Respiratory Services
What is Respiratory Paediatrics?
Respiratory paediatricians have specialised knowledge and skills in the investigation, diagnosis and treatment of children’s chest and lung problems. These include children with:
- lung damage after premature birth
- congenital lung and airway problems
- severe pneumonia and its complications
- chronic scarring of the lung (bronchiectasis)
- cystic fibrosis
- complex immunological disorders affecting the lung
- disorders of breathing during sleep
- those who require long term mechanical support for their breathing.
The Starship Respiratory Department provides care for children from all over New Zealand. We work in conjunction with a general paediatrician in a child’s home region. The department is made up of a multi-disciplinary team of nurses, physiologists, physiotherapists, dietitians, speech and language specialists and administrative staff in addition to the doctors.
We also work alongside the adult Lung Transplant service (at Greenlane) to assess children for paediatric lung transplantation. Lung transplant in children is doneat The Alfred Hospital in Melbourne, Australia.
Some children with a primary (main) illness affecting a different organ system (e.g. joints, immune system, heart, nervous system etc) can have additional lung problems that also require support from specialist respiratory paediatricians - working together with the child’s primary specialist.
Consultants
- Dr Alana Ainsworth Respiratory Paediatrician
- Assoc Professor Cass Byrnes Respiratory Paediatrician
- Dr Fei Dy Respiratory Paediatrician
- Dr David McNamara Respiratory Paediatrician and Sleep Specialist, Clinical Leader
- Dr Anna Mulholland Respiratory Paediatrician, Sleep Specialist
- Dr Jacob Twiss Respiratory Paediatrician, Sleep Specialist
- Dr Julian Vyas Respiratory Paediatrician
Referral Expectations
The department provides specialist respiratory paediatric care for children across New Zealand with severe, complex or rare problems. For the vast majority of children we see, this care is provided in conjunction with a local general paediatric specialist. We usually do not accept referrals from a general practitioner (GP), and require that a child has been initially assessed by a local general paediatrician. However, there are some circumstances that mean a direct referral from a GP is appropriate (e.g. if a child moves into the area with a known diagnosis of cystic fibrosis). If there is thought to be any unusual circumstances to bypass an initial general paediatrician referral the GP should write to the Respiratory Department setting out the previously established diagnosis.
Some of the reasons for referral to a respiratory paediatrician are listed below. Follow the associated links to kidshealth.org.nz for further information.
- Chronic Lung Disease of Prematurity (CLD)
- Cystic Fibrosis (CF)
- Severe asthma
- Bronchiectasis
- Sleep related breathing disorders
- Congenital lung / breathing problems
- Chronic pulmonary aspiration syndrome
- Interstitial lung disease
- Bronchiolitis obliterans
- Lung biopsy
- Consideration for lung transplant (see kidshealth.org)
- Pleural Effusion / emphysema
- Recurrent pneumothorax
PLEASE NOTE: Frequent chest infections are very common in childhood, and usually do not mean a child has a serious underlying problem. Some symptoms are important however, e.g:
- coughing most days even when the child doesn’t have a temperature or runny nose
- regularly coughing up green or yellow sputum (phlegm or mucus)
- wheezing even when well, or wheezing that doesn’t go away after taking Ventolin
- exercise ability reduced by shortness of breath, when compared to others of the same age
- increasing shortness of breath over the last few weeks or months.
If your child has any of these symptoms, or if you are worried that your child may have a problem with their lungs, you should see your GP. He or she can then refer you to a paediatric specialist who can review your child more carefully, and perhaps perform some further tests. If the general paediatrician confirms a problem, or would like a second opinion, he/she can then refer your child to a specialist respiratory paediatrician.
Once your child’s referral is accepted, an appointment time will be sent directly to you. If the date offered is not suitable for you, please contact the clinic schedulers on the phone number given on the right, and arrange a different date. If you do not attend the appointment given without notifying us you will be offered one more appointment. If you don’t attend that second appointment you will be referred back to your local paediatrician, and no further appointments will be sent.
For urgent conditions your child may be admitted directly to hospital rather than waiting for a clinic appointment.
If you receive an appointment you will need to go to Outpatients on Level 3 of Starship Children's Hospital where your child will be assessed by specialised doctors. This usually takes an hour or two in total including additional tests done on the day.
