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Program and Services

Services Offered:

  • Asthma management and education, 914-493-7585
  • Center for Aerodigestive Disorders, 914-493- 7585
  • Center for Health Lung Development (BPD), 914-493-7585
  • Pediatric Flexible Bronchoscopy Service, 914-493-7585
  • Childhood Interstitial l Lung Diseases Center, 914-493-7585
  • Children's Environmental Health Center of Hudson Valley, 914-493-7585
  • Care of the technology-dependent child, 914-493-7585
  • Armond V. Mascia, M.D. Cystic Fibrosis Center for Children and Adults, 914-493-7585
  • Primary Ciliary Dyskinesia Center, 914-493-7585
  • Pulmonary Function and Exercise Testing, including infant pulmonary function tests, 914-493-5491
  • Pulmonary rehabilitation, 914-493-7585
  • Sleep apnea and other sleep disorders, 914-493-7585
  • NYS-approved Infant Apnea Center, 914-493-7585
  • Tracheostomy management, 914-493-7585
  • Other acute and chronic respiratory diseases affecting infants, children and adolescents, 914-493-7585
  • American Lung Association accredited Asthma Clinical Research Center, 914-493-5491
  • Allergy Evaluation and Management for Children and Adults, 914-493-7585
  • Evaluation and Care of Diseases of the Immune System, 914-493-7585

Programs:

Center for Aerodigestive Disorders

Director: Christy Kim, M.D.
For appointments or to contact us, call 914-493-7585

Our Center for Aerodigestive Disorders is the home for a state-of-the-art multi-disciplinary program developed to deliver specialized care for children with a variety of complex medical conditions that involve both the respiratory tract and gastrointestinal tract. The lungs and the intestinal tract are intimately related, as they both arise in the fetus as one organ which subsequently divides. As a result, many children have respiratory symptoms related to diseases of the GI tract, and GI symptoms related to disease of the lungs and respiratory tract. Medical specialists in the past tended to work in their own silos. Our center is a recognition that pediatric pulmonologists and gastroenterologists need to closely work together in both the diagnosis and treatment of many children. Our center staff works closely with our colleagues in both pediatric allergy and otolaryngology as needed to offer a complete team approach. For instance, sometimes there are actual anatomic connections between the respiratory and GI tracts that may require surgery. Allergies may also cause both breathing issues, such as coughing and wheezing, and also symptoms from the GI tract, such as swallowing difficulties, nausea, vomiting, burping, abdominal pain, constipation and diarrhea.

In addition to physicians and surgeons, our staff includes two dieticians, swallowing specialists, respiratory therapist, social worker, and psychologist, all working together to assure that every child is treated as an individual, with their own unique needs. Children with swallowing difficulties are also well served if they are evaluated and managed at a center such. Swallowing problems are very common, both in children with other medical conditions, and in children with no other known medical issues.

Our group has eight convenient offices throughout the Hudson Valley to make it easier for children to be seen close to their home.


Center for Healthy Infant Lung Development (BPD)

Director: Agnes Banquet, M.D.
For appointments or to contact us, call 914-493-7585

Our Center for Healthy Development cares for children with a variety of respiratory (breathing) issues from early infancy. The most common of these newborn lung diseases is Bronchopulmonary Dysplasia (BPD). BPD is a chronic lung disease that mainly affects premature babies and can vary from mild to a very severe disease. After going home from the neonatal care unit, these children continue to need close follow-up to monitor their respiratory condition. Nutrition and growth are very important, especially in the first two-three years of life, because during this time their lungs are growing and trying to heal. Children with prematurity and BPD often have more difficulty with respiratory infections which can result in asthma-like symptoms with coughing, wheezing and breathing difficulty.

It is strongly recommended that all premature infants who had significant respiratory illness while in the neonatal unit be followed by a pediatric pulmonologist, particularly those who go home on oxygen and medications for their breathing. Our faculty is very experienced in the care of these children. Particularly during the first few years of life, the care of a pediatric pulmonologist can significantly decrease the frequency and severity of their illnesses.

In our clinic, patients are evaluated regularly for their progress, medical history and examinations are carried out at every visit. Many patients with BPD require oxygen at home, sometimes just when they are ill, sometimes just at night, sometimes all of the time. Some of these babies also require oral medications such as diuretics and inhaled medications. Many of these children require routine prophylactic treatment through the winter season with a monthly intramuscular injection specially designed to help decrease the likelihood of these children requiring hospitalizations. These injections are not perfect but they can help.

The regimen must be adjusted frequently as babies grow and change. Treatment plans are reviewed at each visit and changes are made according to the child's condition.

