Since this is a pediatric pulmonology clinic, I deal with all types of respiratory illnesses. This includes persistent coughs, asthma, allergies, croup symptoms, and everything related to the bronchi and lungs.

How can parents determine whether they should consult an ENT specialist or a pulmonologist?

In the case of an upper respiratory illness, where a child has a persistent cough, an enlarged adenoid can cause prolonged respiratory symptoms or possibly sinusitis. In such cases, an ENT specialist can be helpful. However, if the ENT specialist cannot find an upper respiratory cause for the persistent cough, they will refer the patient to me. A cough accompanied by wheezing and difficulty breathing is specifically a pulmonological issue. It is important that such cases be referred to a pediatric pulmonology clinic by the pediatrician.

Increasingly, parents are also coming to me on their own because they suspect allergies. Asthma symptoms can appear as early as infancy and are often associated with upper respiratory infections and viral illnesses. Fortunately, not all cases develop into true “asthma” later on; these are known as infant and toddler viral-induced wheezing, which children may “outgrow.” However, their treatment is similar to that for true asthma.

How curable are these diseases, or is it more about symptomatic treatment?

Nowadays, these diseases can be treated very effectively with good medications. In many cases, asthma is caused by a non-viral, non-bacterial airway inflammation, which can be resolved or at least alleviated by inhalation treatments if therapy is started at the right time.

Unfortunately, we are seeing an increasing number of young children with asthma, allergies, and croup.

Indeed, air pollution significantly contributes to these conditions. More and more children, often at a very young age, are coming to me with these issues, sometimes as early as infancy and toddlerhood. This is a condition that children will have to live with, and they need to understand that it is a “lifetime” condition that is manageable. It is the doctor’s responsibility to achieve the longest possible symptom-free state with the appropriate treatment.

Why did you choose pulmonology within the field of pediatrics?

My father was an adult pulmonologist, and he inspired my interest in this specialty. He introduced me to the intricacies of adult pulmonology and familiarized me with the interesting aspects of bronchoscopy. After completing my pediatric specialization, I decided to focus on pediatric pulmonology. I began my career at the Szent Rókus Hospital (formerly Semmelweis Hospital) and gained thorough experience in pediatric pulmonology at various departments of the Svábhegyi Children’s Sanatorium. Later, I worked at the Pediatric Department of the Törökbálint Lung Institute. I have been a general pediatrician for 27 years and continue to practice pediatric pulmonology.

Is there a fundamental difference between adult and pediatric pulmonology?

Fortunately, in children—unlike in adults—there are very few cases of cancer. This is a fundamental difference. However, we do encounter developmental abnormalities, but our primary focus is on treating asthma and allergic conditions.

Which of these conditions require the most attention?

Asthma management requires a lot of attention. In the past, children often had to return to the hospital with severe asthma attacks, but fortunately, modern medications and inhalation (steroid) treatments have made these difficult situations increasingly rare, allowing asthma symptoms to be well managed. It’s important to pay close attention to differential diagnosis during care. For example, recurring pneumonia might be due to developmental abnormalities or even the aspiration of a foreign object. This is quite common in children. Parents might not even notice when a child accidentally inhales a small toy part or seeds—often peanuts or sunflower seeds—during play. This can cause coughing, which may later decrease, but the foreign object can insidiously remain in the lung. X-rays may only reveal a shadowy foreign object or inflammation in the surrounding area.

What are the most common and the most severe problems in your practice?

Fortunately, severe asthma cases are becoming increasingly rare. It is always challenging when a child is on multiple medications; it’s crucial to ensure proper use and that the medications are not forgotten. The application of inhalation systems can be problematic, and often even the parents are not familiar with them. Teaching and monitoring the correct use of these systems is definitely the doctor’s responsibility. It is necessary to check every three months to ensure that the devices are being used correctly. We also need to monitor lung function, which can be difficult in children under six and later in teenagers as well. Often, it is a challenge to communicate effectively with adolescents, which is not an easy task, but I enjoy it.

What would you like to make sure to tell parents?

The risk of foreign body aspiration is significant in children under six years old. It’s crucial to be very careful with eating oily seeds! If a child must have peanuts, they should not be running around while eating. It’s also not advisable to eat such things in the car or to chew gum.

Parents often find it difficult to accept that allergy testing is not useful for children under three years old, as the results are unreliable and skin tests are not evaluable. Blood tests can provide more reliable information, but even then, everything can change in the child’s body.

Parents might think that allergy testing should be done immediately when allergic symptoms appear. However, it is important to know that testing during the season when symptoms occur is not ideal. It is best to wait until the pollen season ends before conducting tests. If the therapy applied to the symptoms is successful, it already indicates the presence of an allergy.

It is very important to avoid taking antihistamines at least a week before the allergy test, as they can distort the results.

