Pediatric Pulmonology Referral Guidelines

Specializing in the diagnosis and treatment of complex respiratory conditions and disorders, the pediatric Pulmonology practice at Valley Children’s provides 24/7 service in the inpatient, outpatient and emergency care settings.

We work closely with other hospital services such as the neonatal intensive care unit, but almost 90% of our patients are treated on an outpatient basis. Our pulmonology team participates in clinical research involving conditions including cystic fibrosis (CF). We have about 160 CF patients participating in research projects. We are a multidisciplinary California Children’s Services (CCS) Cystic Fibrosis Center.

Pediatric pulmonologists are medical doctors who have had at least four years of medical school, three years of residency training in pediatrics, at least three more years of fellowship training in pediatric pulmonology, and certification from the American Board of Pediatrics in both pediatrics and the subspecialty of pediatric pulmonology.

Patients with the following conditions should be referred to a pediatric pulmonologist:

Chronic cough
Difficulty breathing
Recurring pneumonia (infection of the lungs)
Cystic fibrosis (a genetic disease with pulmonary and nutritional symptoms)
Apnea (when a child’s breathing stops for a prolonged time)
Chronic lung disease in premature infants
Noisy breathing

Refer to Pulmonology

Refer to the Pediatric Pulmonology Department at Valley Children's online through CareLink or our referral portal, or refer via fax.

Refer a patient

Contact Pulmonology

Contact Pediatric Pulmonology via phone (559-353-5550) or fax (559-353-5587).

Contact a Physician Liaison

Physicians can reach a physician liaison for help with referrals or other questions by calling 559-353-7229.

Download these pulmonology referral guidelines as a PDF

Condition	Pre-Referral Work-up	When to Refer
Asthma, Recurrent Cough, or Wheeze Referring provider should send: clinical history, respiratory history since birth, all lab results pertaining to the problem, and chest radiographs.	Spirometry (pulmonary function testing) in patients over 5 years old Allergy testing CXR, sinus films Immunology Bronchoscopy, if needed	Has been hospitalized, intubated / ICU admission, frequent Emergency Department visits Frequent need for oral steroid bursts Less than 2 years old Unresponsive to usual therapy with increasing medication use Complicating conditions, such as rhinitis, sinusitis, GE-reflux, pneumonia Abnormal spirometry or needs frequent monitoring with spirometry History of chronic lung disease, prematurity, S/P RSV
Bronchopulmonary Dysplasia, Chronic Lung Disease	Serum electrolytes Capillary blood gas Chest radiograph	Unstable respiratory status or is slow to improve Supplemental oxygen requirement Difficulty growing or feeding problems / G-tube feedings Rehospitalization after discharge Inability to wean medications and / or oxygen
Cystic Fibrosis	Repeat sweat chloride test, if indicated DNA analysis if not already done Other blood work (vitamin levels) Sputum culture / throat culture	Sweat chloride is positive Positive newborn screening
Sleep Disorders	Polysomnogram ENT evaluation, if indicated Echocardiogram (to assess for pulmonary hypertension) Capillary blood gas, serum electrolytes Lateral neck	Any symptoms of sleep difficulties: Sleep disorder breathing, snoring, daytime somnolence, growth delay, and enuresis
Hyperlipidemia	May be managed by primary care; selected referrals may be appropriate Fasting lipid profile prior to visit
Hypertension	Referral to Nephrology if not associated with coarctation of the aorta -- will have EKG at cardiology evaluation and possibly echo, stress test or event monitor