Education is a big component of our care and we focus on educating families about this condition, therapies, symptoms to watch for as well as environmental control measures and required immunizations.

Our group has eight convenient offices throughout the Hudson Valley to make it easier for children to be seen close to their home.


ARMOND V. MASCIA, M.D. CYSTIC FIBROSIS CENTER

Director: Allen J. Dozor, M.D.
For Information, call 914-493-7585

The Armond V. Mascia, M.D. Cystic Fibrosis Center has been accredited by the Cystic Fibrosis Foundation for over forty years. Our Center is dedicated to excellence in patient care, education and research. Our center has a well-established multidisciplinary team dedicated to patients with CF. Within our center, we have both pediatric and adult CF programs.

Mission Statement:
The mission of our CF Center is to enable our patients with cystic fibrosis to fulfill their maximal potential with the support of their families by providing state-of-the-art clinical care. To further this goal, our center is dedicated to the education of all patients, their families, healthcare professionals and the community, the pursuit of rigorous research and continuous quality improvement.

CF Center Staff:

CF Center Director: Allen J. Dozor, M.D.
CF Center Physicians: Agnes Banquet, M.D.
Jay Boyer, M.D.
Amy Brown, M.D.
Elizabeth De la Riva-Velasco, M.D.
Bindu George, M.D.
Suzette Gjonaj, M.D.
Christy Kim, M.D.
Y. Cathy Kim, M.D.
Sankaran Krishnan, M.D.
Diana Lowenthal, M.D.
Yehudit Pollack, M.D.
Nadav Traeger, M.D.
John Welter, M.D.

Adult CF Center Physicians:
Lisa Paul, M.D., Adult CF Program Director
George Maguire, M.D.

CF Center Director of Quality Improvement:
John Welter, M.D.

CF Center Nurse:
Maryann Francella, L.P.N.

CF Center Social Worker:
Kim Jacobs, LMSW

CF Center Respiratory Therapist:
Lisa Monchil, RRT, CCRC, AE-C

CF Center Research Manager:
Meighan Gallagher

CF Center Research Coordinators:
La Toya Holness
Armando Ramirez, L.P.N.
Kathryn Nath, R.N., P.N.P.
Christine Bereth

CF Center Pulmonary Function Technicians:
Richard Griffin, M.S., RPFT
Conor Coen, CPFT

CF Center Dieticians:
Mary Sexton, R.D.
Diane Lindsay-Adler, R.D.

CF Center Psychologist:
Arlene Adler, Ph.D.

CF Center Coordinator:
Jennifer Luchetta

Adult CF Program Coordinator:
Tracy French

What is Cystic Fibrosis?

Cystic fibrosis (CF) is an uncommon disease which affects the entire body, particularly the lungs, pancreas and gastrointestinal (GI) tract, and the reproductive tract. CF was first recognized in the 1930’s, and since then dramatic improvements in therapy have steadily improved the lives of people with this terrible disease. However, there is still no cure. Cystic Fibrosis is a genetic disease. All patients with CF have inherited mutations of the CF Gene (also known as CFTR) from both parents. Many people carry one mutation, referred to as carriers, and they have no symptoms. There are about 30,000 people who have CF in the United States. Cystic Fibrosis affects Our group has eight convenient offices throughout the Hudson Valley to make it easier for children to be seen close to their home. Approximately 1 out of every 3,000 Caucasians. The risk is lower in other races.

How does CF cause illness?

The CF gene causes abnormal movement of salt and water into and out of cells. This results in abnormal mucus, particularly in the bronchial tubes (airways), in the pancreas, liver, GI tract, and the reproductive tract. There is an extraordinary amount of variability in symptoms between patients. Some patients are very ill in the first year of life, but others may not be diagnosed until adulthood. Because of sticky mucus in the ducts of the pancreas, most patients with CF have difficulty growing and gaining weight. Because of sticky mucus in the lungs, most patients develop chronic cough and other respiratory symptoms. Because of sticky mucus in the reproductive tract, many patients have difficulties with fertility.

How is CF diagnosed?

The most common test for CF is called a sweat test. Patients with CF do not sweat any more or less than other people, but the salt concentration is higher in the sweat. This test is tricky to perform accurately, and therefore it is essential that all sweat tests be performed at CF Centerssuch as ours that are accredited by the Cystic Fibrosis Foundation. Since the gene was discovered in 1989, more and more people are being diagnosed with genetic blood tests. These tests can miss CF and need to be interpreted very carefully. In the United States, all states have now added Cystic Fibrosis to the diseases routinely tested for in all newborns. Therefore in the future most patients will be diagnosed in the first couple of months of life, often before there are any symptoms. There are good reasons to believe that early diagnose will further add to the dramatic improvements in life expectancy that are occurring. However, these newborn screening programs are not perfect and rarely can miss the diagnosis. All newborn screening results should be confirmed with either repeat blood tests or sweat tests.

