TeleMEDICINE

Making a telemedicine appointment is simple, and can be done in 2 easy steps.

REGISTER: 

Register for a free account-you can do this even before you or your child needs a telemedicine visit. 

Access care quickly and easily — via the Mia Bella Pediatrics/Anytime Telecare website or App (click for Apple products or Windows/Google)— from your smartphone, tablet or computer. The Mia Bella Pediatrics practice code is 0001.

Then, tell us a little bit about yourself, including:

• Your name and contact information.
• Your health insurance provider and policy number (optional)-we have this on file at the office
• Your preferred Mia Bella Pediatrics physician name so that we can share notes from your visit
• Set up your child’s profile (or your profile if you are the patient). Simply tell us: Name, birthdate, gender, height and weight, and about any allergies, current medications, and medical conditions

TO SCHEDULE A VISIT:

Mia Bella Pediatrics has selected that only our office staff or physicians can schedule appointments. Thus, once you have created an account and registered, please call the office (949) 206-0001 to make your telemedicine appointment.

In the future, Mia Bella Pediatrics may introduce options for patients and families to self-schedule and ask for their own appointment times.

BEFORE LOGGING ON:

1. Use a brightly-lit room.
2. Use a room that is QUIET (away from the TV, other siblings, the barking dog, dad singing karaoke, etc). 
3. Use a room where you have the best cellular service (if using smartphone), the best wifi connection (a wireless laptop), or a desktop with a LAN connection (“hardwired computer).
4. For kids 4 and under, don’t be afraid to bend the screen time rules a bit!  Use their favorite video to get them to sit still for a few minutes so you can take your child’s temperature, heart rate, and respiratory rate (see below).
5. Take your (or your child’s):

• Weight (if your child won’t cooperate, stand on the scale while holding your child and record the combined weight of you and your child. Then stand on the scale by yourself and record your weight.  Subtract your weight from the combined weight to get your child’s weight).
• Temperature (number and method of measurement)
• Heart rate-count the number of beats in 30 seconds (put your hand on their chest and count each time their heart beats)
• Respiratory rate-count the number of breaths in 30 seconds (again, put your hand on their chest and count each time their chest goes out)
• Photos that are up-close and well-focused, if applicable (rashes, wounds, visible injuries, etc)

LOGGING ON:

1. Log-in to your Anytime Pediatrics account 15 min prior to your appointment time.

2. Click on the appointment icon:

• ​If using your smartphone: Click on the calendar icon with the red #1 at the bottom of the page, which takes you to the “My Appointments” page.
• If using a laptop or desktop: Click on the “My Appointments” tab with the red #1 at the top of the page, which takes you to the “Appointments” page.

3. Click on the green “Start Visit” button on the far right next to the appointment that has been created by our office for you.

4. Select “Chief complaint” (why did you make an appointment) on the drop down

5. On “visit details,” fill out ALL questions:

• Weight
• ALL medications (prescription, over the counter, vitamins/supplements)
• Additional Symptoms (a brief description of ALL symptoms and concerns).  
• Please enter TEMPERATURE, HEART RATE AND RESPIRATORY RATE HERE!
• Upload CLOSE UP AND FOCUSED photos of rashes, wounds, or other physical findings that are of concern.
• Hit “continue” and the appointment will send an alert to our Medical Assistant, who will begin a written “chat” with you to make sure all of your information for the appointment is ready.  
• ONCE ALL THE ABOVE HAS BEEN COMPLETED, and it’s your appointment time, your Mia Bella physician will then start the virtual video appointment.

There are many visits that may qualify for our new telemedicine services. Ultimately Dr. Dina, Dr. Kraft, or Dr. McNulty will determine if you should come in for an in-office visit. If your diagnosis requires a physical examination or tests/xrays for diagnosis (i.e. knee pain, dizziness, difficulty breathing, sore throat), a telemedicine visit is likely not appropriate, and you should call our office for an in-office visit. You can then wait in your car until it is time for you to be roomed.

Examples of types of visits that can be done via telemedicine are:

Same day visits:

• Abdominal pain
• Constipation
• Croup
• Diarrhea
• Pink eye
• Rashes
• Stye
• Thrush
• Viral illness (Fifth disease, Roseola, Hand/Foot/Mouth, the common cold)
• Vomiting (Gastroenteritis/stomach flu)

Comprehensive visits:

• ADHD medication follow-ups
• Anxiety and depression follow-ups
• Behavioral/Development consult (developmental delay, temper tantrums, anger management)
• Feeding or sleeping issues
• Maintenance medication appointments (Asthma, Allergies)
• Nutrition/Obesity follow-ups
• School difficulties (Learning Disabilities/IEP/504) follow-ups

Your visit will be billed similarly as to when you are in the office. Your Copay/coinsurance will be collected before the appointment begins. A debt or credit card MUST be on file for all telemedicine appointments.

