text: Pediatric Telehealth in the COVID 19 Pandemic Era and Beyond The coronavirus disease 2019 COVID 19 pandemic led to an unprecedented demand for health care at a distance and telehealth the delivery of patient care using telecommunications technology became more widespread Since our 2018 state of the art review assessing the pediatric telehealth landscape there have been many changes in technology policy payment and physician and patient acceptance of this care model Clinical best practices in telehealth on the other hand have remained unchanged during this time with the primary difference being the need to implement them at scale Because of the pandemic underlying health system weaknesses that have previously challenged telehealth adoption including inequitable access to care unsustainable costs in a fee for service system and a lack of quality metrics for novel care delivery modalities were simultaneously exacerbated Higher volume use has provided a new appreciation of how patients from underrepresented backgrounds can benefit from or be disadvantaged by the shift toward virtual care Moving forward it will be critical to assess which COVID 19 telehealth changes should remain in place or be developed further to ensure children have equitable access to high quality care With this review we aim to 1 depict todays pediatric telehealth practice in an era of digital disruption 2 describe the people training processes and tools needed for its successful implementation and sustainability 3 examine health equity implications and 4 critically review current telehealth policy as well as future policy needs The American Academy of Pediatrics AAP is continuing to develop policy specific practice tips training modules checklists and other detailed resources which will be available later in 2021 