What is the treatment for a runny nose in children?

Treatment of Runny Nose in Children

For children with runny nose, supportive care with nasal saline drops or spray is the first-line treatment, while avoiding over-the-counter cough and cold medications in children under 6 years due to safety concerns and lack of efficacy. 1

Determining the Cause

Before initiating treatment, it's important to determine whether the runny nose is caused by:

1. Viral upper respiratory infection (common cold)

   • Most common cause
   • Typically improves within 10-14 days
   • Mucus may start clear and become cloudy or colored (even yellow/green) as a normal part of the inflammatory process 2, 1

2. Allergic rhinitis

   • Associated with itchy, watery eyes, sneezing, and itching of nose or throat 3, 4
   • May be seasonal or perennial

3. Bacterial sinusitis

   • Consider if symptoms are:
     • Persistent: runny nose and daytime cough for ≥10 days without improvement
     • Severe: fever ≥39°C (102.2°F) for ≥3 days with thick, colored nasal discharge
     • Worsening: initial improvement followed by new fever and increased cough/runny nose 2

Treatment Algorithm

Step 1: Supportive Care (First-Line for All Cases)

• Nasal saline drops or spray

  • Safe with minimal risk of adverse effects 1
  • May help clear secretions and reduce symptom severity 5
  • Can be used in all age groups

• Nasal suctioning (for infants and young children)

  • Use bulb syringe or nasal aspirator to clear secretions 1
  • Particularly helpful for children who cannot blow their nose

• Adequate hydration

  • Helps thin mucus secretions

• Acetaminophen or ibuprofen

  • For pain or fever relief at age-appropriate dosing 1
  • Not directly treats runny nose but helps with associated symptoms

Step 2: Condition-Specific Treatment

For Viral Upper Respiratory Infections:

• Continue supportive care
• Avoid antibiotics as they are ineffective against viruses 1
• Avoid over-the-counter cough and cold medications in children under 6 years due to:
  • Lack of proven efficacy 2
  • Potential toxicity and safety concerns 2, 1
  • Reports of serious adverse events including fatalities 2

For Allergic Rhinitis:

• Intranasal corticosteroids (for children ≥2 years)

  • Most effective pharmacologic treatment for allergic rhinitis 6, 7
  • Newer agents like mometasone furoate have improved safety profiles 6
  • Consider for persistent symptoms

• Second-generation antihistamines (for children ≥2 years)

  • Consider for mild intermittent symptoms
  • Avoid first-generation antihistamines due to sedation and anticholinergic effects 2, 6

For Bacterial Sinusitis:

• Antibiotics if diagnostic criteria are met
  • Amoxicillin is first-line for children under 5 years 2
  • Macrolides may be considered for children ≥5 years 2

Important Cautions

• Avoid topical decongestants in children under 1 year due to narrow therapeutic window and risk of cardiovascular and CNS side effects 2
• Limit topical decongestant use to no more than 3 days in older children to prevent rebound congestion (rhinitis medicamentosa) 2
• Avoid oral decongestants in children under 6 years due to safety concerns 2, 1
• Avoid antihistamines for non-allergic causes of runny nose 2

Prevention Strategies

• Frequent handwashing for family members and caregivers 1
• Avoid exposure to tobacco smoke 1
• Consider temporary absence from daycare during acute phase if feasible 1
• Allergen avoidance for children with allergic rhinitis 8, 7

When to Seek Further Medical Attention

• Symptoms persisting beyond 10-14 days without improvement
• High fever (≥39°C/102.2°F) for more than 3 days
• Severe headache, facial pain, or swelling
• Difficulty breathing or rapid breathing
• Signs of dehydration

Most children with runny nose have a self-limiting viral infection that resolves with supportive care. Careful assessment of symptoms can help distinguish between viral infections, allergies, and bacterial sinusitis, guiding appropriate treatment decisions.