From common to complex, our team of specialists is dedicated to diagnosing and treating your child’s lung and sleep problems

Aerodigestive problems include disorders related to abnormal  interactions between the upper and lower airway  and the gastrointestinal tract, and are frequently seen in children with complex multisystem conditions. Our aerodigestive group joins pulmonary and sleep specialists together with a full multidisciplinary team that includes otolaryngologists, (ENT), gastroenterologists, pediatric surgeons, neurologists, and speech and language pathologists who meet regularly to coordinate care in order.  The team works together  to help your child with problems such as:

• Airway stenosis and malacia
• Aspiration
• Chronic cough
• Eosinophilic esophagitis
• Gastroesophageal reflux disease (GERD)
• Recurrent pneumonia
• Swallowing difficulty
• Vocal cord paralysis

If your child is having choking episodes, chronic cough, difficulty or painful swallowing, frequent vomiting or food regulation, recurrent respiratory infections, recurrent croup or chronic noisy breathing, you should consult our team.

Allergic bronchopulmonary aspergillosis is a hypersensitivity lung disease that is due to an abnormal immunologic response  to Aspergillus fumigatus (a type of fungus found throughout your environment in places like soil, household dust and plant matter.

While many children can inhale these spores on a daily basis, children with asthma and cystic fibrosis are typically at a higher risk of this condition. Patients may  experience intractable wheezing and coughing, bronchiectasis (a condition where the airways in your lungs are damaged, making it hard to clear mucus) and declining lung function.

Our team of pediatric pulmonologists will be able to help diagnose and treat this condition effectively.

Asthma is a condition caused by airway inflammation that is usually allergic in nature.   It causes the airways to swell and narrow and produce extra mucus. This can make breathing difficult and trigger coughing during the day, at night or with activity. It can also cause wheezing, breathlessness, chest tightness and shortness of breath. It may be misdiagnosed as recurrent bronchiolitis, bronchitis, or pneumonia.  It is one of the most common chronic (long-term) diseases in children, and a major cause of disability, hospitalizations, emergency room visits, and missed school days, but treatment can be quite effective.  Unfortunately, the diagnosis is often missed or underappreciated, especially in infants and young children, but in teenagers as well.  Learn more about asthma here

Bronchiectasis is a condition in which  the airways are damaged, making it hard to clear mucus and leading to chronic infection. It is typically secondary to other disorders including cystic fibrosis, primary ciliary dyskinesia, immunodeficiency disorders, and chronic aspiration.   While the damage cannot be reversed, treatment can help reduce the symptoms and prevent further damage.

Premature babies with underdeveloped lungs may have  respiratory problems shortly after birth and are at risk for Bronchopulmonary dysplasia (BPD). While BPD can be serious and needs intensive medical care, most infants fully recover with little to no long-term health problems.

Your baby may be at risk if they have a low birth weight and are born more than 10 weeks early. Treatment is focused on supporting the oxygen needs of infants to allow them to have enough oxygen to grow and thrive.

Children with chest wall abnormalities may have rib abnormalities, or sunken in or protuberant breast bones. This is usually benign, but can can sometimes difficulty breathing, especially with exertion. Our pulmonary specialists are experts at evaluating chest wall abnormalities and determining the need for surgical treatment.

Congenital lung anomalies, or congenital lung malformations (CLM) happen to a developing baby. These anomalies can range from small lesions to large lesions that affect the baby in the womb.  They are often detected prenatally or soon after birth, but sometimes appear and begin to cause problems later in life.

Our pulmonary team works with our neonatologists to treat infants with congenital lung abnormalities that appear in the perinatal period, and are expert at diagnosing and determining treatment in those children who develop problems later in life. 

Cystic fibrosis (CF) is a genetic disease that is caused by abnormalities in the movement of salt and water across cell membranes.   Cystic Fibrosis affects the gastrointestinal tract and the sweat glands, but its respiratory system manifestations have the most significant effect on overall health.

Because of universal newborn screening for this condition, most children are diagnosed with cystic fibrosis in the first few weeks of life, before they even have symptoms. Cystic fibrosis is a lifelong condition which requires intensive and complex treatment, but responds well to this treatment.  Our CF Foundation-accredited pediatric CF program works closely with our adult program and is in the forefront nationally in clinical care and research.

Learn about our cystic fibrosis treatment program and how we can help your child.

Interstitial lung diseases in children is an umbrella term for a group of rare lung diseases that can affect your baby, child or teen. They affect the substance of the lung tissue and cause symptoms such as chronic coughing, fast breathing or shortness of breath. These children often require oxygen and other treatments. Some interstitial lung diseases that only occur in children include:

• Pulmonary interstitial glycogenosis
• Infant neuroendocrine cell hyperplasia
• Developmental disorders, such as alveolar capillary dysplasia
• Lung growth abnormalities or malformations

Other systemic conditions such as lupus may cause interstitial lung disease in children as well as adults, and may progress to pulmonary fibrosis. Our pediatric pulmonary specialists are trained and experienced in the diagnosis and treatment of interstitial lung disease.

