Comprehensive Airway Respiratory Esophageal (CARE) Team

When a child has an airway or upper digestive disorder, it can result in certain symptoms such as noisy breathing, recurrent croup or a chronic cough. These patients may require the input of multiple specialists to determine an accurate diagnosis and/or to coordinate management of care.

We developed the Comprehensive Airway Respiratory and Esophageal Team (CARE Team), a family-centered multidisciplinary program for treating young patients with complex problems related to the airway and upper digestive systems. Our program brings a wide variety of pediatric specialists together who meet once a month to discuss patients and develop a treatment plan as a collective group; they also perform joint procedures in the operating room.

The CARE Team’s areas of expertise include:

Pediatric otolaryngology (ENT)

Our pediatric otolaryngologists and airway nurse practitioner provide expertise in airway, voice, nasal and sinus disorders. Diagnostic evaluations and medical therapy are initiated in our state-of-the-art Hearing and Speech Center. We provide expertise in caring for children with tracheostomy tubes and offer an array of surgical options for children with airway problems including airway reconstruction for children with complex airway stenosis. Compassionate care is combined with sophisticated technology for the best possible outcome.

Pediatric pulmonology

Our pediatric pulmonologists provide expertise in all aspects of pediatric pulmonary disease, including:

• Ventilator dependent and/or tracheotomized patients
• Obstructive and central apnea
• Congenital lung diseases
• Pulmonary involvement in congenital heart disease
• Interstitial lung disease
• Asthma
• Cystic fibrosis

Comprehensive clinical pulmonary evaluations and access to various child-oriented diagnostic techniques (including full pulmonary function testing and challenge tests, sleep studies, flexible bronchoscopy and radiologic tests) are available to patients. The team approach allows us to provide not only a comprehensive evaluation, but also a coordinated plan of care specifically geared toward children with complex pulmonary and upper digestive problems.

Pediatric gastroenterology 

Our pediatric gastroenterologist uses clinical evaluation, as well as the latest diagnostic techniques, to evaluate and treat upper digestive disorders. Some common signs and symptoms we find in children are:

• Cough
• Asthma
• Hoarseness
• Nodules in the vocal cords
• Redness and swelling of the vocal cords
• Acid reflux

Using both upper endoscopy and pH-impedance studies, we are better able to provide a rational treatment algorithm for our patients, evaluating and treating acid reflux and other esophageal disorders, such as eosinophilic esophagitis.

Speech language pathology

Children with a compromised airway often have difficulty with functional speech and/or safe swallowing. Our speech language pathologists perform instrumental evaluations to comprehensively assess swallow function and voice production and establish a plan of care. As a member of the multidisciplinary team, the speech pathologists assist in providing a holistic approach to patient care.

Pediatric critical care

Patients with complex airway problems are often treated in the Pediatric Intensive Care Unit (PICU), either at the time of diagnosis or during the course of treatment. The PICU provides a safe, monitored environment to foster recovery from acute illnesses as well as postoperative care. Comprehensive care is provided by multiple specialists and led by the pediatric intensivist.

Pediatric general and thoracic surgery

When a general or thoracic pediatric surgeon is needed, you can trust our dedicated doctors. Our surgeons on the CARE Team deal primarily in enteral access, procedures for gastroesophageal reflux disease, including laparoscopic Nissen fundoplication, and in tracheopexies and aortopexies for refractory tracheomalacia. They use cutting edge, minimally invasive techniques in order to perform these procedures. Our general and thoracic pediatric surgeons have specific knowledge of the intricacies of treating children with complex airway and upper digestive disorders and take special care to make them feel as comfortable and relaxed as possible, while ensuring optimal outcomes.