Discussion
viral exanthems, anxiety, atopic dermatitis, miliaria, unawareness
MILIARIA, ATOPIC DERMATITIS, VIRAL EXANTHEM
Paediatric advice services provide guidance for parents, enhance clinician–patient communication, and improve parental satisfaction and accessibility to non-urgent health advice.The PAL operated via a single mobile phone attended by a clinical staff member during standard business hours on a voluntary rotating roster basis. The overall cost was minimal, with one-off costs for a mobile device and telephone number, given the voluntary basis of the team and the operation during business hours. Given 46.4% of PAL calls required a follow-up consultation, continuity of care was one challenge faced by PAL clinicians. However, detailed clinical documentation with all follow-up consultations occurring within one business day allowed for a streamlined process. Telephone consultation without real-time visualisation of a dermatological complaint provided some difficulty in clinical assessment. Photographs provided by parents assisted in clinical decision making. However, using a live audiovisual telehealth service in future studies may ameliorate this challenge.In our study, the majority of concerns could be addressed by PAL staff alone, and the large majority of concerns were resolved within two telephone calls. This is likely to have reduced the demand on emergency services for non-urgent concerns. Factors including the parent’s perception of urgency, uncertainty in their own assessment of the child’s symptoms and unawareness of service availability all influence a parent’s decision to seek help.Dermatological concerns were the most common reason to contact the PAL across all ages, with a proclivity for summer and winter months. Many dermatological conditions, such as miliaria, atopic dermatitis and viral exanthems, present frequently during early childhood, often with seasonal variability.PAL callers were more likely to be older mothers, first-time parents, university-educated and/or have used IVF or donor gametes compared with non-callers. This is consistent with literature indicating that first-time mothers of a higher maternal age have increased levels of psychological stress and anxiety during both pregnancy and the postpartum period.While patient satisfaction is associated with the availability and use of medical advice lines,Paediatric advice services are well recognised as valuable and convenient means of empowering parents and reducing parental concerns, helping to inform decision making and parental help seeking.