Intranasal Corticosteroid for a 2-Year-Old
For a 2-year-old child, mometasone furoate (Nasonex) at 1 spray per nostril once daily (100 mcg total daily dose) is the appropriate choice, as it is FDA-approved for children as young as 2 years of age. 1
Age-Appropriate Options
- Mometasone furoate is specifically approved for children ≥2 years at a dosage of 1 spray per nostril once daily 1
- Triamcinolone acetonide (Nasacort) is also approved for children ≥2 years at 1 spray per nostril daily for ages 2-5 years 1
- Fluticasone propionate is NOT appropriate as it is only FDA-approved for children ≥4 years of age 1
- Budesonide nasal spray is NOT appropriate as it is only approved for children ≥6 years of age 1
Safety Profile in Young Children
- Studies with mometasone furoate at recommended doses show no effect on growth compared to placebo in children 1
- Intranasal corticosteroids when given in recommended doses are not generally associated with clinically significant systemic side effects 2
- Studies have failed to demonstrate any consistent, clinically relevant effect on the hypothalamic-pituitary-adrenal (HPA) axis in children 2, 1
- Growth suppression has been reported only with long-term use of beclomethasone dipropionate that exceeded recommended doses or administration to toddlers 2
Important Administration Considerations
- Prime the bottle before first use and shake before each use 1
- Have the child blow their nose prior to using the spray 1
- Keep the head in an upright position during administration 1
- Hold the spray in the opposite hand in relation to the nostril being treated to direct spray away from the nasal septum 1
- Do not close the opposite nostril during administration 1
Common Side Effects and Monitoring
- The most frequent adverse events include headache, viral infection, pharyngitis, epistaxis, and cough—all generally mild to moderate 1
- Local side effects such as nasal irritation, bleeding, and nasal septal perforation are rare and can be avoided with proper administration technique 2
- Periodically examine the nasal septum during long-term use to detect mucosal erosions 1
Critical Pitfall to Avoid
- Do NOT use beclomethasone dipropionate in toddlers, as growth suppression has been specifically reported with this agent in this age group 2