Fluticasone Propionate (Flonase) Dosing for an 11-Year-Old
An 11-year-old child should use 1 spray of fluticasone propionate (Flonase) in each nostril once daily, for a total daily dose of 100 mcg. 1, 2, 3
Age-Specific Dosing Guidelines
Children aged 4–11 years: The American Academy of Otolaryngology-Head and Neck Surgery recommends 1 spray per nostril once daily (50 mcg per spray, 100 mcg total daily dose). 1, 2, 3
Adolescents ≥12 years and adults: The dosing increases to up to 2 sprays per nostril once daily (200 mcg total daily dose). 1, 3
This lower pediatric dose (100 mcg) has been proven equally effective as the 200 mcg adult dose in multiple clinical trials of children aged 4–11 years with seasonal and perennial allergic rhinitis. 4, 5, 6
Duration of Use Before Checking with a Doctor
Children aged 4–11 years should not use fluticasone propionate for longer than 2 months per year without consulting a physician. 7
This precaution exists because long-term intranasal corticosteroids may slow growth rate in some children, though whether this affects ultimate adult height remains unknown. 7
Adolescents ≥12 years can use the medication for up to 6 months of daily use before requiring medical follow-up. 7
Administration Technique to Maximize Efficacy
Prime the bottle before first use by shaking and spraying away from the face until a fine mist appears. 1, 2
Have the child blow their nose before administering the spray. 1, 2
Keep the head upright during administration (not tilted back). 1, 2
Use the contralateral hand technique: Hold the spray bottle in the opposite hand relative to the nostril being treated (right hand for left nostril, left hand for right nostril). This directs the spray away from the nasal septum and reduces epistaxis risk by four times. 1
Breathe in gently during spraying, and do not close the opposite nostril. 1, 2
Do not share the bottle between family members, as this spreads germs. 7
Expected Onset and Duration of Effect
Symptom relief begins within 12 hours of the first dose, with some patients experiencing benefit as early as 3–4 hours. 1
Maximal efficacy requires days to weeks of regular daily use, so the medication should be continued even when symptoms improve. 1, 2, 7
The medication works by blocking multiple inflammatory substances (histamine, prostaglandins, cytokines, leukotrienes) at the source in the nasal mucosa, unlike oral antihistamines that only block histamine. 7
Common Side Effects in Children
Headache, pharyngitis (throat irritation), epistaxis (nosebleeds), and nasal burning or irritation are the most common adverse events. 2, 3
Epistaxis typically presents as blood-tinged nasal secretions rather than severe nosebleeds and can be minimized with proper contralateral spray technique. 1
Nausea, vomiting, asthma symptoms, and cough may also occur but are less common. 2
Safety Profile in Pediatric Patients
Multiple studies demonstrate no suppression of the hypothalamic-pituitary-adrenal axis at the 100 mcg daily dose in children aged 4–11 years. 4, 6
Morning plasma cortisol concentrations remain normal and similar to placebo-treated children. 4, 6
No effect on growth has been demonstrated at recommended doses (100 mcg daily) in clinical trials. 1, 5
Contraindications
Do not use if the child has ever had an allergic reaction to fluticasone propionate or any component of the formulation. 2, 3, 7
Consult a physician first if the child is taking HIV medications (such as ritonavir), ketoconazole pills, or other steroid medications for asthma, allergies, or other conditions. 7
Important Clinical Pitfalls to Avoid
Do not increase to 2 sprays per nostril in children aged 4–11 years, even if symptoms are severe—the 100 mcg dose is as effective as higher doses in this age group. 4, 5, 6
Do not use "as needed"—regular daily use is essential for maintaining symptom control, as the medication requires consistent use to reach and maintain maximal efficacy. 1, 2, 7
Do not stop abruptly when symptoms improve—continue daily use as long as the child is exposed to allergens (pollen, dust, pet dander, mold). 7
Do not spray in the eyes or mouth—the medication is designed to work only in the nasal passages. 7