The Snotty or Runny Nose Treatment In Infants and Kids (Nasal Congestion and Nasal Obstruction)

There are a number of reasons why a child or infant has what people call a "snotty" nose. Related to this condition are symptoms of nasal congestion and even obstruction along with drainage out from the nose. Exacerbating this situation is the inability of the child to know how to blow the nose to clear such secretions. In severe cases, persistent mouth-breathing may occur. Among the most common causes of the snotty nose, nasal obstruction, and nasal congestion in infants and kids are:

Adenoid Hypertrophy (Very Common)
Turbinate Hypertrophy (Common)
Significant Deviated Septum (Uncommon)
Allergies (Common)
Infection (upper respiratory illness and/or bacterial infections) (Common)
Rarely, genetic conditions like cystic fibrosis and immotile ciliary syndrome
Rarely, anatomic conditions such as choanal atresia

Treatment truly depends on the actual cause as often, the symptoms of the snotty nose are indistinguishable among the possibilities listed above. Note that sinus infection is not mentioned above. That's because sinuses do not develop until the age of 7 and do not reach full sizes until adolescent years. As such, kids less than 3 years do not generally have significant sinusitis.

Regardless of the cause, saline spray or saline bullets to the nose followed by nasal bulb suctioning is highly recommended as often as 3 times a day to help alleviate these symptoms. A word here about nasal bulb suctioning... There are a few things one should keep in mind when looking for a nasal bulb suction to use on your child.

Make sure the nasal tip is rounded to prevent nasal trauma no matter how firmly you push against your child's nose
Make sure you can see into the bulb to ensure adequate suctioning as well as to know when it needs to be cleaned
Make sure it can be taken apart for cleaning

In our office, we do recommend two models that fit these criteria shown below (we DO sell these in our office):

Nasal Bulb Suction

Recommended due to these advantages:

• Rounded tip to prevent nasal trauma.
• Clear top so you can see what you suctioned out (as well as know when it's time to clean it).
• Can be taken apart in 2 pieces for easy cleaning (the blue detaches from the clear).

Sold in our office for $12

Nasal Bulbs from Amazon.com

Nasal Aspirator

Recommended due to these advantages:

• Rounded tip to prevent nasal trauma.
• Clear tubing so you can see what you suctioned out (as well as know when it's time to clean it).
• Can be taken apart for easy cleaning (but not as easily as the product above)

Sold in our office for $15

Sold in Amazon.com

Watch video on YouTube (Starting at 30 seconds into the video)

Generic Nasal Bulb Suction

NOT recommended in our practice because:

• Tip is pointed which may irritate the nose due to repeated traumatic insertion over time.
• Difficult to clean as you can't take it apart increasing risk of infection.

SO, what are some of the clues to help determine the actual cause and therefore guide treatment?

"Symptoms are all year round and does not seem related to illness or the seasons."

Adenoid Hypertrophy is a VERY common cause of this particular problem. Adenoidectomy is curative. However, risks of bleeding and swelling in the post-operative period is higher in kids less than 3 years of age and therefore is not recommended unless the child is truly suffering. Better to wait. Starting from the age of 2 years old, steroid nasal sprays for at least 3 months is something to try (read the research here and Cochrane review here). Turbinate hypertrophy and deviated septum are other less common causes, both treatable by surgery. Again, better to wait if possible. Rarely, anatomic problems such as choanal atresia may exist.

One test to help definitively determine what may be going on is Fiberoptic Nasal Endoscopy. This test is usually done at the time of the initial office visit.

"Symptoms occur mainly with fever and copious colored nasal drainage."

Most likely due to a viral illness (most common) followed by bacterial super-infection (bacteria super-infection means when a bacterial infection occurs in setting where viral illness is also present). Less common is bacterial infection alone. A viral component is most likely present if symptoms do improve partially with antibiotics followed by immediate recurrence of symptoms after antibiotics completed resulting in repeated courses of antibiotics. In this scenario, it is best to avoid antibiotics unless the child is quite ill as only time will allow for the viral illness to resolve which is the main problem. Conservative care with saline spray to the nose followed by bulb suctioning is recommended.

In rare cases, genetic abnormalities such as cystic fibrosis, immotile ciliary syndrome may be the root cause. If nasal polyps are seen in kids, the suspicion for genetic diseases increases. (Of note, adults may develop nasal polyps due to non-genetic diseases.)

If no fever is present, but drainage is an issue, allergies may be a problem.

Also, many of these symptoms often improve markedly after an adenoidectomy. Steroid nasal sprays are also helpful if adenoidectomy is to be avoided (read the research here and Cochrane review here).

"Nasal congestion with clear drainage, especially during certain times of the year. Crusty nose is also an issue."

Certainly sounds like allergies. Treatment with antihistamines and if older than 2 years, steroid nasal sprays is recommended. Saline spray followed by nasal bulb suctioning is also quite helpful in this situation.

Also, many of these symptoms often improve markedly after an adenoidectomy. Steroid nasal sprays are also helpful if adenoidectomy is to be avoided (read the research here and Cochrane review here).

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