Nasal Congestion Management in Children

Introduction to Nasal Saline Irrigation

Nasal saline irrigation is recommended over nasal suction for children with nasal congestion, particularly for one-year-old children, due to its better effectiveness for rhinological symptoms, fewer complications, and greater parental satisfaction, as supported by the American Academy of Pediatrics 1

Nasal saline irrigation effectively removes debris from the nasal cavity and temporarily reduces tissue edema in infants older than 6 months, making it a suitable treatment for persistent nasal congestion lasting more than 10 days 1
Escalation of care is recommended if symptoms persist beyond 10 days without improvement, or if fever ≥39°C (102.2°F) lasts for at least 3 days with thick, colored nasal discharge, or if symptoms initially improve but then worsen with new-onset fever or increased cough 1

The American Academy of Pediatrics recommends using nasal saline irrigation 2-3 times daily during episodes of congestion, with physiological saline solution (0.9% sodium chloride), directing the solution away from the nasal septum, and keeping the child's head in an upright position, for maximum effectiveness 1, 2
Consistent and regular application of nasal saline irrigation is crucial for improving nasal airflow and quality of life in infants older than 6 months, as supported by evidence from Pediatrics 1
General precautions include avoiding medication sharing between children to prevent infection spread, not using decongestants for more than 3 days to prevent rebound congestion, and avoiding directing spray toward the nasal septum to prevent irritation and bleeding, as advised by pediatric guidelines similar to those from Praxis Medical Insights 2

Suctioning of clear amniotic fluid from nose and mouth should not be used as a routine step for newborn infants at birth, as recommended by the American Heart Association, based on evidence from Circulation 3
Irregular or inconsistent use of nasal saline irrigation reduces its effectiveness, highlighting the importance of consistent application, as noted by pediatric guidelines similar to those from Praxis Medical Insights 2