In many cases, the test may not match the symptoms; we treat the symptoms rather than the type of allergy indicated by the test. So, if someone is symptom-free during the period when the test shows a positive result, treatment might not be necessary; instead, it’s better to wait.

Similarly, blood tests often show false positives, so everything should be evaluated based on the symptoms. The situation is equally complex with food allergies.

And one more request for patients: it is essential for the medical history of the child to have a meeting with the parents. Therefore, please make sure that either the mother or father comes along with the child.

To what extent can respiratory allergies be traced back to psychological causes?

A significant part of asthma is influenced by emotional balance. Therefore, psychological support is very important for this group of diseases as well. Boys are more likely to “outgrow” asthma by adolescence or adulthood compared to girls, due to both hormonal and psychological factors. Even with simple hay fever, it can be observed that the condition is more stubborn and harder to control in patients who are under stress.

To conclude with a more personal question: What do you do in your free time, and how do you unwind?

My family mostly occupies my free time, as I have three grown children and five grandchildren. I would like to paint and draw, but I currently have little time for these activities. I really enjoy reading.

Thank you for the conversation!

The post Interview with Dr. Zsuzsanna Tengelyi, pediatric pulmonologist appeared first on Maternity.

During high school, I initially thought I would choose an engineering field. Then, when it came time to select electives, I was watching the series Grey’s Anatomy, which completely captivated me. I started attending biology and chemistry electives. The university entrance exam also went well, and I was admitted to Semmelweis University. At first, I was a bit uncertain whether this was the right university, but over time, I grew more and more fond of what we were learning.

Where did you go to high school?

I’m from Hajdúböszörmény, where I graduated from high school. I attended an eight-grade secondary school. After successfully passing the university entrance exam, I moved to Budapest and lived in a dormitory.

When and how did you decide to specialize in gynecology, and why did you choose this field?

Initially, I wanted to be a pediatrician, and I felt that way until the third year. At that point, I started working as a pediatric nurse in the emergency department at Heim Pál Children’s Hospital, which I really enjoyed. We also did adult emergency courses, and that’s when I first encountered adult medicine. It made me realize that I was also interested in this area. I started enjoying working with adults, which made me uncertain about pediatrics.

At university, we had to choose a mandatory clinical practice, and I ended up choosing the gynecology clinic. There, I could work with both newborns and adults, so I decided to give it a try. When I first participated in a delivery, I completely fell in love with obstetrics and gynecology. I knew immediately that this was what I wanted to do.

I did my clinical practice and all my clinical work at the Semmelweis University Baross Street Clinic, and I wrote my thesis there. I was so enchanted by obstetrics and gynecology that I never regretted my choice. Although I continued to work at Heim Pál Children’s Hospital afterwards and still really love the community there, I feel that obstetrics and gynecology was the right decision for me.

How did you join the Maternity residency program?

The truth is that finding a residency position in Budapest is extremely difficult due to the high number of graduates and the many applicants from outside the city. I didn’t know that Maternity offered residency opportunities, but my TDK supervisor at the time informed me that they had a residency program. She suggested I give it a try because it could be a great opportunity, so I sent in my resume. Meanwhile, I participated in several job interviews and was even considering returning to Debrecen.

In the end, I received a call from Maternity saying they liked my resume and asked when I could come for an interview. I attended two interviews: one with the clinic director and one with Professor Ács. I was very nervous since I hadn’t met them personally before; all I knew was that Professor Ács was the director of the Semmelweis University Department of Obstetrics and Gynecology and Dr. Hupuczi was the director of Maternity Private Clinic. Both interviews were exciting, and by September, I had started working as a resident.

Do you like working here?

Yes, I particularly do. During our university rotations, we had the opportunity to observe the workings of other hospitals, which provided us with a lot of learning and experience. This makes it even more valuable to appreciate the opportunities and the environment we have here.

As a resident, what are your responsibilities, and what does a typical day look like for you?

There are six of us residents. On days when we assist in the operating room, one or two residents are present there. On these days, we need to be in the operating room at the start of surgeries and assist the doctors throughout the day. The others handle ward duties. For example, during rounds, patients regularly meet with residents. We also maintain contact with other hospitals, call ambulances if necessary, administer blood, and perform ultrasounds and other examinations.

If the fourth resident is also on duty, they assist colleagues with administrative tasks, conduct research, and compile statistics. This is a great help to those who spend the entire day in the operating room.

Of the six residents, two are already specialist trainees, and we also have a ward doctor who works as a general physician at the institute. They perform similar tasks to the residents but spend all their days at the clinic.

When will you become a specialist?

After obtaining the general medical degree, the first two years of residency involve completing mandatory rotations in various institutions and fields. As a resident and specialist trainee, there are tasks and competencies that we can perform independently, and these are assessed through various examinations. Currently, I am a second-year resident, and the next step in my training is to become a specialist trainee, which is tied to an exam. After that, I will be able to perform more tasks independently and eventually have my own practice under specialist supervision.