Children with plastic bronchitis have a build up of fluid in the lymph nodes which form a rubbery-like plug making it difficult to breathe.

It is most common with patients who have certain forms of < href="https://www.chrichmond.org/services/childrens-hospital-foundation-heart-center/congenital-heart-disease">congenital heart disease, lymphatic abnormalities, and occasionally other  lung diseases and infections.

Children who have plastic bronchitis may have symptoms like coughing, oxygen deprivation and are prone to coughing fits in which they may cough up these plugs.

At Children’s Hospital of Richmond at VCU, we can diagnose lymphatic abnormalities and treat them with our team of internationally-known experts in this condition.

Primary ciliary dyskinesia (PCD) is a genetic condition that affects cilia, the small, hair-like structures that help cleanse the airway by moving bacteria and other particles up and out.     As a result, children with PCD experience chronic year-round cough and bronchitis that leads to lung damage.  The condition is also typically associated with unexplained respiratory distress in the newborn period and chronic middle ear and sinus infections, and oftentimes situs inversus (a mirror-image reversal in the placement of the major organs inside the body).

Our team of pediatric pulmonologists use specialized tools such as nasal nitric oxide measurement in diagnosing and treating children with this disease.

Pulmonary fibrosis is a lung disease that happens when the lung tissue is damaged or scarred, making it difficult for your lungs to work properly.  This may occur due to certain systemic diseases such as lupus, severe lung infections, or as a side effect of cancer treatment.

While symptoms can vary in each patient, the most common symptoms of pulmonary fibrosis include:

• Shortness of breath
• A dry cough
• Aching muscles and joints
• Widening and rounding of the tips of the fingers and toes
• Unexplained weight loss
• Fatigue

While there isn’t a way to repair the lung damage that has been caused, medications and therapies can help improve the quality of life by easing symptoms.

Pneumonia is a lung infection which may be diagnosed clinically by physical exam or on x-ray.  However, it is often difficult to distinguish pneumonia from other causes of lung and airway inflammation.

Children diagnosed with repeated episodes of pneumonia may have a weakened immune system, congenital lung anomalies, or may have other underlying medical conditions such as aspiration syndromes, asthma, bronchiectasis, or neuromuscular weakness.

Treatment of recurrent pneumonia in children depends on the cause, age of the child and how severe the infection is. Our specialists will be able to run tests to diagnose and recommend the most efficient treatment for your child.

Children with complex lung disorders originating in the newborn period, or due to congenital abnormalities, severe infection, or neuromuscular weakness may require long term support with an artificial airway (tracheostomy), oxygen, or mechanical ventilation.

The chronic ventilator program at CHoR brings together pediatric pulmonologists with neonatologists, pediatric critical care specialists, otolaryngologists, gastroenterologists, and neurologists, along with other support staff, to provide multidisciplinary care to children with these complex care needs.

Many neuromuscular diseases weaken the breathing muscles, making it difficult for children to take a full breath and generate a strong cough, which can lead to recurrent pneumonia and atelectasis (mucous plugging of parts of the lung), sleep-disordered breathing, and respiratory failure.

Our pediatric pulmonary and sleep specialists participate in the multidisciplinary neuromuscular clinic, alongside neurologists, cardiologists, rehabilitation specialists, and other support staff to help care for children with the many neuromuscular diseases that cause breathing problems, such as spinal muscular atrophy (SMA), muscular dystrophy (BSD) and other myopathies.

Sickle cell disease is an inherited blood disorder that affects hemoglobin, the molecule in red blood cells that delivers oxygen to cell throughout the body.  The disorder cause red blood cells to take on a distorted shape that clogs and inflames the blood vessels.  Sickle cell disease causes low blood counts, painful crises, and infections, especially in the lung.  Children with sickle cell disease are more likely to have asthma and obstructive sleep apnea, and as they get older they are susceptible to pulmonary hypertension and the development of restrictive lung disease. Lung disease is therefore an important comorbidity of sickle cell disease.

Our pulmonary team works closely with the sickle cell clinic to follow all children with sickle cell disease and monitor their lung health for any complications.  If your child with sickle cell disease gets out of breath with exercise, recurrent bronchitis or pneumonia, or snores, and has not seen a pulmonologist, it is important to make sure that one of our pulmonary specialists evaluates him or her.

• Insomnia
• Narcolepsy
• Restless Leg Syndrome
• Sleep disordered breathing(obstructive sleep apnea)

Sleep disordered breathing is an umbrella term for breathing difficulties occurring while your child is sleeping. It can range from frequent loud snoring to obstructive sleep apnea, which happens when there is a blockage of the airway while sleeping.

Most commonly, you’ll notice your child snoring loudly on most nights that is sometimes interrupted with snorting and gasping noises, waking them up from sleep.

Our experts will help diagnose sleep disordered breathing and work through treatment options at our sleep center. Often times, we partner with our ENT specialists to ensure we have a plan that helps your child.