Nasal congestion


What is nasal congestion?

Nasal congestion (a stuffy nose) is NOT a condition; it is a SYMPTOM of a condition.

Because a mucus nasal discharge OFTEN accompanies nasal congestion may people believe the congestion is DUE to the thick mucus, but this is incorrect!. Nasal congestion occurs when the membranes lining the nose become swollen from inflamed blood vessels.

The air we breathe contains many impurities such as pollutants, chemical fumes, dust, pollens, mould spores, germs from others coughing and sneezing etc. Our nose acts as a FILTER. Anything that gets into our nose, which our body's immune defenses recognizes shouldn't be there, will cause a release of the body chemical 'histamine'.

Histamine dramatically increases the blood flow to the nose, causing swelling and congestion of nasal tissues. The swelling stimulates the nasal membranes to produce excessive amounts of mucus. Mucus is produced in an attempt to 'flush out' whatever it is our body wants to get rid of.


Is nasal congestion a serious problem?

Because nasal congestion is a symptom and NOT a condition, on it's own it is generally NOT serious in the short term. However, the condition or illness CAUSING the nasal congestion could also cause OTHER symptoms or problems which MAY be serious. 

Babies are essentially 'nose breathers', so they quickly become upset if nasal congestion is severe enough to affect their ability to breathe through their nose. Unfortunately breathing difficulties related to nasal congestion can sometimes affect a baby's ability to feed properly, which may further add to his distress.

Hearing problems and delayed speech development can occur as a result of REPEATED ear infections, which are frequently associated with long term nasal congestion (due to allergies, chronic illness or enlarged adenoids).  


What causes nasal congestion in infants?

You may automatically start to worry about illness when your baby's nose sounds stuffy but nasal congestion is NOT always due to illness. A stuffy nose is one symptom, which can be caused by a number of different disorders.

Common reasons for nasal congestion in the early years of life include...

  • Dry air
  • Irritants
  • Infections
  • Allergies
  • Enlarged adenoids
  • Foreign bodies
  • Overuse of some nasal sprays or drops

1. Dry air

Newborn babies have tiny noses. They also have very narrow nasal passages which are SENSITIVE to dry air. Exposure to dry air (occurring in the winter months) can dry out your newborn's nasal secretions, which in turn results in noisy breathing.

Although NOT technically nasal congestion, because the noisy breathing is due to the structure of the nose and/or drying of nasal secretions and NOT due to inflamed nasal passages, it is often MISTAKEN as nasal congestion.

What to watch for!

  • Your newborn baby is WELL
  • Noisy breathing is related to the nose (i.e. NOT from his chest)
  • There is NO nasal discharge

What helps!

a) A larger nose - for that you will have to wait. Provided your baby is WELL and his feeding is unaffected NO TREATMENT is necessary.

b) SALINE NASAL DROPS may be useful to moisten his nasal passages to help to clear any dried secretions causing the noisy breathing.

c) Since VAPORIZERS add water (moisture) to the air, they MAY be helpful in the winter months when the air is particularly DRY.


2. Irritants

Irritants such as wind, dust, chemical fumes, cigarette smoke and milk (brought up into your baby's nose when he spits up) can all irritate the delicate tissues in your baby's nasal passages. This irritation results in nasal congestion and a clear nasal discharge.

What to watch for!

  • Noisy breathing.
  • Your baby is WELL.
  • A CLEAR watery nasal discharge.
  • Sneezing is common.

What you can do!

SALINE NASAL DROPS can be used to assist to clear your baby's nose and settle irritation.


3. Colds and flu

Nasal congestion and discharge are COMMON symptoms of an upper respiratory tract infection i.e. COLD or FLU (short for influenza).

Due to an immature immune system, colds and flu are very COMMON in infancy and early childhood. A baby is likely to experience 6 to 10 COLDS during his first year of life. Colds and flu are caused by any number of different VIRUSES, some of which can be transmitted from person to person through the air, but MOST of which are transmitted from hand-to-nose contact.

COLDS are far more common than the FLU. People often say they have the flu when they have a simple cold. A cold is less serious than flu and the symptoms are also less severe. Colds are mostly a nuisance and usually NOT a serious health risk. At worst a cold can occasionally lead to a secondary bacterial infection of your baby's middle ear or sinuses, which can be treated with antibiotics.

Flu symptoms are much MORE debilitating than a cold and generally involve headaches, fever, muscles aches and pains, poor appetite and fatigue. If the flu is misdiagnosed as a bad cold, potentially life-threatening flu complications like pneumonia may be overlooked. If your child appears to be active, it is more likely he has a cold.