Why should patients with CF be cared for at our CF Center?

Since CF is relatively uncommon, many physicians know little about it or have very little experience. In recognition of this problem, families of patients with CF started the Cystic Fibrosis Foundation over fifty years ago. One of the goals of the foundation is to assure that there are experienced centers of excellence throughout the United States. There are now about 110 accredited CF Centers including ours. We believe that all patients with CF should be followed at an accredited center. The accreditation process is very rigorous and gives assurance that all patients with CF will be receiving state-of-the-art care. All CF Centers are dedicated to excellence in patient care, education, and research.

Our CF Center has a very experienced multidisciplinary team that stands ready to help patients of all ages. We have a beautiful modern office suite with easy access to laboratory and radiological procedures if they are needed. Like all accredited centers we have a long-standing quality improvement program. Since 50% of patients with CF are now adults, we have a well established adult program. In addition, our center is also a member of the CF Foundation Therapeutics Development Network which directs all clinical trials of new therapies for people with CF. This additional level of accreditation assures that our patients have access to cutting edge clinical research.

Is our Center performing CF research?

Yes, all physicians at our CF Center are on the faculty of New York Medical College and research is a major part of our mission. We have a 5 member research staff and we are involved in research ranging from basic laboratory research to clinical trials of up and coming therapies, to epidemiological research.

How can I learn more about Cystic Fibrosis?

There is a wealth of information about CF on the internet, but like all topics, not all of the information is completely accurate. The single best resource is the Cystic Fibrosis Foundation. Their website is http://www.cff.org


Childhood Interstitial Lung Disease Center

Director: John Welter, M.D.
For appointments or to contact us, call 914-493-7585

Our center is the only such center in the Hudson Valley, dedicated to caring for children with a variety of interstitial lung diseases. These conditions are rare, and therefore best cared for by a team with experience, both in diagnosis and treatment.

We specialize in innovative, family-centered care that supports children and their family at all stages. Our multidisciplinary team includes not only physicians and surgeons, but nurses, dieticians, social workers and respiratory therapists. We work with families to plan individualized therapy depending on the specific condition. Our goal is to offer the best care of the child’s respiratory health, growth and nutrition. Additionally we provide education about pediatric interstitial lung disease and family support. If indicated, we also assist in arranging home health care support and supplies, transportation services, and visiting nursing services.

Our team, includes specialists from pathology, radiology, surgery, immunology, rheumatology, gastroenterology, neonatology, critical care, and cardiology.

What is Childhood Interstitial Lung Disease?

Interstitial lung disease is not a single disease. There are many distinct chronic diffuse lung disorders, which fall under the umbrella diagnosis of Children’s Interstitial Lung Disease. Sometimes children are born with these disorders, and symptoms occur at birth or soon thereafter. Sometimes these diseases develop gradually over time. Some children with interstitial lung disease have other medical conditions such as heart disease, joint disease (arthritis), blood disorders such as sickle cell anemia, cancer, or chronic inflammatory bowel disease (such as Crohn’s or Ulcerative Colitis).

Since childhood interstitial lung diseases are rare, they are frequently missed. Many children are first thought to have asthma, since asthma is so common. It may take many months or even years for parents and families to recognize that standard asthma therapy is not effective and it is time to consider less common possibilities, including childhood interstitial diseases. Individually the disorders are rare, but collectively they are not. Symptoms can range from mild to severe and have different treatments and outcomes. Some of the disorders are specific to the lungs while others are pulmonary manifestations of systemic disorders. It is very important that childhood interstitial lung diseases are diagnosed as soon as possible, so optimal therapy can begin right away.

Our group has eight convenient offices throughout the Hudson Valley to make it easier for children to be seen close to their home.


Pediatric Flexible Bronchoscopy Service

Director: Nadav Traeger, M.D.
For appointments or to contact us, call 914-493-7585

Our physicians are experts in performing this often essential diagnostic test, using state of the art bronchoscopes available in appropriate sizes for children of all ages.

Bronchoscopy can be an important component in the evaluation of:

• Noisy breathing

• Chronic cough

• Asthma that is difficult to control

• Airway malformations

• Chronic or recurrent pneumonia

• Airway masses or foreign bodies

These procedures are performed in the Pediatric Operating Rooms (for outpatients) or in the Pediatric Intensive Care Unit (for inpatients) of the Maria Fareri Children's Hospital at Westchester Medical Center. During the procedure the child is unconscious in order to maintain patient comfort and make the procedure successful, with anesthesia performed by highly skilled Pediatric Anesthesiologists or Intensivists.

