Pediatric Pulmonology and Sleep Health

Complex conditions affect multiple organ systems at the same time, such as the lungs, heart, brain, muscles, and others. A pediatric pulmonologist will likely be part of your child’s care team if they have a condition that affects their lungs, airways, or breathing. Examples include:

Muscular weakness syndromes

Breathing is powered and controlled by a several muscle groups, including the diaphragm, chest muscles, and abdominals. Weakness in these muscles can make it more difficult to breathe and, in severe cases, contribute to respiratory failure. Conditions that cause muscle weakness include muscular dystrophy, spinal muscular atrophy (SMA), nemaline myopathy, and many others.

Pulmonary hypertension

Narrow blood vessels in the lungs force the heart to work harder to move blood through them. This can cause respiratory problems like shortness of breath and also damage the heart over time.

These conditions are present at or shortly after birth and usually have symptoms that are noticeable right away or become noticeable in early childhood. Examples include:

Alpha-1 antitrypsin deficiency

Due to a genetic abnormality, the body does not produce enough of a specific protein that protects the lungs. This can cause respiratory symptoms (including coughing, wheezing, and shortness of breath after mild exercise) and may lead to lung and liver damage.

Bronchomalacia and tracheomalacia

Children with these conditions are born with weak, underdeveloped airway walls that are prone to compressing or collapsing. This can affect the windpipe (tracheomalacia), the bronchial tubes leading from the windpipe to the lungs (bronchomalacia), or both.

Bronchopulmonary dysplasia (BPD)

Also known as chronic lung disease of infancy, this condition affects some preterm babies who need oxygen therapy or mechanical ventilation after birth.

Congenital lung malformations

Structural problems with lungs that are present at birth. This can result in airways being blocked, lungs failing to develop to a normal size or level of function, and other problems.

Cystic fibrosis (CF)

This genetic disorder causes the lungs to produce excessively thick, sticky mucus. Over time, the mucus builds up in the lungs and can lead to difficulty breathing, persistent coughing, and chronic respiratory infections.

Primary ciliary dyskinesia

Symptoms of this genetic condition include difficulty breathing, chronic wheezing or coughing, difficulty clearing mucus from airways, and frequent respiratory infections. It is caused by a genetic abnormality that prevents cilia, tiny hairlike structures in the airways, from sweeping away mucus and debris.

These conditions cause swelling, inflammation, narrowing, or scarring in lung tissues, such as the airways that move air throughout the lungs (bronchi and bronchioles), the air sacs (alveoli), or the tissue that surrounds and supports the lungs. They include:

Asthma

Narrowing of the airways in the lungs, which can cause symptoms such as shortness of breath, coughing, wheezing, and tightness in the chest. It is often triggered by an allergic reaction or physical activity.

Bronchiectasis

The airways in the lungs become widened and damaged, which makes it harder for the lungs to clear out mucus. Built-up mucus can further damage the lungs and increase the child’s risk of developing chronic lung infections.

Bronchiolitis

Inflammation of bronchioles, the network of small airways within the lungs that connect directly to the air sacs (alveoli) where oxygen and carbon dioxide are exchanged.

Bronchitis

Inflammation of the bronchial tubes, the two main airways that branch off from the bottom of the windpipe (trachea) and lead to each lung.

Hypersensitivity pneumonitis

Inflammation of the air sacs and surrounding tissues of the lungs caused by an allergic reaction. It is a form of interstitial lung disease (ILD) that affects both children and adults.

Interstitial lung diseases (ILDs)

This refers to a group of conditions that cause inflammation and scarring (pulmonary fibrosis) in the tissues surrounding the air sacs in the lungs. This makes it more difficult for oxygen to enter the bloodstream. Forms of ILD that develop during childhood, known as childhood ILDs (chILDs), often have very different root causes than adult-onset ILDs and require different treatments.

Recurrent pneumonia

Pneumonia is the general term for infections that cause swelling or fluid buildup in the air sacs in the lungs. This often causes cold-like or flu-like symptoms that can persist for more than week. Severe cases can also cause vomiting, breathing difficulties, very high fever, chest pain, or confusion. If your child has pneumonia more than once in a one-year period, it could be a sign of a more serious condition that requires treatment.

Because many sleep disorders are closely linked with respiratory system problems, many pediatric pulmonologists treat them. Conditions we treat include:

Idiopathic hypersomnia

Difficulty waking and excessive daytime sleepiness, even when getting plenty of sleep. A child with this condition may easily sleep through the night and take naps during the day, but still won’t feel rested.

Insomnia

Difficulty falling asleep, staying asleep, or early waking, especially when it causes daytime symptoms like fatigue, inattention, irritability, or other cognitive or behavioral problems.

Narcolepsy

This brain disorder causes people to feel excessive daytime sleepiness and fall asleep at unwanted times without warning — even during activities or conversations. Nighttime sleep is typically poor. Most people with narcolepsy also experience sudden, brief losses of voluntary muscle control for up to a few minutes at a time (cataplexy).

Nocturnal hypoxia

Oxygen in the bloodstream drops to dangerously low levels during sleep. It is a common complication of some sleep disorders (including sleep apnea) and can lead to serious health issues if not treated.

Obstructive hypoventilation syndrome

Chronically slow or shallow breathing that prevents some severely overweight kids from getting enough oxygen or removing enough carbon dioxide from their blood. In addition to poor sleep quality, it can cause life-threatening heart problems and other complications if left untreated. Most kids with this condition also have sleep apnea.

Periodic breathing in infants

A baby’s breathing during sleep alternates between brief pauses (up to 10 seconds) followed by several quick, short breaths. This cycle may repeat several times before returning to a more regular rhythm. Treatment may be needed if your baby stops breathing for more than 10 seconds at time, shows signs of oxygen deprivation (such as blue lips or difficulty waking), or periodic breathing continues after six months of age.

Periodic limb movements of sleep

Repetitive leg or arm movements during sleep, often every 20 to 40 seconds, which can wake a child or reduce their quality of sleep and cause daytime drowsiness.

Sleep apnea

Breathing stops and starts during sleep. This may be due to a physical blockage in the airway caused by the relaxation of throat muscles (obstructive sleep apnea) or a problem with the part of the brain that regulates breathing rhythm (central sleep apnea).

Airways are the network of tube-like passages that transport air into and out of the lungs. The upper airways include the nasal cavities and sinuses, throat (pharynx), and voice box (larynx). Conditions we treat include:

Chronic rhinosinusitis (chronic sinusitis)

Long-term (12 weeks or more) swelling of the sinuses of the nose and face, which can result in chronic runny nose, congestion, difficulty breathing, pain or tenderness in the face, and other symptoms.

Croup (recurrent)

Viral infection that causes swelling in the upper airways. Symptoms include difficulty breathing, hoarseness, fever, and coughing that sounds like a seal’s bark.

Vocal cord disorders

Conditions affecting the vocal folds of the larynx, which can cause symptoms like raspy or breathy voice, difficulty swallowing, or difficulty breathing. Examples include infections (such as laryngitis), tumors or polyps on the vocal folds, and vocal fold paralysis.