From the Guidelines
For a 9-month-old baby with chronic severe rhinitis, I strongly recommend consulting a pediatrician before starting any treatment, as their guidance is crucial in managing the condition effectively and safely. The management of chronic severe rhinitis in infants requires a comprehensive approach that includes both non-pharmacological and pharmacological interventions. According to the practice parameter for the diagnosis and management of rhinitis 1, a thorough history and physical examination are essential in identifying potential allergens and irritants that may be contributing to the symptoms.
Non-Pharmacological Interventions
Some key non-pharmacological interventions include:
- Using saline nasal drops (2-3 drops in each nostril) followed by gentle suctioning with a bulb syringe to provide immediate relief 1.
- Keeping the baby hydrated and using a cool-mist humidifier in their room to moisten air passages.
- Elevating the head of the crib slightly by placing a towel under the mattress to help drainage.
- Avoiding potential allergens like dust, pet dander, or smoke.
Pharmacological Interventions
For persistent symptoms, the pediatrician might recommend an antihistamine like cetirizine (Zyrtec) in age-appropriate dosing (typically 2.5mg once daily for this age), though medication should only be used under medical supervision 1. It's also important to note that intranasal corticosteroids are typically the most effective medication class for controlling sneezing, itching, rhinorrhea, and nasal congestion, but their use in infants should be carefully considered and monitored due to potential side effects 1.
Importance of Medical Supervision
Chronic rhinitis in infants can be caused by allergies, environmental irritants, or frequent infections. The immature immune system of babies makes them more susceptible to nasal congestion, and their narrow nasal passages can make symptoms seem more severe than in older children or adults. If symptoms persist despite these measures, further evaluation may be needed to rule out other conditions like adenoid hypertrophy or anatomical abnormalities. Therefore, consulting a pediatrician is essential to ensure that the baby receives appropriate and safe treatment.
From the FDA Drug Label
Pediatric patients (4 years of age and older) should be started with 100 mcg (1 spray in each nostril once daily). The safety and effectiveness of Fluticasone Propionate Nasal Spray, USP, in children below 4 years of age have not been established
The safety and effectiveness of fluticasone (IN) have not been established in children under 4 years of age. Therefore, it is not recommended for a 9-month-old baby with chronic severe rhinitis 2, 2.
From the Research
Diagnosis of Chronic Rhinitis in Children
- The diagnosis of pediatric chronic rhinosinusitis (CRS) is primarily based on clinical history and signs supported by objective findings, such as nasal endoscopy and/or computed tomography (CT) imaging 3.
- Cultures are indicated in patients who have not responded to medical therapy or have significant comorbidities 3.
- Allergic rhinitis (AR) is one of the most common chronic diseases in children, and its diagnosis is based on symptoms such as sneezing, itching, runny nose, and nasal congestion 4.
Treatment Options for Chronic Rhinitis in Children
- Nasal saline irrigation, nasal saline spray, and oral antibiotics are currently recommended for initial medical management of pediatric CRS 3.
- Intranasal corticosteroids, such as fluticasone, are currently the first-line therapy for allergic rhinitis 5, 6.
- Intranasal antihistamines, such as azelastine, have comparable efficacy to intranasal corticosteroids in symptom control and may be considered as a safer replacement for long-term use in patients with allergic rhinitis 5.
- Allergen avoidance and a variety of available pharmacotherapies are also important in the treatment of allergic rhinitis 7.
Management of Chronic Rhinitis in 9-Month-Old Babies
- There is limited information available on the management of chronic rhinitis in 9-month-old babies, and treatment should be individualized based on the specific needs of the child.
- Nasal saline irrigation and nasal saline spray may be used in infants, but oral antibiotics and intranasal corticosteroids should be used with caution and under the guidance of a healthcare professional 3.