At the end of the five-year residency program, we take a comprehensive board exam, and from that point on, we can work as specialists without supervision.

What are your plans for the period when you will be a specialist?

That’s a difficult question. What is certain is that my interest in obstetrics and gynecology is very strong. I am particularly drawn to obstetrics and I truly enjoy it. Not only the manual work but also prenatal care and continuous patient interaction are important to me. At the same time, I would like to continue working in the operating room in the long term.

What challenges do you face on a daily basis?

There are many situations that I personally did not anticipate and that deeply affect or challenge me. Often, quick decision-making is required, which can be difficult and demands a lot of knowledge. Making the best decision in a matter of moments is truly a challenge. However, we work in a very supportive environment here, which helps us learn and adapt.

On the other hand, as a resident and specialist trainee, I need to excel in multiple areas simultaneously. I must be knowledgeable in everything and stay up-to-date with the latest information and research. I need to understand surgery, anesthesia, and obstetrics and gynecology all at once. This can be challenging at first, but it provides a diverse set of skills that are very valuable both for my current role and future work. It will take a lot of time to gather all this knowledge.

What is teamwork like with the doctors and other residents?

I believe that the relationship among residents is very good, and we manage work-related stress effectively while coordinating our time well. We get along not only at work but also at conferences and in our personal lives, which is very positive. I feel that the specialists also appreciate our presence and the assistance we provide in various areas. This is mutual, as they support and teach us in many ways. Overall, an excellent work environment has developed, with a good dynamic between the specialists and residents/specialist trainees.

How much free time do you have, and how do you spend it?

The rotations and on-call shifts require a lot of time and energy, especially if one wants to develop and learn. Adding conference participation, reviewing articles, and advancing in research means extra work. However, I believe that we, as young professionals, also strive to ensure we have some free time and not let work consume our entire lives.

Experienced doctors often emphasize the importance of working hard and giving our best, but they also stress that it’s necessary to take breaks when we reach the point of exhaustion. Since this is not a “9-to-5” job, we need to learn to balance work and rest while we are still young.

Although work is currently our primary focus, creating a stable personal life is essential. If I spent all my free time on work, I would eventually lose my enthusiasm. It’s important for me to take time for myself—such as going for a run or working out—to recharge. I have five workout sessions as a fixed part of my weekly routine, whether in the morning or evening.

Spending time with friends is also significant for me; my close friends are not in the medical field, so when we are together, the environment and topics are completely different, which helps me relax.

Of course, I also make time for my family, although it can be challenging since they live in Hajdúböszörmény. Fortunately, they are very flexible. If I’m on call during the weekend, they sometimes visit, so we can spend at least a few hours together. This is all very important to me.

Thank you for the conversation, and we wish you much success!

DOROTTYA RÓZSA, M.D.

Obstetrician and gynecologist resident

Wednesday: 16:00 - 18:00 (every two weeks), Thursday: 8:00 - 12:00 (every two weeks)

The post Interview with Dr. Dorottya Rózsa, obstetrician-gynecologist resident appeared first on Maternity.

Developmental neurology addresses a wide range of questions and issues, including:

• If there were problems during pregnancy, and the obstetrician-gynaecologist believes these could affect the baby’s neurological development.
• If the parents have hereditary diseases or conditions that could impact the baby’s neurological development.
• If there were complications around the time of birth, such as a low Apgar score, or if the baby required medical care in the minutes or hours after birth.
• After a premature birth.
• If the baby shows delays in movement or other developmental areas, such as speech, or if there are changes in behavior following an illness.
• If a parent, nurse, or general practitioner notices abnormalities in muscle tone.
• If the baby is lagging behind in motor or cognitive development compared to age-appropriate milestones as assessed by a nurse, general practitioner, or other specialist.
• If the baby holds its body in an unusual or asymmetrical way (such as consistently in a C position or turning its head in only one direction).
• If there are recurring muscle twitches in any part of the body.
• If there are difficulties in speech development.

And now, if you don’t mind, let’s get to know you a little better! Why did you choose the medical profession?

In my childhood, I was always interested in natural sciences and nature. This fascination likely developed because my parents and I spent a lot of time outdoors, going on many hikes. I always had a keen eye for discovering interesting things in nature. Additionally, my elementary school biology teacher played a significant role; she was a dynamic and captivating personality. Over time, these experiences led me to focus on the human body. I considered biology and dentistry, but ultimately chose the most complex field, medicine. During my pediatric practice at the Tűzoltó Street Children’s Clinic, I found that pediatrics was a much more humane and compassionate field compared to others, and as a medical student, I received excellent practical training for future medical practice.

What makes pediatrics feel more humane compared to adult medicine?

