What to Expect
 When your child visits the Pulmonary, Allergy and Cystic Fibrosis Center at Miller Children’s Hospital, they may end up needing some tests done to help better diagnose their condition. It is important that as you understand what is involved in your child’s test(s) before, during and after as well as how to prepare for each test. Also sometimes an infant or child may need to be sedated for a test in the pulmonary function testing lab, which requires special instruction and preparation for your child.
When sedation medication is needed, there are important rules for eating and drinking that must be followed in the hours before the test. The nurse will give you specific eating and drinking instructions for your child based on their age. Follow the specific instructions given to you by the nurse. Generally, the guidelines are:
For children older than 12 months
After midnight on the night before the test, do not give any solid food or non-clear liquids to your child. That includes milk, formula, juices with pulp, coffee and chewing gum or candy.
For infants under 12 months
- Formula-fed babies may be given formula, up to 6 hours before the scheduled arrival time.
- Breastfed babies may nurse, up to 4 hours before the scheduled arrival time.
For all children
- In the hours up to 2 hours before the scheduled arrival time, give only clear liquids that are water based, such as Pedialite®, Kool-Aid®, ice, jello, ice pops, clear broth and juices you can see through, such as apple or white grape juice.
- Nothing can be given to eat or drink in the 2 hours right before the scheduled procedure time.
- If these instructions are not followed, your child’s test may have to be postponed or rescheduled for a different day.
- The iPFT should be done when your child is well. If he or she is congested, wheezing or has a fever the day before or the day of the test. The test may need to be rescheduled for another day.
- Please bring 1-2 bottles of clear liquids with you to the test so you can feed your child after the test.
- Please allow time for travel and parking before the test so that you arrive on time for your appointment. If you are late, your child’s test may have to be postponed or rescheduled for a different day.
- If your insurance company requires a referral for this test, please bring one with you to the test.
- It is beneficial if your child is somewhat sleepy when he or she arrives for the test. Put your child to bed later than usual the night before the test and wake him or her up a little earlier than usual.
Medications
- You should not give your child a breathing treatment using a bronchodilator for at least 6 hours before the infant pulmonary function test. Bronchodilators include albuterol, Proventil and Atrovent.
- If your child takes other medication by mouth, ask the doctor if your child may take it and how close to the testing time it should take be taken.
Before the Test
- One parent or guardian may stay with your child during the test. Other adults and siblings must stay in the waiting room during the test.
- You and your child will be called to the examining room and you will be asked some screening questions by a nurse or one of the doctor’s assistants. The assistant will take your child’s vital signs, weight and medical history. As the parent or legal guardian, you will be asked to sign a consent form for testing.
- You may ask any questions or discuss concerns about your child’s test at this time.
- Your child may wear normal clothes or pajamas to the test. Before the test begins, you will be asked to take off your child’s clothes down to a diaper.
Before a Pulmonary Function Test
- Your child can’t eat any solid foods six hours or drink any liquids four hours before the test.
- Know that these tests cause no discomfort to your child.
- They do require the child to be relaxed and breathe into a mask so a mild sedation is required which allows the child to sleep through the entire procedure.
- Once your child is asleep the test will begin and takes about 50 minutes.
During the Pulmonary Function Testing
- Your child is placed in a special bed and a mask will be placed over his/her mouth and nose.
- A loose fitting jacket is placed around your child’s chest and abdomen.
- He or she will be given a few deep breaths from the mask and then the bag is inflated so it gently squeezes the chest causing him or her to blow out. This is similar to asking older children to take a huge breath and blow out as hard as they can.
- For the last part of the test the size/capacity of the lungs is measured.
- The top of the bed is briefly closed around the child.
- The air coming in and out of the child's lungs is stopped for a few seconds which causes a pressure change in the box and enables the computer to calculate lung capacity.
After the Pulmonary Function Test
- After the test we will wake your child up immediately.
- Most children wake up easily and ask for something to drink.
- You may notice that your child is slightly uncoordinated for the rest of the day and it is important to watch him or her carefully to prevent any injuries from falls or bumps.
- Most children will nap the day of the test and return to their normal sleep pattern that night.
- You will be given special discharge instructions as well as a number to call if you have any questions following the test.
- You can expect the health care team to have results within one week of your child’s test.
Before the Broncoscopy Test
Before your child undergoes the bronchoscopy, you should not let them eat or drink anything after midnight prior to the procedure.
During the Broncoscopy Test
- When you and your child arrive for the bronchoscopy at Miller Children’s (or if the patient is already in the hospital), an intravenous catheter (IV) will be started for administration of medication and fluid.
- Your child will then be connected to a monitor for continuous monitoring of their heart rate, blood pressure, and oxygen level in the blood.
- If needed, supplemental oxygen will be supplied through a small tube inserted into the nostrils or a facemask.
- Medication is then given through the IV to make sure your child is relaxed and sleepy for the flexible fiber optic bronchoscopy.
- Prior to the insertion of the flexible bronchoscope, a local anesthesia with topical lidocaine is given in the nose and to the back of the throat.
- The flexible bronchoscope can be introduced either through the mouth or the nose.
- Some patients may require a special tube to be inserted through the mouth, passing the vocal cord, and into the trachea to protect and secure the airway.
- Once the bronchoscope is in the airway, an additional topical anesthetic will be sprayed into the airway for local anesthesia to minimize discomfort and coughing spells to your child.
Flexible bronchoscopy rarely causes any discomfort or pain. Your child may feel the urge to cough because of the sensation of a foreign object in the "windpipe." Again, this feeling can be minimized by pre-procedural medication given for relaxation and local anesthesia with lidocaine. The procedure usually takes between 15 - 60 minutes. If a specific area needs to be more thoroughly evaluated or an abnormality is detected during the procedure, samples will be collected.
After the Broncoscopy Test
- Your child will be taken to an observation area for monitoring for one to two hours until any medication given wears off and they are able to swallow safely.
- Some patients may cough up dark-brown blood for the next one to two days after the procedure. This is expected and should not be alarming.
- However, if there is persistent bright red blood in the spit, the doctor must be consulted immediately.
- A follow-up visit with the doctor will be scheduled to review the results, which are typically available within one week.
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