A pediatric pulmonologist is a physician who specializes in treating a wide variety of respiratory problems in children. This is a specialized pediatrician who has completed four years of medical school, three years of a pediatric residency, and at least three years of training in pediatric pulmonology.
A pediatric pulmonologist treats common childhood respiratory conditions such as asthma, recurrent pneumonia, sleep apnea, and certain genetic lung diseases such as cystic fibrosis.
The pediatric pulmonologist typically sees children in the office setting for routine breathing tests, medical therapy assessment, test results such as chest X-rays, and follow-up on blood work. Additionally, the doctor may see hospitalized patients with a severe asthma attack, pneumonia, or other significant breathing problems that need more urgent evaluation and treatment. A typical procedure that a child lung specialist performs includes a flexible fiberoptic bronchoscopy, which helps the doctor visualize the lung tissue directly and helps obtain a diagnosis and treatment plan. Another type of common testing is the pulmonary function test (1). This involves inhaling and exhaling into a device that measures lung volume and helps assess for common lung problems. The results of this test help determine what medications may be necessary. A sleep study may be performed in cases of disordered sleep patterns. This involves the patient sleeping overnight in a special laboratory while the heart rate, sleep quality, oxygen level, and many other parameters are measured in detail (2). The results of this test may indicate sleep apnea. In such cases, a pediatric sleep specialist can advise a treatment plan to help restore quality sleep and help the child return to optimal daytime functioning.
Other Roles of Pediatric Pulmonologists
A pediatric pulmonologist’s less common services may include ventilator management in patients with advanced lung diseases. These children may have temporary respiratory infections that will resolve and will no longer require a ventilator. Other patients may have chronic lung conditions that will, unfortunately, require long-term ventilator use. The pediatric pulmonary specialist may care for these patients in the critical care unit of a hospital or a long-term pediatric care facility.
What’s the Difference Between a Pediatric Pulmonologist and General Pulmonologist?
A pediatric pulmonologist specializes in the health of respiratory diseases of children. While many lung diseases affect both children and adults, the evaluation and treatment of these diseases may differ. A pediatric pulmonologist is attuned to specific common pediatric lung conditions and how they can affect the child’s overall development. The job of the child lung specialist is to keep the lungs healthy and prevent long-term scarring or damage (3).
The lungs are directly and constantly exposed to the environment, making them prone to infections, toxins, and allergens, especially during childhood. Respiratory disorders are the number one cause of pediatric hospital admissions, keeping child pediatric pulmonologists in high demand (4). There is currently a critical shortage of these specialists throughout the United States.
The child’s airway is smaller and less rigid than the adult’s, so the child is more prone to respiratory infection. In addition, the child’s higher respiratory rate makes him more prone to airborne infections than an adult. Also, the pediatric airway is shorter than an adult’s, so any infection is more likely to cause difficulty with breathing. The pediatric lung evolves and develops quickly as the child progresses from the newborn stage into later childhood. Lung damage that might occur early on can have a lifelong effect on the patient and affect the quality of life for years to come. The pediatric pulmonologist keeps all these issues in mind during the evaluation and treatment of the child.
Five Common Conditions Pediatric Pulmonologists Treat
While pediatric pulmonologists treat various lung health conditions, they don’t do surgery or other procedures. The most common conditions they treat include asthma, sleep apnea, bronchitis, respiratory syncytial virus (RSV), and cystic fibrosis.
Asthma is a chronic condition that affects about 6 million children in the United States. Typical symptoms include cough, wheezing, shortness of breath, and chest tightness. The cells of the airway become inflamed, leading to airway obstruction, spasms of the airway, and mucus production. Severe asthma attacks can be life-threatening and cause permanent lung scarring.
A commonly used medication is an inhaled steroid to reduce inflammation of the airway.
Pediatric Asthma – StatPearls – NCBI Bookshelf (nih.gov)
Four Conditions Pediatric Pulmonologists Treat:
Pediatric Obstructive Sleep Apnea
Sleep apnea is a condition in which a child’s breathing is partially or completely blocked during sleep. This causes the child to partially or fully wake up during the night, sometimes multiple times per night, resulting in a severely suboptimal quality of sleep. This results in fatigue, daytime sleepiness, and often, poor school performance.
Symptoms of sleep apnea include snoring, mouth breathing, and restless sleep. Common causes of this condition in children are enlarged tonsils and adenoids. A specialized test called a sleep study, or polysomnography can diagnose the presence of sleep apnea.