You will be responsible for the cost of the visit. You are responsible for determining if this is a covered service with your insurance.

If you come into the office on the same day from the telemedicine visit, you will only be charged once, as both visits count as one. If you do not come into the office on the same day, we are unable to combine the visits, as insurance limits us to a single day time frame. For these two visits, you will be billed for each visit separately.

Mia Bella Pediatrics has decided to make it policy that only established patients can utilize our telemedicine component. It will be easier to provide appropriate care to patients with an established patient-doctor relationship. Thank you for understanding.

However, we are more than happy to see new patients in person in a timely manner. Please call the office to make an appointment.

As long as you have been seen within 2 years, we can conduct a telemedicine visit.

When Does Your Child Have a Fever?

• Rectal, Forehead or Ear temperature: 
• 100.4° F (38.0° C) or higher
• Oral (mouth) temperature: 100° F (37.8° C) or higher
• Under the arm (armpit) temperature: 99° F (37.2° C) or higher
• Caution: Ear temperatures are not accurate before 6 months of age

Where to Take the Temperature

• Rectal temps are the most accurate. Forehead temps are the next most accurate. Oral and ear temps are also accurate if done properly. Temps done in the armpit are the least accurate. Armpit temps are useful for screening at any age.
• Age under 3 months old (90 days old). An armpit temp is the safest and is good for screening. If the armpit temp is above 99° F (37.2° C), re-check it. Use a rectal reading. Reason: If young babies have a fever, they need to see a doctor now. New research shows that forehead temps may also be accurate under 3 months of age.
• Age 3 months to 4 years old.  Rectal or forehead temps are accurate. An ear thermometer can be used after 6 months old. An armpit temp is good for screening if it is taken right.
• Age 4 years and older.  Safe to take the temp orally (by mouth). Ear and forehead thermometers are also good.
• Digital (electronic) thermometers are easily found in stores. They do not cost very much. They can be used for rectal, armpit and oral temps. Most of them give an accurate temp in 10 seconds or less. The AAP suggests you replace any glass thermometer in the house with one of these products.

Rectal Temperature: How to Take

• Age: Birth to 4 years old
• Have your child lie stomach down on your lap. Another way is on the back with the legs pulled up to the chest.
• Put some petroleum jelly on the end of the thermometer and the anus.
• Slide the thermometer gently into the anus no more than 1 inch. If your child is less than 6 months old, put it in no more than ½ inch. That means until you can no longer see the silver tip.
• Be gentle. There should not be any resistance. If there is, stop.
• Hold your child still. Leave a digital thermometer in until it beeps (about 10 seconds).
• Your child has a fever if the rectal temp is above 100.4° F (38° C).

Armpit Temperature: How to Take

• Age: Any age for screening
• Put the tip of the thermometer in an armpit. Make sure the armpit is dry.
• Close the armpit by holding the elbow against the chest. Do this until it beeps (about 10 seconds). The tip of the thermometer must stay covered by skin.
• Your child has a fever if the armpit temp is above 99.0° F (37.2° C). If you have any doubt, take your child's temp by rectum or forehead.

Oral Temperature: How to Take

• Age: 4 years and older
• If your child had a cold or hot drink, wait 30 minutes.
• Put the thermometer under one side of the tongue towards the back. It's important to put the tip in the right place.
• Have your child hold the thermometer with his lips and fingers. Don't use the teeth to keep in place. Keep the lips sealed until it beeps (about 10 seconds).
• Your child has a fever if the temp is above 100° F (37.8° C).

Digital Pacifier Temperature: How to Take

• Age: Birth to 1 year. Only good for screening. Requires the baby to suck on it, which is not always possible. 
• Have your child suck on the pacifier until it beeps (about 10 seconds).
• Your child has a fever if the pacifier temp is above 100° F (37.8° C).

Ear Temperature: How to Take

• Age: 6 months and older (not accurate before 6 months)
• This thermometer reads the heat waves coming off the eardrum.
• A correct temp depends on pulling the ear backward. Pull back and up if over 1 year old.
• Then aim the tip of the ear probe between the opposite eye and ear.
• Parents like this thermometer because it takes less than 2 seconds. It also does not need the child to cooperate. It does not cause any discomfort.
• Caution. Being outdoors on a cold day will cause a low reading. Your child needs to be inside for 15 minutes before taking the temp. Earwax, ear infections and ear tubes do not keep from getting correct readings.

