Monday Medical for Feb. 21
February 20, 2005
Children are expected to suffer as many as 10 colds a year, which translates into 70 to 100 days of nasal congestion annually. Because a stuffy nose is a common condition for the pediatric population, it can be challenging to distinguish between the child with “one cold after another” and a child who needs to see a doctor.
Making the diagnosis and identifying its causes are necessary to prevent the progression of chronic congestion, including sinusitis, ear infections, mild to severe sleep disturbances and abnormal facial growth and development.
There are several sources of children’s congestion. A thorough history and physical exam frequently will identify the causes. However, X-rays and lab tests sometimes may be required.
The common viral “cold” is the most frequent reason for a child’s stuffy nose. Transmitted by hand-to-nose contact, the virus causes a release of chemicals. This triggers an increased blood flow to the nose, causing swelling, congestion and copious mucus production. Decongestant medications and antihistamines help relieve symptoms, but the time to develop an immune-system response is the only cure.
A viral infection lowers a child’s nasal resistance to bacterial infections. Acute sinusitis is characterized by congestion lasting more than 10 days, yellow-green nasal drainage, post-nasal drip, cough, bad breath, irritability, fatigue and swelling around the eyes.
Most children who have a bacterial infection will respond well to antibiotic therapy. Nasal saline spray and decongestants thin mucus and relieve stuffiness. If symptoms persist, the bacteria may be resistant to antibiotics, or the child may have predisposing risk factors for sinusitis that need to be investigated.
Another cause of congestion is deformities of the nose and septum — the thin, flat cartilage and bone that separates the nose. Most deformities are caused by injury. Seven percent of newborns suffer significant nasal injury in the birth process. Add the tumbling that comes with learning to walk, and many kids have crooked septums.
Enlargement of the adenoids, tonsil-like tissue at the back of the nose, also creates nasal obstruction in children. It may be associated with snoring and dental deformities, as well. Even if a child’s anatomy is normal, a well-placed pea, bean, bead, button or bit of plastic can lead to nasal obstruction and drainage.
Allergic rhinitis, or “hay fever,” is an exaggerated inflammatory response to a foreign substance such as pollen, mold, animal dander or house dust. Stuffiness, sneezing, watery nasal mucus and itchy eyes and nose are the hallmark symptoms for allergic rhinitis. Non-sedating oral antihistamines and steroid nose sprays provide symptom relief. Avoiding foreign substances and receiving allergy shots are the most specific treatments.
Vasomotor rhinitis is an inflammation of the nasal membranes, caused by an abnormal interplay between nerves and vessels in the nose. Symptoms of nasal obstruction, such as post-nasal drip, clear nasal drainage and sneezing, are responses to environmental triggers, such as smoke, dust, fumes and changes in temperature and humidity. Like allergic rhinitis, this common cause of congestion improves with use of topical nasal steroids and antihistamines.
Chronic nasal congestion adversely affects the quality of life for children. Imagine enduring a cold for 200 days. If your child seems to have more colds than other children or seems to always breathe out of his or her mouth, see a physician to evaluate the cause and treatment.
Maryann P. Wall, M.D., F.A.C.S., is a board-certified
otolaryngologist and facial plastic surgeon in Steamboat Springs.