A short pediatric pulmonology referral framework.

Together We Breathe is designed to support pediatric colleagues, not replace them. A specialist pediatric pulmonology view can help when the pattern is unclear, when treatment is not working, or when the family wants a structured second view alongside ongoing care.

When pediatric pulmonology review may help.

The list below reflects common reasons general pediatricians and other doctors send children for stable specialist review. None of these are absolute — they are starting points.

• Recurrent or persistent cough — especially night cough, cough lasting more than four weeks, recurrent post-viral cough or any chronic wet cough.
• Recurrent wheeze beyond the typical preschool viral-wheeze pattern, or wheeze that is not responding to standard therapy.
• Asthma with poor control despite appropriate therapy, frequent reliever use, repeated oral-steroid courses, frequent night symptoms or exercise limitation.
• Repeated nebulization at home with unclear indication, or treatment escalation without clear pattern review.
• Recurrent pneumonia — more than one in a year, focal recurrent pneumonia, or pneumonia in a child with growth or feeding concerns.
• Suspected protracted bacterial bronchitis, bronchiectasis, primary ciliary dyskinesia, cystic fibrosis or aspiration-related cough.
• Allergic rhinitis with significant impact on sleep, school or asthma control.
• Sleep-disordered breathing — loud snoring, observed pauses, restless sleep, daytime symptoms, where pediatric sleep input may help.
• Abnormal lung function, imaging or allergy reports needing interpretation.
• Inhaler or device technique problems despite repeated counselling.
• Complex or syndromic children with respiratory concerns needing coordinated input.

When in-person care is the right answer.

Useful referral context.

The more clearly the breathing story is captured at referral, the more useful the review. Useful items, where available:

• Duration and pattern of symptoms — dry vs wet cough, episodic vs persistent, day vs night, trigger pattern.
• Wheeze pattern — viral-triggered, multi-trigger, episodic, persistent, exercise-related.
• Previous prescriptions and response — inhalers, nebulizations, antibiotics, oral steroids, antihistamines, leukotriene antagonists.
• Inhaler / spacer / mask device used at home, with brand and dose if possible.
• Chest imaging — chest X-ray, CT or other relevant imaging with reports.
• Lung function reports — spirometry, FeNO, oscillometry where available.
• Allergy reports — skin prick test, specific IgE.
• Sleep study summary if sleep-disordered breathing is the concern.
• Growth data — recent weight, height and pattern over time, particularly in chronic wet cough or recurrent pneumonia.
• Family history — asthma, atopy, lung disease, TB contact, neonatal lung problems, immune concerns.
• Any short videos of breathing or noisy symptoms safely recorded at home.

What the family will experience.

The pathway is intentionally structured. Families do not pay before suitability has been reviewed for the child's specific concern. After a brief safety triage, a stable video review is scheduled where appropriate. A structured advice note can be shared after consultation so the family — and, with consent, the referring doctor — have clear next steps.

What this practice will not do.

• Manage acute breathing distress, hypoxia or suspected foreign body online.
• Change a child's medicines without reviewing device, technique and previous response.
• Bypass an existing in-person specialist or treating physician without discussion.
• Issue prescriptions outside the family's jurisdiction in ways that conflict with local pediatric prescribing norms.
• Replace the relationship the family has with their regular pediatrician.

Doctor questions.