Recommendations and options regarding your child's future treatment plan will be discussed with you. You should bring with you to the appointment:
- Any letters or reports from your doctor or another hospital
- Any X-Rays, CT or MRI films and reports
- All medicines your child is currently taking including herbal and natural remedies
- Your child's pharmaceutical entitlement card.
At the clinic you will be seen by either the consultant or the registrar, who will discuss your child with the consultant at the time, or after the clinic. If your child is old enough they may need to do some lung function tests before being seen by the doctors (see Procedures and Treatments below).
Common Conditions / Procedures / Treatments
Lung function tests
From 5 or 6 years old, children do a lung function test (spirometry) when they attend clinic. This is a test to see how well the air flows out of the lungs.
One of the specialist physiologists at the clinic will carefully explain the test to you and your child at the time. The results of the test will be known to the doctor when you are seen in the clinic, and can help the doctor in making a diagnosis of your child’s problem, or how to alter treatment to give your child maximum benefit.
Chest X-Ray
It is very likely your child will have already had chest X-Rays before being seen. Depending on where you live, these X-Rays may be able to be seen on the computer when you are seen in the clinic. Sometimes it can be helpful to repeat an X-Ray at the time of the clinic. This might even mean doing one when your child is well, to show what the lungs look like “at their best”. The doctor in the clinic will explain to you if an X-Ray is necessary, and why. The X-Ray can be discussed with you later in the clinic.
Chest computer tomography (CT) scan
Sometimes more detail is needed than a chest xray can show. This is the case if there is concern your child may have a more complicated lung problem. In these cases, a CT scan (CAT scan) of the chest is requested. This can’t be done at the time of the clinic, but will be requested for a later date. The test requires that the child lies very still for approximately 3-5 minutes at a time, and can hold their breath for 20 seconds. If this is difficult for your child the doctors may suggest that the scan be done under a general anaesthetic. This is to make sure the picture from the scan is of the best quality to give as much information about your child’s chest as possible.
Sputum microbiology
If your child regularly coughs up sputum (also called mucus or phlegm), the doctors may want to take a sample of this to see if any particular organisms are growing in it. For those children who cannot cough up phlegm there are other methods to get a sample including taking a swab from the nose, or from the back of the throat. These swabs are a little unpleasant for younger children, but take only seconds to perform. There are no long lasting ill effects from swabbing. The result from the swab takes approximately one week to come back to the doctors.
Flexible bronchoscopy
Sometimes, it may be recommended that a flexible bronchoscopy is performed. This is a test where a small ‘scope (camera on a guidable arm) is passed into your child’s airways to actually see what the lungs look like. This test allows the doctors to see if there are any poorly grown, or misshapen airways; any airways squashed (e.g. by glands); or if the airways look inflamed. It is usual to perform a “lavage” at the same time as the bronchoscopy. This is a test where an amount of saline (salt water) is washed into the lungs, and immediately sucked back out again. In doing this we can get better samples of mucus from which we can look for organisms, and sometimes also look for evidence of other, more complicated problems. The lavage doesn’t cause any serious or long term side effects. If a bronchoscopy (with or without lavage) is thought to help towards your child’s care, your doctor will discuss this with you. You can find more information using the “bronchoscopy” link, above.
Sleep studies
Some children can have a problem of breathing that is more severe when they are asleep. In order to understand this better, it may be necessary to get your child to have a “Sleep Study”. This term covers a range of tests that are all done during sleep. The most basic test (overnight pulse oxymetry) is usually able to be done by your local community children’s nursing team, at home. The results may then need to be forwarded to us at Starship for comment. Other, more sophisticated, sleep tests can only be done in hospital, at present. This would require your child and an accompanying adult to be admitted for an overnight stay, when the test equipment would be set up, and a recording obtained. In most cases a single night’s stay is all that is needed. The results from these more detailed tests are not available on the day after the readings are taken, but are usually back by a couple of weeks after the test is done. Some children without complicated medical needs will have their sleep study performed at the New Zealand Respiratory and Sleep Institute. Even though this is not on the Starship Campus, these sleep studies are reported by the Starship sleep specialists in the same way as studies done at SCH are.