Pulmonology

The pediatric pulmonologists at Riley Hospital for Children, Indiana University Medical Center provide diagnosis and treatment of infants, children and adolescents with acute and chronic respiratory disease. In addition to caring for patients throughout the Midwest, we are active in researching ways to prevent serious lung damage in children with cystic fibrosis. Our research efforts in the treatment of pediatric asthma allow us to offer selected patients the latest medications before they are available to the public.

Specialized Care for Breathing Problems

Pediatric pulmonologists are physicians who specialize in caring for children with breathing disorders of all kinds. We provide thorough evaluation, then design a treatment and follow-up program to meet the needs of each child. The kinds of problems treated include asthma, wheezing, coughing, chest pain, viral respiratory infections, structural abnormalities in the respiratory system, and chronic lung disease in premature infants. Special programs are offered for children and adults with cystic fibrosis and for children with apnea (stopping breathing). Our Children's Sleep Disorder Center offers state-of-the-art evaluation of sleep disorders of all kinds. It is the only such center in Indiana and is nationally recognized.

National Prominence

Riley's pulmonary intensive care programs ranked number 7 overall in the U.S. by Child Magazine. No other Indiana hospitals pediatric pulmonary intensive care programs made the national rankings.

The Latest Technologies for Diagnosis

IU Medical Center's Pulmonary Diagnostic Center provides specialized lung function testing for children through the Pediatric Pulmonary Function Laboratory. This specialized laboratory performs testing for physicians throughout Indiana and is one of only a few places in the country to offer pulmonary function testing for infants. Other diagnostic methods include fiberoptic bronchoscopy, an outpatient procedure that lets doctors see inside the child's air passages. Our metabolic and exercise testing laboratory, which is also available to physicians throughout Indiana, is used to help evaluate the cause of a child's breathing problems.

Helping children and families at Home

We work closely with families and other health care professionals to coordinate home care planing for children who need ventilators, monitoring, supplemental oxygen or private duty nursing care. Our home care programs not only provide sophisticated technology in the home settings, but also offer 24-hour support from our pediatric pulmonologists, respiratory therapists and nurse specialists.

Cystic Fibrosis Center

The Riley Cystic Fibrosis Center provides state-of-the art, advanced care for children with cystic fibrosis. The Center is among the leading programs in the nation and is recognized for excellence in care, research and leadership. The Riley Cystic Fibrosis Center is Indiana’s only program accredited by the Cystic Fibrosis Foundation. Our cystic fibrosis team is multidisciplinary, bringing together physicians, advanced practice nurses, dietitians, nurses, respiratory therapists, social workers and child life specialists. A specialist treats and evaluates the child and, if needed, calls upon Riley subspecialists for a complete treatment plan.

The Riley Cystic Fibrosis Center also supports a fully accredited Cystic Fibrosis Care Center for individuals 18 years and older when it is time for a patient to move from pediatric care to the specialized needs of adult care.

Research at the Center has led to the development of many new therapies and improvements for cystic fibrosis care and clinical trials are supported by the Cystic Fibrosis Foundation and National Institutes of Health.

Riley Asthma Care Center

At the Riley Asthma Care Center, we understand that asthma can be a difficult problem for patients and their families to manage. We know that poorly controlled asthma can interfere with children's school and family life, and prevent them from joining sports and other activities. We have seen how the fear of an asthma attack itself can cause children and their families to limit activities.

That is why for decades, Riley physicians and pulmonary team members have worked to improve the quality of asthma care by participating in asthma medication studies, providing state-of-the-art care, and continually striving to gain a better understanding of the impact of childhood asthma on school, sports, and family life.

Based on our broad experience treating childhood asthma, we have developed a comprehensive educational approach to asthma management that can help patients and their families take control over their asthma.

Our program, the ABCs of Asthma Management, consists of complete physical exams, lung function testing, asthma medications, and most importantly, education for patients and their families.

With the help of our experienced team of pediatric pulmonologists and allergy specialists, asthma clinical nurse specialists, pharmacologists, and respiratory therapists, an asthma management plan will be created to fit each individual child and family. The plan will meet all of the following goals:

• Preventing daily symptoms of cough and wheeze.
• Reducing exercise limitation.
• Maintaining normal daily activity levels including participation in sports and extracurricular activities.
• Preventing worsening of asthma symptoms and reducing the need for urgent office visits, emergency room visits, or hospitalizations.
• Providing optimal medications with minimal to no side effects.
• Meeting the families' and patients' expectations of complete asthma care.

Children's Apnea Program

The Children's Apnea Program has been in existence for over 20 years at Riley Children's Hospital as a hospital based program with community outreach. The cornerstone of the program is cooperation among disciplines such as social work, nursing and pediatrics as well as communication with local hospitals, physicians, public health nurses and health care vendors across the state of Indiana.

Riley Children's Hospital is the primary referral center for the evaluation of children with apnea for the State of Indiana and bordering areas of Illinois and Ohio. Physician referral is requested so that the physician at Riley can work cooperatively with the infant's primary physician.

Patients are followed by using clinic visits and telephone calls. Follow-up information is routinely sent to the referring physician. Public Health nurses provide contact with patients we cannot reach by phone.

