Online doctor for kids in Puerto Rico: babies, children and teens

It's a video visit, in English or Spanish, with Dr. Diana Nieves Castro, MD: a general practice physician licensed in Puerto Rico, with several years of emergency-department experience. That background helps her sort out quickly what can be treated at home and what needs a next step.

We see adults and children of all ages: babies, kids, teens, and 18- to 20-year-olds, who are still minors under Puerto Rico law. If your child has a regular doctor, let them know about the visit and any new medicine, as the American Academy of Pediatrics (AAP) recommends. Visiting the island? The same visit works for your family while you're here.

Here's how it works:

The most common reasons parents book, at any age:

• Colds, coughs, congestion and fever.
• Sore throats and ear pain in children.
• Pink eye, allergies and bug bites.
• Rashes and skin problems: diaper rash, eczema, hives, hand, foot and mouth, teen acne.
• Common at school and daycare: chickenpox, impetigo, molluscum contagiosum, head lice and pinworms.
• Diarrhea and vomiting, constipation and mild tummy aches.
• Burning when peeing or a possible urinary tract infection.
• Asthma and other diagnosed conditions: follow-up and medication refills.
• Medication questions, and a note for school or daycare.

Many childhood illnesses are diagnosed from the history and what the doctor sees on camera. When that isn't enough, a lab order completes the picture: a throat test or culture if she suspects strep, for example, or a urine test if she suspects a urinary infection. She reviews the result and adjusts treatment.

Most colds are viral and don't get better with antibiotics, so the doctor prescribes one only when the evaluation calls for it. The FDA says children under 2 should not be given any cough and cold product containing a decongestant or antihistamine, and manufacturers label these products "do not use in children under 4 years of age."

In Puerto Rico the age of majority is 21, and the medical board's telemedicine regulation (Reglamento 9107, Regla 19) requires written authorization from whoever holds patria potestad (parental authority) or from a court-appointed guardian. Here's how it works in your child's visit:

• You sign the written consent as a parent with patria potestad or as a legal guardian.
• You show photo ID on camera at the start of the visit.
• You stay on camera for the whole visit, even if your child is an 18- to 20-year-old.

Another adult, such as a grandparent or nanny, is welcome to sit in but can't take the parent's or guardian's place. If the parent or guardian check can't be completed, the visit doesn't go ahead and you get a full refund. Visits are not recorded.

If your child missed school because they were sick and the doctor considers it appropriate after the evaluation, she gives you a doctor's note dated the day of the visit, at no extra charge.

Puerto Rico public schools accept a written excuse signed by the parent or guardian within 5 days of the absence, under the Department of Education's attendance regulation, and a school can ask for medical certification, for example when health-related absences keep recurring. Private schools and daycares set their own rules: ask which document they accept.

For your child's safety, if you see any of these signs, call 911 or go to the emergency room, even in the middle of the night. If you think your child swallowed something harmful, call Poison Help at 1-800-222-1222.

Book a visit soon if a fever lasts more than 24 hours in a child under 2, more than 3 days in a child 2 or older, 5 days or more at any age, or keeps going above 104 °F (40 °C).

• Under 3 months: a temperature of 100.4 °F (38.0 °C) or higher. Go to the ER right away.
• Under 1 year: a weak, high-pitched or nonstop cry; a bulging soft spot; fewer wet diapers with listlessness; green or bloody vomit; can't keep fluids down.
• 1 to 5 years: high-pitched noisy breathing at rest; drooling or unable to swallow; peeing only once or twice a day, sunken eyes or cold hands.
• 6 to 17 years: a severe headache with a stiff neck; chest pain or fainting during exercise; severe pain in the lower right belly; testicle pain; shortness of breath with asthma despite the inhaler; thoughts of self-harm (call 988 or Línea PAS).
• Any age: a rash with fever that doesn't fade under a pressed glass, a seizure, a stiff neck, a child who is very floppy or hard to wake, trouble breathing or bluish lips, or signs of severe dehydration.