Topics:
- Asthma
- Lung Health & Procedures
Children are not just small adults. This is why, especially when it comes to caring for their health, they need specialized doctors. As any pediatric pulmonologist will tell you, children’s lungs are a great example of this basic truth
“When you are born your lungs are not fully developed, even if you are carried to full term. You have enough air sacs, or alveoli, to participate in gas exchange, but your lungs continue to grow throughout infancy, childhood and even into your late teens,” explained Jessica Saunders, MD As a pediatric pulmonologist at Joe DiMaggio Children’s Hospital, she sees firsthand just how much can happen during that time
“You develop more alveoli, your airways widen and your lung function really doesn’t hit its peak until your early 20s. Which is why children are so much more susceptible to illness.”
What Conditions Do Pediatric Pulmonologists Treat?
In her practice, Dr. Saunders oversees the care of children in the NICU who are born as early as 22 weeks, through to young adults as both inpatients and outpatients. Currently, she is the director of cystic fibrosis (CF) and primary ciliary dyskinesia (PCD) programs, which focus on rare but serious lung diseases that are diagnosed predominantly in children. In fact, before recent medical advancements, there were many diseases that only pediatric doctors received training for because children rarely made it to adulthood. Cystic fibrosis is an example of such a disease, and it is this gap in knowledge that has led to many adults with CF continuing to see their pediatric pulmonologist even past the normal age range. “There are a lot of conditions that we train for, CF being a big one, that adult practitioners didn’t use to see. Luckily, things are changing for the better and many of these patients are living much longer.”
But the most common referral pediatric pulmonologists receive is for childhood asthma. Asthma affects about 4.6 million children in the U.S. (roughly 1 in 12) and while most are managed in primary care, pediatric pulmonologists provide specialized expertise to help children learn to manage their asthma as their lungs change and grow. Chronic cough and recurrent pneumonia are also common conditions that require a pediatric pulmonologist
Additionally, because many childhood disorders have a respiratory component, pediatric pulmonologists are consulted for a wide variety of diseases. For instance, Dr. Saunders has seen patients with Duchenne’s muscular dystrophy, cerebral palsy, spinal muscular atrophy, sickle cell and obstructive sleep apnea, to name a few. “Many NICU babies have lung problems secondary to their prematurity, which is called bronchopulmonary dysplasia. So that is another big one,” she said. “But we get referrals for anything that causes a child to struggle to dispel mucus or breathe normally. So, we see a lot of different things.”
How Does Diagnosis and Treatment Differ for Kids?
Unlike adults, children cannot always articulate what is wrong with them. Conditions often present differently in children than they do in adults. So, it is essential for parents to work in tandem with their child’s pulmonologist. “Where an adult can say something like ‘I feel short of breath with activity,’ or ‘I cough when I’m around perfume,’ kids can’t explain that. They may just stop running when they are playing soccer or sit out at recess,” Dr. Saunders said. “So, it is recognizing those subtle signs they are telling us so we can investigate further.”
Pediatric pulmonologists tailor their approach based on a child’s age and stage. If they are very young, they may not have much of a medical history, so a physical exam and observation in the room are essential. This is especially true if they are too young for pulmonary function testing, which can be hard to do before age 6. “It’s not one-size-fits-all,” Dr. Saunders elaborated. “For the youngest kids, parent reports and observations are key. As kids get older, we can start doing pulmonary function tests and relying on them a little bit more. And once they are young adults, we ask them to answer questionnaires and prompts like adults.”
Additionally, walking in with a smile and trying to make things fun and engaging for both children and their parents is important in pediatrics. Pediatric pulmonologists work hard to keep kids giggling and make sure parents are relaxed enough they feel comfortable opening up to the doctor.
Why Do Parents Need to Get Involved?
Though it may be a parent’s initial instinct to sit back and just listen, Dr. Saunders urges them to get involved. Shared decision making and parental engagement are vitally important, especially for pediatric medicine. “Parents know their kid better than anyone else, and their observations are incredibly valuable to me. So, I really try to take the time to listen to parents concerns and ask them detailed questions.”
Additionally, transparency allows pediatric pulmonologists to address problems promptly and soothe any parental anxiety. “Parents need to feel like they understand the treatment decisions and why it is right for their child.”
She gives an example of a child vs an adult asthma treatment plan. Adults oversee their own medicine regiment; they keep their controller medicine and emergency inhalers on hand and have an action plan ready which they implement themselves. But parents often need to help their child remember to take their medicine, make sure their emergency medicine is available if their child has a flare-up and understand side-effects, so they know when to contact their child’s healthcare provider. “We really need to work together to keep kids healthy and out of the emergency room.”
Though there are a lot of things that can affect lung health, Dr. Saunders encourages parents to trust their instincts when it comes to their child. “If it feels like something isn’t right, bring it up with your doctor. If your child is sick more often or longer than other kids or their breathing symptoms are interfering with their playing, that is something their doctor should know and may be a reason to be referred to a specialist.” Children are resilient, and many childhood illnesses are treatable, but prompt diagnosis is an important step in getting a child the help they need. “Seeing a pediatric pulmonologist early can make all the difference in their growth, development and quality of life,” Dr. Saunders concluded.
Blog last updated: August 25, 2026
