What is your role and what does it take to be a practitioner in your field?
My name is Jason Fullmer, MD, FAAP, FCCP, and I am a Pediatric Pulmonologist. I am also an Assistant Clinical Professor through the University of Texas–Southwestern Medical School as I help to educate pediatric residents involved in the UT–Southwestern Residency Program in Austin. A Pediatric Pulmonologist is a pediatric subspecialist. It requires completing medical school and a Pediatric residency program, then an additional 3 years of postgraduate fellowship training in Pediatric Pulmonology. Typically a pediatric subspecialist is Board certified in Pediatrics as well as their subspecialty. I am Board certified in Pediatrics and Pediatric Pulmonology through the American Board of Pediatrics. I am currently a member of the American Thoracic Society, American Academy of Pediatrics and the American College of Chest Physicians.
What exactly do pediatric pulmonologists do?
Pediatric Pulmonologists will often assist the Neonatologist in the care of infants in the intensive care unit with respiratory problems. This can range from helping to diagnose and manage rare lung diseases, to performing procedures such as a bronchoscopy, to helping with ventilators and oxygen therapy in infants with the more expected complications of prematurity. We help the treating neonatologist know when a child is ready for discharge and can help with home equipment needs (for example, home oxygen). We also play a big role in educating families about disease processes and goals of care.
Once discharged from the NICU, infants may follow up in the Pediatric Pulmonology clinic to help manage weaning from supplemental oxygen, weaning from cardiopulmonary monitors (apnea monitors) and reinforcing the treatment plan. Infants with rare lung diseases will also be seen in outpatient follow up. Once a child is established in the Pediatric Pulmonology clinic, sick visits can be arranged to help manage respiratory exacerbations. Depending on the disease process, this may involve breathing treatments, systemic steroids, antibiotics or additional supplemental oxygen. At Austin Children’s Chest Associates (and many other Pediatric Pulmonology offices), we also offer the “RSV shot” or Synagis® to help protect premature infants from Respiratory Syncytial Virus during the Fall and Winter seasons.
How can families protect themselves during the cold and flu season, especially when it comes to RSV?
As previously mentioned infants born prematurely often have a lower pulmonary reserve. A cold or virus that might just be a minor illness in an adult can cause severe problems in an infant with lung disease. Typically, viral infections like RSV are spread by droplets. The most effective way to prevent the spread of viral infections is to avoid sick people and wash hands frequently. RSV is a virus that typically spreads through the Austin area from October to March. Everybody gets RSV before they are 2 years old, but infants can get quite sick with it as it causes an illness known as bronchiolitis. Bronchiolitis is the most common reason children are admitted into the hospital.
Therapy is primarily supportive care and oxygen until they improve. In babies that are high risk for respiratory problems, it is important to avoid crowded places during cold and flu season. Certain high risk infants that meet the very rigid criteria outlined by the American Academy of Pediatrics may also qualify for a shot called Synagis® during RSV season. This shot is an antibody against RSV and provides the infant some protection if he/she is exposed to RSV.
What should parents watch for?
Signs that a baby is doing well include good weight gain and growth, and a normal respiratory rate and pattern. Parents will know their child’s baseline respiratory status the best. Concerning signs are rapid breathing, retractions while breathing, poor feeding and weight gain. Infants born prematurely will typically have low pulmonary reserves so may not be able to tolerate colds and viral infections well. Parents should be on the look out for signs of infection such as runny nose, increased cough or fussiness, or fever.
What conditions are common in babies that have been in the NICU?
We see many different conditions. The more common conditions we see include the following:
- Respiratory Distress Syndrome
- Bronchopulmonary Dysplasia
- Transient Tachypnea of the Newborn
- Meconium Aspiration
- Congenital Diaphramatic Hernia
- Pulmonary Hypertension
- Dysphagia and Aspiration
- Apnea of Prematurity
We will also help diagnose rarer conditions such as:
- Inborn Errors of Surfactant Mutation
- Alveolar Capillary Dysplasia
- Pulmonary Hypoplasia or Aplasia
When would a family talk to you?
Often the first meeting is in the NICU during the initial consultation. At Austin Children’s Chest Associates, we have a full time Pediatric Pulmonologist on call at all times. We provide consultation to all Neonatal ICUs in the Austin area so we are available to see patients in the hospital. Once discharged, our communication is during clinic visits or over the phone as needed.
What sorts of care, therapy and consultation do you provide?
As a pediatric subspecialist, we have the luxury of having longer appointment times than a general pediatrician. This allows more time for personalized education on a child’s disease process and care. We also provide a pediatric pulmonologist on call at all times. This allows easy access to a knowledgeable provider 24 hours a day should the family have any concerns. In addition, we work closely with community pediatricians and other pediatric subspecialists. Communication between caregivers is very important in a child with complex health problems.
What would you tell families they should expect when they’re going to meet with you during their first visit?
Often the first visit is a bit overwhelming. The first visit focuses a lot on education, why I have been consulted, and what my role will be in their child’s care. We will talk extensively regarding the pulmonary disease process we are treating and the treatments I will recommend. Often the first visit is over an hour long. I would recommend that parents take notes and write down questions to ask to help them not feel so overwhelmed. My goal is to have parents become experts in their child’s care so we can make management decisions together.
What role does the family play in working with you and their child?
The family obviously plays the biggest role in the care of their child. We really stress close communication when it comes to following the care plan. We need to hear any concerns regarding medications or therapies, and we need to be in close contact with the family at the start of any respiratory illnesses.
What resources would you recommend for parents who want to find out more about your field?
You can visit our website, Austin Children’s Chest Associates, to find more information about Pediatric Pulmonology and the conditions we treat as well as information regarding our providers. Families can also visit Dell Children’s Medical Center which has a Children’s Health Encyclopedia available in English and in Spanish to get additional information regarding specific disease processes and conditions.