What to watch for!

  • Your child may be mildly unwell to very unwell.
  • Nasal discharge; Clear at first, then turns yellow, becomes thicker and may turn green. Clears again as the cold improves.
  • Fever.
  • Cough.
  • Horse voice.
  • An older child may complain of a headache, joint pains, muscle aches or a sore throat.
  • A baby may develop feeding difficulties (depending on how badly congested his nose is OR how sore his throat is).

Symptoms generally improve in 2 weeks.

What helps!

a) It's wise to see a doctor to assist with the diagnosis of a cold or flu if you are unsure.

b) Your baby may NOT feel like eating, but try to encourage lots of fluids.

c) Congestion is often worse when lying down, so keep your baby in a semi-upright position by elevating the top end of his mattress.

d) Encourage your whole family to wash their hands regularly to reduce the risk of spreading the illness to other family members.


4. Allergies

Nasal congestion or discharge is a COMMON symptom of an allergic reaction. Hay fever (also known as seasonal allergic rhinitis, rose fever, grass fever and summertime cold) is caused by an allergic reaction to substance in the air, such as pollen that can get into the nose, sinus, throat and eyes.

Although more common in spring and summer, allergic rhinitis can occur any time in response to other things that may or may NOT be airborne, such as mould, aminal hair, insect bites or house dust. LESS commonly, nasal congestion or discharge can also occur as a reaction to 'allergens' contained in milk, foods or medications.

If UNTREATED symptoms may last for weeks or even months.

What to watch for!

  • CLEAR watery nasal discharge.
  • Sneezing
  • Endless sniffing.
  • Dry cough.
  • Wheezing.
  • Rashes.
  • Itchy watery eyes.

Where the allergy is due to food or milk, additional symptoms may include...

  • Vomiting.
  • Excessive gas
  • Loose watery stools (diarrhea)

What helps!

a) Discovering the source of the allergy, so that it can be AVOIDED would be most helpful, but NOT always possible.

b) Anti-histamines reduce the body's allergic response. Although a variety of antihistamines are available over-the-counter many of these are NOT suitable for babies and children. See a doctor if your child has any allergy-type symptoms.


5. Enlarged adenoids

Tonsils and adenoids are glandular tissue near the entrance to the breathing passages. Although you can see tonsils by looking in your child's throat, adenoids are located behind the nose and are NOT directly visible.

Tonsils and adenoids are part of our body's defense against infections. They filter out bacteria and viruses entering through the nose and throat and produce antibodies to help the body fight infections. Sometimes tonsils and adenoids can become infected by the germs they are trying to eliminate; they then become sore and swollen.

Generally adenoids get larger between birth and 4 years of age and then become progressively smaller. However a child may be born with large adenoids, which have developed while he was in the womb.

Enlarged adenoids can cause nasal OBSTRUCTION. In severe cases, they can block nasal passages completely. Enlarged adenoids can also cause sleep disturbances. In some cases large adenoids are associated with the development of fluid in the middle ear ('glue ear').

What to watch for!

  • Your child may complain that it is difficult to breathe through his nose.
  • Noisy nose breathing.
  • Speech may sound nasally like the nostrils were pinched.
  • Breathing though the mouth.
  • Snoring while sleeping.
  • You may notice your child stops breathing for a few seconds while sleeping (sleep apnea).

What helps!

The ONLY treatment for enlarged, obstructing adenoids is to surgically remove them. Antibiotics and other medication do NOT help. Your child's doctor will advise you on the best course of action. Referral to an ear, nose and throat specialist may be necessary.


6. Foreign bodies

A foreign body refers to any object that is placed in the ear, nose or throat that's NOT meant to be there. Children under the age of 5 years are curious and occasionally put small objects, such as beads, dried beans, popcorn, nuts, buttons, marbles, paper, pebbles, plastic toy pieces, foam rubber or small batteries up their noses.

Children are often afraid to admit they have put an object into their nose, so many parents ONLY become aware of the problem when their child develops symptoms.

What to watch for!

  • Noisy breathing.
  • Only 1 nostril is affected (usually!)
  • Smelly green or yellow nasal discharge.
  • Bloody discharge.
  • The nose may become swollen and tender.

What help!

Obviously REMOVAL of the object, but this is NOT always a simple matter. If you were lucky enough to SEE your child place something up his nose you may be able to remove it. If your child is old enough, encourage him to blow his nose several times. (Press down on his clear nostril so that there is more pressure behind the blocked nostril.) You could also try some SALINE nasal drops and an infant nasal aspirator to suck out the object.