The relationship is more personal. With young children, it is essential to involve the parents and family; their input is crucial because it helps us understand the baby better. A holistic approach is necessary, especially in developmental neurology, where we can only interpret emerging issues in the context of the family. Many problems arise that have not just a physical cause but need to be understood on a familial level. It is important to consider if similar issues have arisen within the family. Factors such as the pregnancy experience and how eagerly the baby was anticipated can significantly impact a baby’s development. Even a challenging life event can be crucial for a baby’s growth.

Why did you become a developmental neurologist?

In the final year of my pediatric residency, I chose child neurology as my first practical rotation at the clinic because I found the cases there to be the most challenging. It felt almost fated that, after my pediatric board exam, I ended up in the developmental neurology department, where Professor Berényi was looking for young doctors. Besides the complexity of the neurological field, I found it exciting to work specifically with children under two years old, as I had less practical experience with them compared to older children.

What does developmental neurology for children examine?

This field is a subset of child neurology that focuses on the neurological development of babies under three years old. It looks at the progression of their motor development, fine motor skills, cognitive abilities, and speech. We assess whether there are any delays or deviations from normal development. At developmental neurology clinics, we examine whether the nervous system of premature babies is developing optimally. We also evaluate those who experienced complications around birth, such as oxygen deprivation or injuries (e.g., arm injuries) during delivery. In such cases, close monitoring of the baby by both the doctor and the nurse occurs during the first months. If significant deviations or several smaller deviations are detected, the baby is referred to a developmental neurologist.

Nowadays, many parents notice deviations and bring their babies in, for instance, if the baby holds its head tilted. We then investigate the cause, which could range from an eye-related issue or weaker neck muscles to the baby’s in-utero position or something more serious. Beyond the physical examination, we need to consider the whole context, including how the pregnancy and delivery went, whether there are similar issues in the family, and if the baby has siblings with similar problems. Often, only by the end of the appointment or during a follow-up visit does it become clear that similar issues have occurred in the family before, such as slower motor development, delayed speech, or behavioral concerns. This can make it easier to determine the appropriate direction for further tests, therapies, or developmental interventions. Recently, an increasing number of parents seek help for issues that intersect with psychology and psychiatry, such as behavioral problems or difficulties with self-regulation, including excessive crying, early sleep disturbances, or feeding issues.

How clear is the line between healthy and unhealthy development?

There are objective criteria. For example, in motor development, we expect that between 3 and 6 months of age, babies should start to roll over; between 6 and 9 months, most will learn to crawl, possibly sit up, and many 1-year-olds will attempt to stand. By 18 months, children typically start walking. The achievement of these gross motor milestones usually falls within a 2-3 month range.

What about speech development?

By the age of two, a vocabulary of 50 words is expected, but there is variability. Newborns initially communicate only through crying, so the nature of the cry is also important. It’s crucial to observe if cooing appears and if there is more varied vocalization. Adequate hearing is a prerequisite for speech development, so if a baby is unusually loud, communicates only by crying, and does not start making varied sounds, there could be a hearing issue. In such cases, an ear, nose, and throat examination and audiological assessment are needed first.

Slow speech development can indicate more complex problems, which may be signaled by other associated symptoms, such as being on the autism spectrum.

How old is this field, and how many practitioners are there in Hungary?

This field has a history of nearly 50 years. There are few of us who specialize specifically in developmental neurology within pediatric neurology. There is one department dedicated to this in Budapest, but colleagues also work in this area as part of the follow-up care for premature infants in obstetric institutions and elsewhere in the country.

It is a significant step for Maternity to have such a specialist available for patients.

Over 1,200 children are born at Maternity each year, and with such a high number of births, there is an increase in premature births and babies born after pregnancies complicated by certain issues. These babies may need the expertise of a developmental neurologist.

What advice do you have for parents?

It is crucial to pay attention to the recommendations of the nurse, family doctor, or other pediatric specialist if they suggest further examination. It’s best to follow this advice before starting extensive therapy or developmental interventions. Additionally, if a therapy is not yielding the expected results, it should be reassessed. Parents should trust their instincts about whether something is right or not, and then consult with the specialist. I am a firm believer in this approach. I consider it very important that the combined efforts of the doctor, the baby, and the parents work together to achieve results.

What do you do in your free time, and what helps you unwind?

I live in Budapest with my family, and I spend most of my free time with my two children. I enjoy being in nature, engaging in good conversations, and I have a passion for gastronomy and theater. I know that as my children grow older, I’ll gradually have more time for activities like the theater.

Thank you for the conversation.

BORBÁLA TELCS, M.D.

Pediatrician, pediatric neurologist

Wednesday (every two weeks): 10:00 - 13:00

The post Interview with Dr. Borbála Telcs, pediatric neurologist appeared first on Maternity.