The Royal Children's Hospital (RCH) in Melbourne has been providing web-based video-consultations for a range of paediatric sub-specialties since 2011. There were 346 video-consultations in the first 16 months, from a total of 65 clinicians. Most teleconsultations were with the family at home. Generally, video-consultation was used for follow-up, after at least one face-to-face visit. A total of 132 users (specialist and regional clinicians, patients and families) responded to an online survey. The major reason for both clinicians and families participating in telehealth was the savings in families' travel time. Key factors for the successful implementation of telehealth at the RCH include: a clear organisational vision; simple web-based technology; clinician ownership; sustained support. The RCH experience suggests that telehealth is suitable for both simple and highly complex paediatric patients.