From the Guidelines
For nasal congestion in children under 2 years old, saline nasal drops or spray followed by gentle suction with a bulb syringe or nasal aspirator is the best initial treatment. This approach is recommended due to the potential serious side effects and lack of proven efficacy of over-the-counter decongestants and cough/cold medications in this young age group 1. Use 2-3 drops of saline solution in each nostril, wait 30-60 seconds to loosen mucus, then gently suction it out. This can be repeated 3-4 times daily as needed, especially before feeding and sleep.
Key Considerations
- Keeping the child well-hydrated with plenty of fluids helps thin mucus secretions.
- A cool-mist humidifier in the child's room can also provide relief by adding moisture to the air.
- Elevating the head of the crib or bed slightly (by placing a towel under the mattress) may help drainage while sleeping.
- Topical decongestants, such as oxymetazoline, are not recommended for long-term use due to the risk of rhinitis medicamentosa, and their use in children under 2 years old should be cautious due to the narrow margin between the therapeutic and toxic dose 1.
- Oral decongestants, such as pseudoephedrine or phenylephrine, are also not recommended for children under 2 years old due to the risk of serious side effects, including agitated psychosis, ataxia, hallucinations, and even death 1.
Non-Medicinal Approaches
- Saline nasal drops or spray followed by gentle suction with a bulb syringe or nasal aspirator is a safe and effective way to relieve nasal congestion in children under 2 years old.
- Keeping the child well-hydrated and using a cool-mist humidifier can also help to thin mucus secretions and provide relief.
- Elevating the head of the crib or bed slightly can help to improve drainage while sleeping.
Overall, non-medicinal approaches are preferred for relieving nasal congestion in children under 2 years old due to the potential risks associated with medications in this young age group 1.
From the Research
Treatment Options for Nasal Congestion in Children Under 2 Years Old
- The use of saline or seawater drops may be added to standard treatment protocols for nasal congestion in children under 2 years old, as they have been shown to provide relief in nasal congestion, weakness, sleep quality, and nutrition 2.
- Non-pharmacological treatments, such as nasal saline irrigation, have been found to be effective and safe in alleviating nasal congestion symptoms in infants and children 3.
- Nasal aspiration with a medical device, associated with an isotonic saline solution, has been shown to lower the risk of developing acute otitis media and rhinosinusitis in children with viral rhinitis 3.
Efficacy of Different Treatments
- There was no significant difference found between the use of saline and seawater drops in terms of nasal congestion relief in children under 2 years old 2.
- Intranasal corticosteroids are recommended as first-line therapy for patients with moderate-to-severe allergic rhinitis and nasal congestion 4.
- Topical nasal steroids have been shown to objectively improve nasal congestion and nasal hyperreactivity in children and adolescents with persistent allergic rhinitis 5.
Safety and Tolerability
- The use of isotonic and hypertonic saline solutions to relieve nasal congestion in infants and children is widespread and has been found to be safe and well-tolerated 3.
- No serious adverse events have been reported with the use of nasal saline irrigation or medical devices for nasal aspiration in children 3.