World-leading children’s respiratory care

Evelina London Children’s Hospital and Royal Brompton Hospital are home to our world-leading children’s respiratory service, supporting patients with both acute and chronic lung conditions. Learn more about our expertise from Dr Jane Heraghty, consultant in respiratory and general paediatrics at Evelina London, deputy cross-site head of paediatric respiratory services, and Dr Samatha Sonnappa, consultant in paediatric respiratory medicine at Royal Brompton and cross-site head of paediatric respiratory services. 

Specialist-led services for complex respiratory cases

Our consultants provide comprehensive management of children with a broad range of respiratory conditions, including: 

• bronchiectasis 
• chronic lung disease 
• congenital lung abnormalities 
• cystic fibrosis 
• exercise-induced breathlessness 
• interstitial lung disease 
• recurrent chest infections 
• severe asthma and preschool wheeze 
• sleep disordered breathing 

“We have a specialist paediatric respiratory service with all assessments tailored specifically for children,” explains Dr Heraghty. “We also have fully comprehensive lung function testing, which a lot of general hospitals won’t have access to, as well as specialists who only do paediatrics.” 

Our consultants at Evelina London and Royal Brompton can also offer specific tests designed for under-5s, tailored to achieve the most accurate results for young patients. These tests aren’t available in adult units, meaning that children can visit facilities which have been developed with them in mind, both for their comfort and for the best test results.  

“Royal Brompton is the only hospital in the south of England where continuous laryngoscopy during exercise can be performed in children and young people with exercise-induced laryngeal obstruction. We’re one of a handful of centres that offers cardiopulmonary testing and paediatric flexible bronchoscopy,” says Dr Sonnappa. “We also offer lung function testing for the under 5s, which is a specialism of ours not widely available privately elsewhere.” This is particularly useful in treating preschool children with wheeze to determine the need for inhaled corticosteroids. 

Dr Heraghty, Dr Sonnappa and the team regularly receive referrals from all around the UK, as well as from international patients, for treatment of both chronic and acute conditions. 

Common respiratory problems in children

“The most common problem we see patients with is recurrent chest infections and ongoing coughing,” explains Dr Heraghty. “The other thing we see a lot of is recurrent croup, as well as snoring and sleep apnoea.” Children with obstructive sleep apnoea may require CPAP at night, which our specialists can provide after a thorough assessment at Evelina London. 

Much of the care provided is about excluding underlying problems causing symptoms, because many children simply have recurrent viral infections. However, the key things our specialists aim to exclude are possible allergies, asthma or aspiration of liquid into the lungs. 

 “We offer a full investigative work-up for recurrent chest infections and wheeze to determine the cause and to decide on best course of treatment,” says Dr Sonnappa. Typically, children come into the hospital for a one-night stay, where they will have a CT scan of the chest, flexible bronchoscopy, 24 hour gastro-oesophageal pH/impedance test to rule out gastro-oesophageal reflux, and other relevant investigations performed in the same visit. Our team aims to complete all tests in a 24 hour period, rather than prolonging the patient’s stay.

Post-pandemic trends in respiratory health

One of the main effects of the pandemic on respiratory care generally is the waiting lists that have formed due to non-essential care being paused. This has resulted in an influx of parents now self-referring their children for private care, especially for ongoing conditions like asthma, recurrent wheeze, chest infections, and exercise-induced breathlessness. 

“We’ve now got a set of children that have been born to mothers that isolated during pregnancy and weren’t exposed to viruses, and therefore didn’t have enough immunity themselves to pass onto their children,” explains Dr Heraghty, a fact which may change the landscape of respiratory illnesses in years to come. 

Dr Sonnappa worked as the clinical lead for respiratory illness for the Pan London Post-COVID Service, which was established in response to a need for long-term specialist services for children following a COVID infection. Her experience in this area has resulted in numerous paediatric long-COVID referrals for breathing difficulties caused by the virus, bringing a new area of expertise to the team.

Maintaining ethical decision-making

Something that our specialists are focused on is holding our young patients front and centre. “I’m very confident in saying that I’m happy not to do tests that I don’t think are necessary,” says Dr Heraghty. “I won’t over-investigate a private patient if I don’t feel that, as an NHS doctor, I would have done the test.” 

Dr Sonnappa echoes the same sentiments: “My NHS practice and private practice doesn’t differ at all – it’s exactly the same pathway, and I won’t recommend investigations just for the sake of it.” Further to this, our specialists work in tandem with their patients’ GPs to prevent unnecessary testing, safeguard the patient, and to maintain transparency when it comes to prescriptions. 

“Working closely with the child’s GP means they’re informed of ongoing treatments and tests, so they’ve got an understanding of a child that needs monitoring,” explains Dr Heraghty.

Combining face-to-face and virtual care

Our team often offer virtual appointments as a first port of call, allowing them to meet our young patients and gain an understanding of their condition, to then establish exactly what tests are needed before an in-person visit for investigations. 

“Doing a virtual appointment first is great because I can review how they’ve been over the last 6 months,” explains Dr Heraghty. “This is especially useful as I don’t see many patients that are acutely unwell on the actual day, and it allows both parents to be there because we can be more flexible with the timings.” 

This approach means that patients and families referred from other parts of the country can streamline their visits and receive the care most appropriate for them in the most efficient way possible.

When to refer to us

Children and young people with recurrent chest infections, wheeze, ongoing coughing, exercise induced breathlessness, snoring and sleep apnoea can be referred to us for private appointments and can be seen quickly in our dedicated paediatric facilities. Parents can also request a private appointment with our specialists for their child. 

To refer a patient, please contact the Guy's and St Thomas' Specialist Care team. 

Dr Jane Heraghty

Consultant in respiratory and general paediatrics 

Dr Jane Heraghty is a consultant in respiratory and general paediatrics, managing children with a range of respiratory conditions, including cough, wheeze, asthma, recurrent chest infections, and sleep-disordered breathing. 

Dr Samatha Sonnappa

Consultant in paediatric respiratory medicine 

Dr Samatha Sonnappa is a consultant in paediatric respiratory medicine and has expertise in diagnosing and treating children with asthma, frequent wheeze, recurrent chest infections, exercise-induced breathlessness, chronic cough, and congenital lung abnormalities.

Get in touch 

For more information on our paediatric respiratory service at Evelina London and Royal Brompton hospitals, please contact our customer services team. Call +44 (0)20 3993 3074 or email [email protected]