From the Guidelines
Nasal saline irrigations are generally safe for 11-year-old children when used properly, as evidenced by the European Position Paper on Rhinosinusitis and Nasal Polyps 2020, which recommends the use of nasal saline irrigation with isotonic saline or Ringer’s lactate 1.
Safety and Efficacy
They can help clear nasal passages of mucus, allergens, and irritants, providing relief from congestion, allergies, and sinus symptoms. For children this age, use a pediatric-sized saline irrigation device with sterile or distilled water (never tap water, which may contain harmful organisms).
Administration
Premixed saline solutions are available commercially, or you can make your own by mixing 1 teaspoon of non-iodized salt with 2 cups of distilled water. Have your child lean over a sink, tilt their head slightly to one side, and gently flush one nostril, allowing the solution to drain from the other nostril. Repeat on the opposite side. Start with smaller volumes (about 2-4 ounces per nostril) and increase as tolerated.
Mechanism of Action
Nasal saline irrigations work by physically washing away irritants and thinning mucus while moisturizing nasal passages.
Monitoring and Precautions
If your child experiences discomfort, ear pain, or worsening symptoms, discontinue use and consult a healthcare provider. Although a Cochrane review found no appropriately designed studies to determine the effectiveness of nasal irrigation for acute sinusitis in children 1, the more recent European Position Paper on Rhinosinusitis and Nasal Polyps 2020 provides stronger evidence for its safety and efficacy 1.
Key Considerations
- Use sterile or distilled water
- Avoid tap water
- Start with smaller volumes and increase as tolerated
- Monitor for discomfort, ear pain, or worsening symptoms
- Discontinue use and consult a healthcare provider if necessary
From the Research
Safety of Nasal Saline Irrigations for Children
- Nasal saline irrigation appears to be safe for children, with no reported serious adverse events 2.
- Minor adverse effects can be avoided with technique modification and salinity adjustment 2.
- The use of a large volume of low-pressure, twice-daily intranasal hypertonic irrigation for 6 weeks is safe and effective in the treatment of pediatric chronic rhinosinusitis 3.
- Nasal irrigation with saline solution may reduce symptom severity in children with upper respiratory tract infections, with a level of evidence of 2 and a recommendation strength of B 4.
- Saline nasal irrigation is beneficial for rhinological symptoms but not respiratory symptoms, and its use appeared to limit the prescription of other treatments, including antibiotics 5.
Efficacy of Nasal Saline Irrigations for Children
- Normal saline nasal irrigation improves Pediatric Rhinoconjunctivitis Quality of Life and decreases acute sinusitis symptoms in children 6.
- Nasal irrigation is an effective adjunctive treatment for pediatric acute sinusitis, and it also improves allergic-related symptoms in children with atopy 6.
- The analysis of four randomized control trials showed a benefit of saline nasal irrigation for certain clinical rhinological symptoms, but no significant improvement of respiratory symptoms or health status 5.
- Long-term use of saline nasal irrigation led to a decrease in the incidence of acute rhinosinusitis and its complications 5.
Considerations for Nasal Saline Irrigations in Children
- Technique modification and salinity adjustment can help avoid minor adverse effects 2.
- The use of a large volume of low-pressure, twice-daily intranasal hypertonic irrigation for 6 weeks is recommended for pediatric chronic rhinosinusitis 3.
- Further research is needed to confirm the findings and to address the full benefits and risks of nasal saline irrigation in children 4, 5.