Online doctor for kids and teens in Puerto Rico

Our online doctor for kids in Puerto Rico is a video visit with Dr. Diana Nieves Castro, MD, a general practice physician licensed in Puerto Rico, for children 6 months and older who are in Puerto Rico. She is not a pediatrician; she treats common childhood problems. A parent with parental authority or a legal guardian signs the consent and stays on camera for the whole visit. It costs US$79, the same as for adults.

Video visit: US$79 · Pay by card · See the price and what is included

Is this an emergency?

This is not an emergency service. Call 911 or go to the nearest emergency room if you have:

A baby under 3 months with a temperature of 100.4 °F (38.0 °C) or higher.
A rash with fever that doesn't fade when you press a glass against it.
A seizure, a stiff neck, or a child who is very floppy or hard to wake.
Trouble breathing: ribs pulling in, flaring nostrils, noisy breathing at rest or bluish lips.
Drooling or unable to swallow.
Signs of dehydration: hardly peeing, sunken eyes, crying without tears, or can't keep fluids down.
Green or bloody vomit, or severe pain in the lower right belly.
Testicle pain, or a hard blow to the head.
Thoughts of self-harm: call 988 or Línea PAS (1-800-981-0023).

Help lines:

911 — Emergencies
1-800-981-0023 — Línea PAS (mental-health crisis line)
988 — Suicide & Crisis Lifeline
1-800-222-1222 — Poison Help

Warning signs: when to go to the ER

Book a visit

Who sees your child

Dr. Diana Nieves Castro, MD, is a general practice physician licensed in Puerto Rico, with several years of emergency-department experience. She is not a pediatrician. For children she treats common problems that can be assessed well on video, and she will tell you plainly when your child needs an in-person visit or a pediatric specialist.

If your child has a regular doctor, that practice remains their medical home for checkups, vaccines and long-term care. The American Academy of Pediatrics (AAP) asks telehealth services outside the medical home to coordinate with it, so please let your child's regular doctor know about the visit and any new medication. If you are visiting or have just moved and don't have one yet, the doctor can help you judge what can wait.

What an online doctor for kids in Puerto Rico can handle

As long as your child looks well and the doctor judges video to be safe:

Coughs and colds without breathing trouble.
Fever with an obvious cause in a child who looks well, within the age and duration limits below.
Pink eye.
Common rashes: eczema, diaper rash, hives with no other symptoms, bug bites and hand, foot and mouth disease. See also rashes in children.
Diarrhea and vomiting without signs of dehydration.
Constipation, seasonal allergies and teen acne.
Medication questions and follow-up visits.
A school note, only after a real visit for a current illness.

What we can't do by video for children

Some things need an instrument, a test or a vaccine, and a screen can't provide them:

Confirming an ear infection. Diagnosing a middle-ear infection means looking at the eardrum with an otoscope. By video we can advise you and help with pain; see ear pain in children.
Strep tests. A sore throat that might be strep needs a rapid test or throat culture in person.
Urine tests for young children. A possible urinary infection in a young child needs a urine test in person.
Fever with no clear cause in a child under 2 that has lasted more than 24 hours, because a urine test may be needed.
Vaccines, the PVAC-3 (hoja verde) vaccination certificate and well-child checks.
Health certificates and school, daycare or sports physicals. See school health forms in Puerto Rico.
Controlled substances, such as ADHD stimulants.
Babies under 6 months: we don't see them.

Parent or guardian rules

Patients under 21: a parent with patria potestad (parental authority) or a legal guardian signs the written consent, stays on camera for the whole visit and shows photo ID on camera. Visits are not recorded. Note that in Puerto Rico the age of majority is 21, so this applies to 18- to 20-year-olds too.

For now we don't accept other adults in the parent's place: a grandparent, aunt or nanny can't bring the child to the visit, even with the parents' permission, unless they are the legal guardian.

If the parent or guardian check can't be completed, the visit doesn't go ahead and you get a full refund. See cancellations and refunds.

Warning signs by age: when to go to the ER

If your child has any of these signs, don't wait for a visit: 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.

A baby under 3 months with a temperature of 100.4 °F (38.0 °C) or higher needs medical care right away. We don't see babies under 6 months.

Get an in-person visit soon, even if it isn't an emergency, 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).

Any age, emergency: 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.
6 to 12 months, emergency: a weak, high-pitched or nonstop cry; a bulging soft spot; fewer than 6 wet diapers a day with listlessness; green or bloody vomit; can't keep fluids down. In-person visit soon: breathing more than 50 times a minute, feeding poorly, or fever with pulling at the ear.
1 to 5 years, emergency: high-pitched noisy breathing at rest; drooling or unable to swallow; peeing only once or twice a day, sunken eyes or cold hands. In-person visit soon: breathing more than 40 times a minute, or ear pain with fever.
6 to 17 years, emergency: 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). In-person visit soon: a sore throat with fever and no cough (needs a strep test) or pain when peeing (needs a urine test).

How to prepare for your child's video visit

Good preparation makes a video visit far more useful. Have ready:

Your photo ID (parent or guardian).
Your child's current weight: children's medication doses are based on weight.
A thermometer, and the last temperature reading with the time you took it.
Any medications your child takes or you have given, and any allergies.
Good light, and your child on camera, awake if possible.

Medicines for children

If appropriate, the doctor can prescribe medication. We do not prescribe controlled substances. For children, doses are based on weight.

The FDA says children under 2 should not be given any cough and cold product that contains a decongestant or an antihistamine, and manufacturers label these products "do not use in children under 4 years of age." Most colds are viral and don't improve with antibiotics; see antibiotics by telehealth.

Price and school notes

A child's visit costs US$79, the same as an adult's. A prescription, lab order or note, if the doctor gives one, has no extra charge: it's part of the visit. See pricing.

Puerto Rico public schools accept a written excuse signed by the parent or guardian within 5 days of the absence, so a doctor's note is often not needed. Private schools and daycares set their own rules. If a school asks for a medical note, the doctor can write one after evaluating your child. For more on getting ready, see the parents' guide to a child's video visit.

Before you book

You must be physically in Puerto Rico during the visit (visitors and tourists are welcome).
We see patients from 6 months old. Patients under 21: a parent or legal guardian must be on camera for the whole visit.
Real-time video only; we do not do phone-call visits.
We do not prescribe controlled substances.

What we don't do by telehealth

Frequently asked questions

What kind of doctor will see my child?: Dr. Diana Nieves Castro, MD, a general practice physician licensed in Puerto Rico. She is not a pediatrician. She treats common problems in children from 6 months old and will tell you when a pediatric specialist or an in-person visit is needed.
Can a grandparent join the visit instead of a parent?: Not unless they are the child's legal guardian. A parent with parental authority or a legal guardian must sign the consent, stay on camera for the whole visit and show photo ID.
Do you see babies under 6 months?: No. We see children from 6 months old. A baby under 3 months with a temperature of 100.4 °F (38.0 °C) or higher needs medical care right away: go to the ER.
Can you confirm an ear infection by video?: No. Confirming a middle-ear infection means looking at the eardrum with an otoscope, in person. By video the doctor can advise you, help with pain and tell you how soon your child should be seen.
How much does a child's visit cost?: US$79, the same as for adults. You pay by card when you request the visit, and if it can't take place you get a full refund.