Faculty in the Division of Pediatric Pulmonology, Allergy and Sleep Medicine at Indiana University School of Medicine are national leaders providing expert specialized care for inpatient, outpatient and follow-up needs.
Pediatric Allergy Services
Pediatric allergists at IU School of Medicine specialize in a wide array of allergic clinical problems that evolve over childhood, including asthma, allergic rhinitis, atopic dermatitis, urticaria, angioedema, anaphylaxis and gastrointestinal allergy. Often, many of these conditions co-exist. Each child undergoes a detailed allergy-oriented history and physical examination to ensure the clinical problem supports a diagnosis of allergy. The history of exposures directs the selection of allergy tests. The allergy program allows for physicians to spend the time needed to listen to a story and select the appropriate tests for making the diagnosis and manage the problem.
Unique to the Riley Allergy Service is the opportunity to perform a food challenge in a controlled clinical environment to verify that a child has outgrown a food allergy or to prove that there truly is a food allergy present. The allergy service also offers: vaccine and drug desensitization procedures as well as diagnostics for stinging insect reactions.
The allergy service works along with the gastroenterology service at Riley Hospital for Children at IU Health to provide a multi-disciplinary clinical experience for children who struggle with eosinophilic esophagitis. Additionally, the allergy service does pollen counting and has the only pollen counter in central Indiana.
IU School of Medicine allergists are involved in numerous community projects that involve asthma and food allergy, and they helped establish the Indiana Joint Asthma Coalition. They also serve and attend food allergy support groups. The Allergy Division offers an Allergy training fellowship program.
Pediatric Inpatient and Home Ventilator Program
The Pediatric Home Ventilator Program at Riley Hospital for Children supports the care of children with respiratory problems that require chronic mechanical ventilation via tracheostomy at home. The program safely and seamlessly transitions children from the hospital to home and provides state-of-the-art care to patients—both at home and in the hospital—with an ultimate goal of improving the quality of life for technology-dependent children and the entire family. The Pulmonary team works with at least two of the child’s caregivers to provide appropriate education in all aspects of medical care that best meets the patient’s needs.
Multidisciplinary, comprehensive training and support is provided to optimize every aspect of a patient’s environment—from selecting the most appropriate portable ventilation equipment to helping establish a medically and socially safe environment at home. This support is ongoing to help families help their child achieve optimal growth and development, minimize hospital visits and improve quality of life.
A key part of a successful home ventilation plan is quality outpatient care. Patients are seen monthly once they are transitioned to home, until their condition improves or their medical condition stabilizes, and then less frequently. Outpatient visits take place in the Pulmonary Medical Service Area of the Riley Outpatient Center. Clinic evaluations include a comprehensive history and physical examination, assessment of growth, measurements of oxygenation and ventilation and, when possible, other measurements of lung function. Communications with the primary care providers and other subspecialists involved in these patients’ care are ongoing.
Pulmonary Hypertension Program
The Pulmonary Hypertension Program is comprised of a multidisciplinary team that includes pediatric pulmonologists, pediatric cardiologists, a nurse coordinator, a nurse practitioner, a cardiovascular geneticist and a cardiovascular pharmacist. The program cares for infants and children with pulmonary vascular disease and employs state-of the-art imaging and novel therapies. The program is in the process of applying for Pulmonary Hypertension Association (PHA) accreditation as a Pediatric Center of Comprehensive Care.
The Aerodigestive Program provides multidisciplinary care from pediatric pulmonology, otolaryngology, gastroenterology, pediatric surgical specialties and speech pathology for children with anatomic and functional problems of the respiratory and gastrointestinal tracts. The team approach enhances the quality of care delivered to our patients and families by efficiently diagnosing and treating children through coordinated appointments and procedures. The Aerodigestive Program aims to provide integrated, standardized care to patients throughout Indiana (and surrounding states) by coordinating clinic appointments as well as diagnostic procedures such as bronchoscopy, GI endoscopy, polysomnography, impedance probe studies and minor outpatient surgical interventions at the same visit/consultation. Families are assisted in this process by a dedicated registered nurse coordinator and respiratory therapist.
Interstitial Lung Diseases
The interstitial lung diseases program is comprised of a multidisciplinary team that includes pediatric pulmonologists, rheumatologists, cardiologists, radiologists and pathologists. The program cares for infants and children with congenital or acquired interstitial lung diseases with modern therapies and diagnostic procedures. This program is in the process of joining the chILD network, a national consortium of hospitals working toward helping children with interstitial lung diseases.
Pediatric Sickle Cell Clinic
The sickle cell clinic provides a comprehensive evaluation for pulmonary complications related to this disease as well as routine management for patients with other comorbidities, including chronic lung disease of infancy and/or asthma. The clinic provides comprehensive pulmonary function testing as well as evaluation for any sleep disordered breathing with prompt referrals to the otolaryngology specialists for surgical interventions when indicated. The clinic is held monthly and works in close collaboration with the hematology program to coordinate care and clinic visits.
The inpatient pediatric pulmonary service provides care to almost 2000 patients each year with focused teamwork to improve the health of children with chronic and acute respiratory problems, including cystic fibrosis, asthma, upper and lower airway obstruction, and respiratory complications of neuromuscular disease. The pulmonary inpatient team includes nursing, pharmacy, respiratory therapy, speech therapy, nutrition, physical and occupational therapy representatives working alongside other pediatric specialties. The clinical service also provides a broad range of inpatient consultations, including those from hematology-oncology, the NICU, PICU and other subspecialty units as well as consults from surgical and medical services. The pulmonary service has a designated floor in the Simon Family Tower.
The pediatric sleep program at Riley Hospital for Children is one of the largest in the world with more than 3,500 pediatric polysomnograms and more than 2,000 patient visits completed each year. Riley also has one of the largest neonatal polysomnography programs in the world with almost 400 neonatal and infant polysomnograms completed each year. Faculty investigators in this area have published manuscripts on the determinants and outcomes of neonatal obstructive sleep apnea and are completing a study on polysomnograms in normal newborns to facilitate clinical decision making, providing a frame of reference for interpretation of these complex and expensive studies. Over the next few years, this team will investigate the determinants and outcomes of the full spectrum of pediatric sleep disordered breathing. Almost 40 percent of patients presenting to a pediatric sleep clinic have insomnia, and investigators are studying the determinants of pediatric insomnia and the outcomes of various therapeutic interventions in this common clinical problem. Additional sleep research examines the development and implementation of evidence-based care for children’s sleep disorders with a focus on the primary care setting. Active studies include 1) the use of a computer decision support system to identify obstructive sleep apnea in primary care; 2) management of infant night wakings in primary care; and 3) behavioral sleep treatment as a therapeutic for children with disruptive behavior disorders.