Pediatric Obstructive Sleep Apnea – Symptoms and Causes – Mayo Clinic
Bronchitis is a condition that causes inflammation of the large airways of the lungs. This condition is common and can cause fever, wheezing, runny nose, cough, and sore throat. It is typically caused by a virus and resolves with rest, adequate fluid intake, and over-the-counter medications, including acetaminophen. In some cases, bronchitis can progress to pneumonia. Additionally, some cases of bronchitis can become chronic, and more commonly associated with exposure to secondhand smoke. Chronic bronchitis typically lasts more than four weeks or recurs after treatment.
Acute Bronchitis in Children (stanfordchildrens.org)
Respiratory Syncytial Virus
A respiratory syncytial virus is a common respiratory virus, with almost all children have had a case of RSV by their second birthday. Symptoms include cough, wheezing, runny nose, and fever. Most of these infections resolve on their own without further problems. However, especially in infants under six months old, RSV can result in severe breathing difficulty that requires hospitalization. In such cases, a pediatric pulmonologist may be consulted to help provide treatments such as IV fluids and mechanical intubation.
Symptoms and Care of RSV (Respiratory Syncytial Virus) | CDC
Cystic fibrosis is a genetic disease in which abnormally thick mucus is produced that can clog the airways. This can result in scarring of the lungs, recurrent infections, and ongoing breathing problems. Lung function typically declines over time and can result in respiratory failure. In the United States, newborns are routinely scanned for cystic fibrosis to ensure rapid identification and initiation of treatment for this condition. About 30,000 people in the United States have cystic fibrosis. It is the most common genetic disease in Caucasians.
Acute Bronchitis in Children (stanfordchildrens.org)
Required Certifications and Schooling to Become a Pediatric Pulmonologist (In the USA)
To become a pediatric pulmonologist in the United States, one must first complete a college degree. Following that, one goes to medical school for four years, then graduates with a medical degree and obtains a medical license to practice medicine. Subsequently, the physician pursues a three-year pediatric residency to gain experience with a wide range of general childhood diseases and treatments and general well-child growth and development. Upon completion of a pediatric residency, one may pursue a three-year fellowship in pulmonology. During this time, the medical resident will be exposed to both common and uncommon lung problems that can affect children, and learn how to treat and monitor them. The fellowship sometimes continues with the fourth year of clinical research.
Certification for a pediatric pulmonary specialist includes board certification by the American Board of Pediatrics. This requires taking and passing a medical test pertaining to general pediatric medical issues. To qualify for this exam, one must have graduated from medical school, have a license to practice medicine, and completed a three-year pediatric training program accredited by the Accreditation Council for Graduate Medical Education (ACGME). To obtain board certification in pediatric pulmonology, one has to have completed an (ACGME) certified pediatric pulmonology fellowship and pass the certification exam. Pediatric pulmonology fellowships are usually small, with only one or two fellowship slots at each institution. Once the doctor obtains board certification, he or she is required to take a recertification exam every seven years to ensure that the physician stays updated on the current treatment standards.
There are currently less than 1,000 board-certified pediatric pulmonologists in the United States, and more are desperately needed.
Pediatric Lung Conditions and Sleep Quality
A child who is experiencing any type of pulmonary disease or condition could have breathing issues that interfere with adequate sleep. This results in the child being exhausted, cranky, and prone to further deterioration of his medical condition. Poor sleep can also manifest as decreased productivity during the day, behavioral issues, and lower academic performance (5). The child’s overall well-being and energy level are likely to be suboptimal if they are not getting enough quality sleep. The whole family dynamic can be stressed when a child has sleep issues.
Ensuring that the child maintains proper nutrition and fitness levels may help a child sleep better through the night. However, some conditions may require medication or further intervention to reach ideal sleep quality.
A child may be sleep-deprived due to an underlying sleep-disordered breathing problem, such as sleep apnea. A pediatric sleep specialist can test for this condition and recommend treatment as necessary.
It may be difficult to find and identify the symptoms associated with sleep apnea. Search and schedule an appointment with your local family pediatric specialists who will share medical records and notes with a child pediatric pulmonologist.
Sleep Problems in Children and Adolescents with Common Medical Conditions (nationaljewish.org)
- Pulmonary Function Tests | Johns Hopkins Medicine
- Pediatric Sleep Study > Fact Sheets > Yale Medicine
- What is a Pediatric Pulmonologist? What They Do, The Conditions They Treat, and When to See One (webmd.com)
- Resources Recommended for the Care of Pediatric Patients in Hospitals | Pediatrics | American Academy of Pediatrics (aap.org)
- Sleep Disorders in Children | Pediatric Sleep Specialists | Duke Health