A bronchoscope is a thin flexible fiberoptic instrument with a tiny camera and light at the tip, that is inserted into the airways through the nose, mouth, or tracheostomy. It is performed for visualization of the major airways and to obtain samples for analysis. This test may be done if your child has wheezing, chronic cough, lung infection or changes on a chest x-ray.

How is the procedure performed?

Your child will be given anesthesia before the test begins, and they are often also given medicine during the procedure to numb the nose and throat. Our specialists then place the bronchoscope either through the nose or the mouth and then gradually move the scope down into the child’s windpipe and large airways. Sometimes, the physician will spray normal saline (salt water) into these bronchial tubes to suction out any secretions and send them to the laboratory for analysis.

How should I prepare my child for bronchoscopy?

• You will be instructed not to feed your child before the procedure. This time will vary depending on the age of your child.

• Feel free to bring your child's favorite toy or blanket for their comfort.

• Please bring with you the names of all of your child’s medications and dosages, and give that list to the nurse when you arrive for the procedure.

What happens after the test?

Your child will be watched closely after the test until he or she is fully awake, which may take about one or two hours. Most children can then go home after bronchoscopy although sometimes they have to stay in the hospital for further observation or if other procedures or plans have been made.

What should I expect when we go home?

Don’t be surprised if your child is still sleepy after they are discharged. It is okay if they sleep. You are welcome to feed your child when they wake up. Sometimes it is recommended that you start with clear liquids to make sure your child is fully awake before introducing solid food. There are no other routine limitations on your child’s activities. Ask you child’s pediatric pulmonologist to be on the safe side.

Some children develop a fever the night after bronchoscopy is performed, so make sure you are prepared with either acetaminophen or other pain relievers. Ask you physician about that. You don’t need to wake your child up to check their fever. If they don’t wake up on their own, then it does not need to be treated. If the fever persists more than 24 hours, call your pediatric pulmonologist or pediatrician and let them know.

Sometimes cultures and other tests are obtained with bronchoscopy, in which case you should check in with your pediatric pulmonologist to learn the results.

When should I call my child’s doctor?

Of course, feel free to call us at 914-493-7585 24/7 if you have any concerns after bronchoscopy. And certainly you should call us is your child seems to be having any trouble breathing.


Primary Ciliary Dyskinesia Center

Director: Sankaran Krishnan, M.D., M.P.H.
For appointments or to contact us, call 914-493-7585

Primary Ciliary Dyskinesia (PCD) refers to a group of medical conditions once thought to be rare, but now are being increasingly recognized. Cilia is the anatomic term for the fine hair-like projections that cover many cells in the body; including, but not limited to cells that line the bronchial tubes (airways) that bring air in and out of your lungs. These tiny projections have many vital functions; and in children and adults with PCD, they do not function (“beat”) properly. Patients with PCD may have a variety of medical conditions that affect the heart, GI tract, genitourinary tract, and even the central nervous system. However, the majority of children recognized with PCD today have chronic coughing and other respiratory symptoms. Not too long ago, it was thought that all patients with PCD had severe lung disease, including lung damage often referred to as “bronchiectasis.” With our improved ability to diagnose these conditions, we now recognize that PCD can be rare and the diagnosis may be missed for decades. Asthma is so common that most children and adults with chronic coughing or other conditions are assumed to have asthma. It is vital that patients and their families and physicians consider the possibility that a child may not have asthma, particularly if their symptoms are not easily controlled with routine asthma medications.

The diagnosis of Primary Ciliary Dyskinesia can be very challenging, and it is essential that all children or adults suspected to have PCD be referred to a center such as ours for proper diagnosis. Our understanding of the genetics of these disorders is exploding, and the list of possible genetic mutations that may lead to PCD is growing monthly. We work very closely with our division of medical genetics to assure that state-of-the-art genetic testing is performed when required.

Our center includes a multidisciplinary team made up of physicians, respiratory therapists, social workers, dieticians, and pulmonary function technicians. We work closely with our colleagues in pediatric otolaryngology, since PCD often causes chronic nasal discharge, recurrent ear infections and sinus infections. PCD can affect the development of the heart, so all patients with suspected PCD require careful assessment by pediatric cardiologists with experience with these disorders.

Our group has eight convenient offices throughout the Hudson Valley to make it easier for children to be seen close to their home.