Nasal congestion

Any advice on how to help clear nasal congestion?

At birth, newborns are obligate nasal breathers. Babies do not learn to breath through their months until about 4 months of age. GERD (reflux or spitting up) is a major cause of recurrent congestion in the first few months of life. The congestion from spitting up into a child’s nasal passages can last a couple days. see congestion in infants.

Children who are in daycare often have a baseline of congestion or runny nose. When congested your child should periodically be able to breath through each side (left or right nare). When a toddler has persistent congestion of only one side, the child should be referred to an ENT for possible removal of a foreign body like a raisin or Barbie shoe.

There are no perfect cures for nasal congestion. When I began my pediatric practice (1999) “cold medications” were approved for children 6 months and older. Since then then FDA, has changed the labeling on “cold medications” to 4 years and older. In general, I do not think these medications help alleviate congestion, though they can help children sleep.

To help with congestion try running a cool mist humidifier. See humidifiers. Older children and adults can try a Neti pot or similar product. These medical devices are basically a plastic teapot that deliver a nasal rinse.

For younger children, you can use a bulb syringe with or without saline. Over the years, I have quit using the bulb syringe beyond the newborn period as it seems to annoy most children and make them cry. As they cry, their nose becomes even more congested.

One of my favorite tricks for congestion is frequent showers. I will often include a congested toddler in my morning shower. They seem to enjoy it, the dried overnight crusties dissolve painlessly and the mucus pours out.

When congestion is making a child miserable, I sometime resort to medications. Afrin is an over the counter medication that can be used for short term (3 days) relief. Afrin can be addictive and courses longer than 3 days can actually make an individual more congested. I will prescribe Nasonex (Mometasone) or Flonase (Fluticasone) for patients with persistent or recurrent congestion. These steroid nasal sprays are intended for patient with allergies.

Written January 2011 by
Dr. Gordon, Orlando Pediatrician