In the past 10 years, the program has enrolled over 3500 infants. Infants with ALTE's, infants who are a sibling of a SIDS infant, and premature infants with apnea account for the majority of patients. We currently have more than 500 patients at home with monitors.

Monitor Support

The Children's Apnea Program has an excellent working relationship with all apnea monitor vendors in Indiana so patients all over the state can be serviced by our program. All homecare vendors we use must provide 24 hour per day service and home visits as needed. We also have an apnea clinic, which meets two days per month, and new patients and follow-up patients can be evaluated five days per week. Patients have access to physicians seven days per week and are encouraged to call for problems. The apnea nurse devotes her time to helping patients with monitoring concerns or problems.

Related Programs

The Children's Apnea Program is supported by the Children's Apnea Laboratory, which was started in 1983 to transcribe and interpret pneumocardiograms and perform sleep studies. The Children's Apnea Laboratory processes oxypneumocardiograms (most by outside hospitals), multi-channel recordings and event recordings for hospital patients, outpatients and referral patients. Approximately 200 studies are performed per month. Pediatric Pulmonary faculty members provide written interpretation on all studies. We guarantee and provide 48-hour turn around time for all studies once received and have a technician available on Saturday for scoring studies.

Our Policy is to provide a report to the physician and then be available for consultation regarding the findings. A recommendation for monitoring or specific treatment can not be appropriately made on the basis of a recording alone, but must take into consideration each patient's history, physical examination and family dynamics. Some abnormal findings require specific interventions or more evaluation.

The Children's Sleep Disorder Center was established in 1986 as a separate entity. Children with persistent symptoms, with obstructive apnea or complex airway problems, can undergo more extensive evaluation here.

Children's Sleep Disorder Center Philosophy

It is important to recognize that Apnea is a symptom, not a disease. The focus of the Children's Apnea Center at Riley Children's Hospital is to first evaluate an infant for potentially treatable causes of apnea or factors that might predispose to SIDS. Children with remedial problems or risk factors, are treated (or counseled if specific treatment is not available) and discharged on an apnea monitor with observation and intervention instructions.

The apnea monitor is a tool for alerting the parent to an alarm situation, and should not be considered a prevention for SIDS. Parent observation and intervention are the key to successful evaluation and treatment of apnea or apparent live threatening events (ALTE).

The Riley Infant Lung Center

At the Riley Infant Lung Center, a specially trained team of pediatric experts will provide pulmonary care for your infant with breathing problems. We know infants with breathing problems require special attention to ensure continued improvement in their breathing function. That is why Riley Hospital for Children has developed a new program to care for infants with chronic lung conditions. The program includes education and training for you and your family on the best ways to provide care for your infant at home. The members of our team have worked together for decades to improve the quality of infant respiratory care by leading in the development of infant lung function testing, providing state-of-the-art treatment and continually improving the quality of life of infants and their families.

Based on our extensive experience in treating infants with lung disease, we have developed a comprehensive approach to educate families about respiratory illness and developed individual programs for the care of each infant. Our program, the ABC's of Managing Infant Lung Disease, coordinates care of the infant before discharge from the nursery, provides evaluation and treatment during the important period of infancy and continued care for those with chronic respiratory problems.

Riley Infant Lung Center Assessment

Assessment begins with the first visits of one of our pediatric pulmonologists and our nurse practitioner to see your child in the newborn nursery. We work closely with your infant's neonatologist to begin planning for your baby's discharge from the hospital. The pulmonologist will review the chart, examine your infant and begin to formulate a plan to care for the breathing problems affecting your infant. Often the pulmonologist will recommend special tests to assess your infant's breathing patterns and oxygen needs. This is done to help find out what kinds of support your baby will need once he/she is home with you. The nurse practitioner from the Infant Lung Center will meet with you to discuss the team's recommendations for the care of your infant.

Beyond the Nursery

Following discharge from the nursery, care for your child's respiratory problems will be managed by the Infant Lung Center Team. Your pulmonologist will direct the care of your infant and will usually see you monthly (more often if needed) for the first several months after discharge. The nurse specialist will also work with your infant during outpatient visits and will be available to provide assistance for medical and homecare questions between visits. Our pediatric dietician and respiratory therapist will also evaluate your infant during outpatient visits and will assist with management of these important aspects of care. We will obtain specialized tests from time to time to help follow your baby's progress and evaluate his/her needs. These tests include infant lung function tests, chest X-rays, blood tests and sleep studies.

Continuing Care

Many children need to continue pulmonary care after graduation from the Infant Lung Center. At one year of age, your child's care will continue to be provided in the Riley Pulmonary Center where your pulmonologist will continue to care for your child along with a team of experts in the care of children with lung disease. Often pulmonary function tests, sleep studies and chest X-rays will be used in the management of your child's lung condition. This care will be coordinated with your child's primary care provider.

Our experienced team of pediatric specialists creates a care plan to fit each infant and family. The goals of the specialized plan are to:

• Reduce symptoms so they do not occur daily
• Educate parents about the warning signs of respiratory distress
• Train families in the use of home oxygen, monitors and medication delivery devices - Achieve and maintain excellent nutrition
• Achieve excellent communication among our team, the parents and the primary physicians