What is a flexible bronchoscopy? 

If your child has a respiratory condition, your pediatric pulmonologist may perform a flexible bronchoscopy to get more information about your child’s condition. A flexible bronchoscopy provides a detailed view of your child’s airways, helps evaluate their airway function, and allows your doctor to collect tissue samples that can be examined under a microscope. A flexible bronchoscopy is also used to remove any substances or foreign bodies that may be blocking your child’s airways. 

A flexible bronchoscopy is usually done under general anesthesia, which means your child will be asleep during the procedure and won’t feel anything. The procedure usually takes place in the operating room, but it may also be done in the Intensive Care Unit (ICU) if your child is already intubated or admitted. 

A bronchoscope is a thin, flexible tube with a camera, a light and a suction port attached to it. During the bronchoscopy procedure, your child’s pulmonologist will insert the bronchoscope through your child’s nose, down their throat and into their airways. The camera allows the doctor to see and take pictures of your child’s airways. The suction port helps collect lung fluid through a process called bronchoalveolar lavage. Bronchoalveolar lavage involves injecting salty water (called saline) through the bronchoscope into your child’s airways. This helps break up substances in the airways, which are then suctioned back up. Your child’s pulmonologist can then examine cells from your child’s airway under a microscope to diagnose lung infections, lung diseases or any other issues. 

Sometimes, doctors can do additional procedures during a flexible bronchoscopy, such as: 

• Biopsies: Taking small tissue samples using special tools, including one that freezes the tissue
• Airway treatment: Opening blocked airways or removing objects that are stuck
• Ultrasound-guided biopsy: Some bronchoscopes have an ultrasound at the tip to help guide where to take tissue samples from the lungs or nearby areas 

If any of these advanced techniques are needed, your child's pulmonologist will tell you ahead of time, and explain all risks, benefits and time required. 

The triple scope 

Flexible bronchoscopy can sometimes be performed at the same time as other procedures performed by Ear, Nose and Throat or Gastroenterology specialists. When these procedures are combined, they are referred to as a "triple scope.” During a triple scope, your child’s specialists will work together to address different symptoms your child is experiencing. Before your child undergoes a triple scope, each specialist will explain their part of the procedure to you, including the risks and benefits. 

How to prepare your child for a flexible bronchoscopy 

Because a flexible bronchoscopy is usually done under general anesthesia, your child will not be able to eat or drink before the procedure. The operating room team will call you ahead of the procedure to confirm the time you should arrive and the time your child needs to stop eating and drinking.  

If your child uses pulmonary medications, like inhalers or nebulized treatments, they should continue to take this medication as usual unless otherwise instructed by your doctor. In most cases, flexible bronchoscopy is an outpatient procedure, which means your child can go home the same day. However, if the procedure is performed while your child is in the hospital, they may need to stay overnight. 

What to expect during a flexible bronchoscopy 

On the day of your child’s procedure, you will meet the pulmonologist doing the procedure and the anesthesiologist caring for your child. An IV will be placed for medication, and the bronchoscope will be inserted after your child is asleep — either through the nose or an airway device used by the anesthesia team. The whole visit lasts about four to six hours, but the actual bronchoscopy only takes about 20-30 minutes. 

After the procedure, your child will be monitored in the Post-anesthesia Care Unit (PACU). Once they are stable, you can take your child home with discharge instructions. Rarely, your child may need to stay overnight. The pulmonologist who performed your child’s procedure will speak to you about the results. 

What to expect after the procedure 

• It is common for children to experience a mild fever, cough or sore throat (especially if a breathing tube was used) after a bronchoscopy. These symptoms usually go away on their own, but you can give ibuprofen or acetaminophen as needed for comfort.
• Some children may need extra oxygen for a short time after the procedure.
• A small amount of blood in the saliva is normal, especially after coughing.
• Rarely, bacteria may reach the lungs during the procedure and cause an infection, which will need to be treated with antibiotics.
• There are no specific activity restrictions after this procedure, and when your child is feeling better, they can return to school. 

A collapsed lung is an extremely rare complication that can be associated with biopsy. If your child’s fever, cough or symptoms worsen after 24 hours, or if they experience shortness of breath or chest pain, contact your doctor right away or go to the Emergency Department.