Reflections of a paediatric pulmonologist: strategies for optimising lung function tests in preschool children

In recent years, our clinical practice as paediatric pulmonologists has focused on refining strategies to optimise pulmonary function tests (PFTs) for preschool children, particularly those aged as young as 2 years and 5 months. This viewpoint reflects on our experience conducting over 7000 spirometry and impulse oscillometry (IOS) tests, sharing practical insights into achieving high success rates with young children. We emphasise the importance of creating a child-friendly, minimally stimulating environment, tailored communication using familiar and engaging language, and leveraging gamification and positive reinforcement. In particular, we highlight the use of role-playing as an effective engagement strategy, allowing children to teach a stuffed toy how to perform the test. Furthermore, we differentiate the approaches required for spirometry, which demands active cooperation, and IOS, which allows for tidal breathing and is more suitable for younger or less cooperative children. Through these strategies, we have achieved consistent, technically acceptable results in preschool-aged children, aligning with the latest standardisation guidelines. Our findings demonstrate the value of adaptability, patience and creativity in paediatric PFTs, suggesting that these approaches improve not only test accuracy but also the overall experience for both children and caregivers. Future research should further investigate these techniques to enhance paediatric pulmonary testing protocols.