DON'T go poking and prodding with tweezers, Q-tips or anything else as you may push the object further back. If the object is NOT EASILY removed, see a doctor.

By the time your child has developed a discharge the tissue surrounding the object is ALREADY inflamed and it's UNLIKELY that you will be successful in removing it yourself, so it's best NOT to try as you may cause MORE damage. If your child has a smelly discharge following removal of the object by your doctor, he may need nose drops or antibiotic ointment.


7. Overuse of nasal sprays

Although OVERUSE of decongestant nasal sprays is a common cause of nasal congestion for adults, it is RARELY the cause of nasal congestion in infants and small children because decongestant sprays are NOT recommended for children under the age of 6 years.

Decongestants can become addictive and actually cause nasal congestion to get worse. Be wary of over-the-counter nasal decongestants sprays as prolonged use of these sprays may damage the delicate tissue in the nose and sinuses. Rebound congestion and inflammation of the nasal membranes can be caused from overuse of nasal sprays.


When to see a doctor

See a doctor is your child...

  • Is having trouble breathing.
  • Is running a fever.
  • Has a cough or wheeze.
  • Has a sticky, thick nasal discharge.
  • Has allergy-type symptoms.
  • Has any swelling of the face.
  • Is NOT drinking.
  • Is distressed.
  • Is less that 3 months of age and has signs of a cold or flu.
  • If you are concerned.

See your doctor for advice BEFORE using medications.


Medications

Over-the-counter medications treat symptoms but do NOTHING to treat the cause. In situations where symptoms are mild NO treatment is necessary. Your child's natural defenses will heal the problem with time. By 'jumping in' with the use of medications you may be interfering with his body's natural healing processes and prolong the symptoms (particularly if the WRONG medication is used).

Where symptoms are MORE debilitating OR distressing for your baby/child medications may be helpful. NO medicine works well for all children and ALL medications can cause side effects. The advantages and disadvantages of using medication needs to be carefully weighed up.

As you can see there are lots of different causes of nasal congestion. There are also many different types of medications used to treat different symptoms. Each one can acts in a different way. Be sure you understand their purpose before giving your child medications.

If you are worried about your baby's nasal congestion it's wise to see a doctor BEFORE using medication.

Saline nasal drops/sprays

A saline solution of 0.9% sodium chloride in water is available in nasal mists, sprays and drops from your local chemist or drug store.

Saline nasal drops or sprays can be helpful to wash out the nose, which may assist in relieving congestion due to 'irritants'. Saline nasal drops can also be used to moistens nasal passages irritated by dry air. However, they will do little to relieve congestion from other causes.

Saline solution, which is a similar consistency to tears, contains NO medications and can be used liberally at your discretion. (Remember to warm it to room temperature before use.)

Chest rubs

Chest rubs make you FEEL as though they are helping because camphor, menthol and eucalyptus oil makes nasal passages more SENSITIVE to cold air. However, studies have shown chest rubs offer NO proven benefit in reducing the symptoms of nasal congestion or nasal discharge. (Chest rubs or vaporizer fluids do NOT contain a decongestant).

Chest rubs can be irritating when placed directly onto your baby's skin.


Treatment aids

Nasal aspirators

If your child is too young to blow his nose, an infant nasal aspirator (bulb) may help to remove some of the mucus. If the nasal discharge is thick and sticky, loosen it by putting 2 or 3 saline nasal drops into each nostril.

Because congestion is due to inflamed blood vessels and NOT blockage from thick mucus, trying to remove the mucus will provide only MINOR, temporary benefit. The UPSET to your child in clearing his nose using a nasal aspirator may NOT be worth it, so it is NOT essential that you do so.

Don't insert Q-tips or cotton swabs into your child's nostrils, as you can do more damage than good.

Vaporizers or humidifiers

Vaporizers or humidifiers can be helpful to moisten DRY AIR but will do little to relieve nasal congestion due to other causes. Vaporizer fluids offer NO proven benefit in reducing symptoms of a cold. Like chest rubs, they simply make nasal passages MORE sensitive.

If NOT cleaned correctly, vaporizers and humidifiers can breed germs and mould, which are then circulated through the air for your baby to breathe in.

DISCLAIMER:
This information should NOT be used as a substitute for the medical care and advice of your child's doctor. There may be variations in treatment that your child's doctor may recommend based on individual facts and circumstances.

Written by Rowena Bennett
RN, RM, MHN, CHN, IBCLC, Grad Dip Health Promotion and author of 'Your Sleepless Baby: The Rescue Guide'

Added April 2004. Revised 2008; Sept 2013.