes it’s a worried mom. Other times, it’s a dad just trying to avoid another late-night urgent care run.
“Doc, my daughter’s running a fever. Can we just do this online?”
It’s a good question. And one I get a lot at Health Express Clinics, especially during flu season or when cedar pollen blankets Lewisville like powdered sugar on a funnel cake.
Virtual visits can be a game-changer for pediatric care—but only if we use them wisely. So let’s talk about when I feel confident treating a child remotely, and when I want to see them in person.
Let’s Start with Fevers: What’s Safe for Telehealth?
Fever in kids makes every parent nervous. I get it. I’m a parent too.
But fever, by itself, isn’t always dangerous. It’s the body’s natural response to infection—a sign the immune system is doing its job. What matters more is:
- How high is the fever?
- How long has it lasted?
- How is the child acting?
If you tell me your 7-year-old has 101.5° and is still eating chicken nuggets and asking to play Xbox? We’re likely okay doing a virtual visit. I can walk you through supportive care, dosing acetaminophen or ibuprofen, and when to check back in.
But I had a case recently—a 3-month-old with a 100.6° fever. The parents wanted to do a telehealth visit. I gently explained that any fever in an infant under 3 months is an automatic “needs to be seen.” Full stop. The risk of serious bacterial infection is just too high.
Red flags that need in-person care:
- Babies under 3 months with any fever
- A child who’s lethargic or not making eye contact
- Difficulty breathing, rapid breathing, or grunting
- Fever lasting 5+ days with no improvement
In many cases, I start the evaluation virtually, and if anything feels off, we bring them in. It’s not about being cautious. It’s about being smart.
Allergies: A Slam Dunk for Virtual Visits
Now, when it comes to allergies? I’m all in on virtual care.
We live in North Texas. Our air is basically a cocktail of cedar, ragweed, mold spores, and dust mites. And let me tell you—kids in Lewisville get hit hard.
The typical story goes like this:
“Sneezing. Runny nose. Itchy eyes. No fever.”
If that’s what you’re describing, chances are it’s allergic rhinitis. We can treat that via telehealth 95% of the time. I usually recommend:
- A second-generation antihistamine (like cetirizine or loratadine)
- Saline nasal rinses (if the child tolerates it)
- Possibly a steroid nasal spray (with guidance)
I had one 10-year-old patient who came to me every spring like clockwork. We handled his allergies virtually for three years straight. His mom told me, “As long as you can keep him in school and sleeping at night, we’re good.”
And that’s the goal, right?
The main time I’d ask you to come in for allergy symptoms is if things start looking like sinusitis or an asthma flare. If there’s facial pain, thick green discharge, or wheezing—it’s probably more than allergies.
Common Parent Questions (I Hear These a Lot)
“Doc, she has a 102 fever but she’s still running around the house. Should I be worried?”
Not necessarily. If she’s playful and hydrated, that’s more reassuring than any number on a thermometer. Still, if the fever sticks around for more than 3 days, let’s talk.
“Can you diagnose strep throat online?”
Sometimes I can make a strong guess based on symptoms—sudden sore throat, no cough, fever, swollen glands. But I prefer a rapid test. We can do a curbside swab or bring you in quickly.
“Are antibiotics safe to prescribe without an exam?”
Depends. I’m conservative with antibiotics. If it’s a classic UTI or clear sinusitis, maybe. But I try to avoid overprescribing—especially in kids.
“Can I show you my kid’s rash on video?”
Absolutely. Just take a photo in natural light, not under a yellow bulb. Rashes like eczema, hives, or contact dermatitis often look textbook on camera.
A Local Twist: How DFW Kids Present Differently
Something I’ve noticed? Kids around here often show allergy symptoms as chronic cough instead of the stereotypical itchy eyes. It throws parents off. They think it’s a cold that never went away.
Especially during spring and fall, I see a lot of kids with what sounds like a mild bronchitis, but it’s really post-nasal drip from seasonal allergies.
One 8-year-old in The Colony came in after three rounds of cough syrup. No luck. We switched gears, started Zyrtec and Flonase. Cough gone in three days.
When Virtual Doesn’t Cut It (And That’s Okay)
As much as I believe in telehealth, I also know its limits.
We had a 5-year-old with what looked like strep. The mom showed me his throat on camera, and I could kind of see some white patches. But something about the kid’s voice concerned me. It was hoarse—deeper than expected. I told her to bring him in.
Glad she did. He had peritonsillar swelling that could’ve become an abscess. We started antibiotics and monitored him closely. That one taught me: trust your gut, even over video.
Another time, a toddler had a mild rash and runny nose. Looked like a viral exanthem. But she was listless, not nursing well, and had a weird whimper when her mom picked her up. Red flags.
I say this a lot: if something feels off to you, it probably is.
What the Latest Guidelines Say
The American Academy of Pediatrics recently released a position paper encouraging the expanded use of telehealth for low-acuity pediatric conditions—like allergies, mild fever, pink eye, and medication refills.
But they emphasized something I’ve always believed:
The key is continuity and clinical judgment.
That’s why at Health Express Clinics, we try to offer virtual care within the framework of a practice that knows your child. You’re not getting a random provider each time.
Seasonal Tips for Parents in North Texas
- Hydrate more than you think you need to. The heat sneaks up, especially during spring sports.
- Watch for allergy triggers early. February through April is brutal for cedar and oak.
- Don’t ignore mild coughs that last more than 2 weeks. Might not be viral. Could be allergy-related.
- Be cautious with over-the-counter meds. Especially multi-symptom cold syrups—they’re often not needed.
Final Thoughts (Doctor to Parent)
I always tell parents: your gut instinct matters.
If something doesn’t feel right, reach out. We can often start with a virtual visit, save you the car ride, and still get your child the care they need.
But if I think your kid needs to be seen in person? I’ll tell you straight. That’s the promise I make to every parent who calls me.
Reviewed by Harveer Parmar, MD, Family Medicine, Health Express Clinics, Lewisville, TX.