Forehead (Temporal Artery) Temperature: How to Take

• Age: Any age
• This thermometer reads the heat waves coming off the temporal artery. This blood vessel runs across the forehead just below the skin. 
• Place the sensor head at the center of the forehead.
• Slowly slide the thermometer across the forehead toward the top of the ear. Keep it in contact with the skin. 
• Stop when you reach the hairline. 
• Read your child's temp on the display screen.
• Note: some newer forehead thermometers don't need to slide across the forehead. Follow the box directions on how to take the temp.
• Used in more doctor's offices than any other thermometer.
• Parents like this thermometer because it takes less than 2 seconds. It also does not need the child to cooperate. It does not cause any discomfort.
• Caution: Forehead temperatures must be digital. Forehead strips are not accurate.

Copyright 2000-2020 Schmitt Pediatric Guidelines LLC

To take your child's pulse, you will need a watch with a minute hand or stopwatch app (easier) with the minutes and seconds displayed. Find a quiet place where your child can sit or lie comfortably.

If your child has just been active (running, jumping, crying, etc.), wait at least 5 minutes to allow the heart time to slow down and return to a normal beat.

To feel a pulse, you press two fingers — your index ("pointer") and middle fingers — onto a major artery in the body. Press gently. Never press with your thumb, as it has a pulse all its own and can throw off a reading. When you've located the pulse, you will feel a throbbing sensation.

There are several areas on the body to read a pulse, but in kids these are generally the easiest places:

• On the neck (carotid artery pulse). The carotid artery runs along either side of the throat (windpipe). Run your fingers about halfway down the neck and press gently to the left or right side of the windpipe (carefully avoiding the Adam's apple in teen boys). Press gently. You should feel the pulse. If not, try again or on the other side.
• On the wrist (radial pulse). This is the spot where most adults have their pulse taken. It can work well in kids, too. To find the right spot, place a finger at the base of your child's thumb and slide it straight down to the wrist. On the wrist, press gently to feel for the pulse. This works best if your child's hand is lying flat or bent slightly backward.
• In the armpit (axillary pulse). Press your fingertips into the armpit, feeling around for the arm bone. When you feel the arm bone beneath your fingers, you should also feel the pulse. This method works well for infants. · In the crease of the elbow (brachial pulse). This location works best for infants. Place your infant on his or her back with one arm flat along the baby's side (elbow crease facing up). In the crease of the elbow, gently place your fingers on the inside of the arm (the pinky side). Feel around for a pulse. Once you've located the pulse (feeling a "throbbing" or "beating" sensation on your fingers), begin counting the beats within a 30-second timeframe. After 30 seconds, stop. Take the number of beats (for example, 45 beats in a 30-second period) and double it. 

So:

• 45 x 2 = 90 beats per minute. The heart rate for your child would be 90, which is within the normal range for most kids. (This is just an example; your child's heart rate may be different.)

If you don't feel comfortable taking a pulse this way, or have difficulty, there is another option. Many smartphone apps and Apple watches can give pulse readings simply by pressing a finger over the camera lens or watch. For a good reading, your child needs to be very still, so this method works best in older kids who are more cooperative.

Set a timer for 30 seconds and count the number of times your child’s chest rises. Double that number to get his respiratory rate.

If your baby or child has any of the following symptoms, it could mean he’s having trouble breathing- please call us or 911 immediately:

• Bluish color around the mouth
• Pale or gray skin
• A grunting sound with each breath out
• Nose flaring
• Significant wheezing
• Upper chest sinks in with each breath

To measure height accurately at home:

1. Remove the child or teen’s shoes, bulky clothing, and hair ornaments, and unbraid hair that interferes with the measurement.
2. Take the height measurement on flooring that is not carpeted and against a flat surface such as a wall with no molding.
3. Have the child or teen stand with feet flat, together, and against the wall. Make sure legs are straight, arms are at sides, and shoulders are level.
4. Make sure the child or teen is looking straight ahead and that the line of sight is parallel with the floor.
5. Take the measurement while the child or teen stands with head, shoulders, buttocks, and heels touching the flat surface (wall). (See illustration.) Depending on the overall body shape of the child or teen, all points may not touch the wall.
6. Use a flat headpiece to form a right angle with the wall and lower the headpiece until it firmly touches the crown of the head.
7. Make sure the measurer’s eyes are at the same level as the headpiece.
8. Lightly mark where the bottom of the headpiece meets the wall. Then, use a metal tape to measure from the base on the floor to the marked measurement on the wall to get the height measurement.
9. Accurately record the height to the nearest 1/8th inch or 0.1 centimeter.

1. Use a digital scale. Avoid using bathroom scales that are spring-loaded. Place the scale on firm flooring (such as tile or wood) rather than carpet.
2. Have the child or teen remove shoes and heavy clothing, such as sweaters.
3. Have the child or teen stand with both feet in the center of the scale.
4. Record the weight to the nearest decimal fraction (for example, 55.5 pounds or 25.1 kilograms).