From the Guidelines
For chronic nasal congestion in children, treatment should begin with identifying and avoiding triggers like allergens or irritants, and the use of saline nasal sprays or drops 2-3 times daily to moisturize nasal passages and clear mucus is recommended. According to the evidence provided by 1, for children with allergic rhinitis, non-sedating antihistamines like cetirizine (0.25 mg/kg/day) or loratadine (5 mg daily for ages 2-6,10 mg for older children) can provide relief.
- Intranasal corticosteroids such as fluticasone (1-2 sprays per nostril daily for children ≥4 years) or mometasone (1 spray per nostril daily for children ≥2 years) are effective for persistent symptoms, working by reducing inflammation in the nasal passages, as stated in 1.
- Nasal decongestants like oxymetazoline should be limited to 3 consecutive days maximum to prevent rebound congestion, as warned in 1.
- For infants, using a bulb syringe after saline drops can help clear mucus.
- Humidifiers in the child's bedroom can provide additional relief by maintaining moisture in the air. If symptoms persist beyond 2-3 weeks despite these measures, or if there are signs of sinusitis, sleep disturbance, or breathing difficulties, medical evaluation is necessary to rule out conditions like adenoid hypertrophy, sinusitis, or anatomical abnormalities that may require specialized treatment, as discussed in 1.
From the FDA Drug Label
Fluticasone Propionate Nasal Spray, USP not only relieves sneezing, itchy nose, runny nose and itchy, watery eyes, but also relieves nasal congestion. Children age 4 to 11 should use a lower dose of Fluticasone Propionate Nasal Spray, USP for a shorter period of time Ages | Children 4 to 11 years of age | Users 12 years of age and older Dosage | 1 spray in each nostril once daily | Up to 2 sprays in each nostril once daily Duration before checking with a doctor | Up to 2 months of use a year | Up to 6 months of daily use
Chronic Congestion Pediatric Treatment:
- For children 4 to 11 years old, Fluticasone Propionate Nasal Spray, USP can be used to relieve nasal congestion at a dose of 1 spray in each nostril once daily.
- The use of Fluticasone Propionate Nasal Spray, USP for children age 4 to 11 is limited to 2 months a year before checking with a doctor, due to the potential for slower growth rate.
- It is recommended to consult a doctor if a child needs to use the spray for longer than 2 months a year 2.
From the Research
Treatment Options for Chronic Congestion in Pediatrics
- The management of allergic rhinitis, which can cause chronic congestion, includes allergen avoidance, pharmacotherapy, and immunotherapy 3.
- Nasal saline irrigations have been found to be beneficial in the treatment of symptoms of chronic rhinosinusitis, and can be used as a sole modality of treatment or as an adjunct to other treatments 4.
- Intranasal corticosteroids and saline irrigations are supported by level-1 evidence for the medical management of chronic rhinosinusitis, and adherence to these medications can improve patient outcomes 5.
Non-Pharmacological Treatments for Nasal Congestion in Infants and Children
- Nasal saline irrigation is believed to alleviate upper respiratory tract infection symptoms by helping to eliminate excess mucus, reduce congestion, and improve breathing 6.
- The use of isotonic and hypertonic saline solutions to relieve nasal congestion in infants and children is widespread, and is considered a safe and valuable therapeutic support 6.
- 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 6.
Pharmacological Treatments for Chronic Rhinitis
- Intranasal corticosteroid spray and oxymetazoline hydrochloride combination treatment may be superior in reducing rhinitis symptoms compared to either intranasal corticosteroid spray or oxymetazoline hydrochloride alone 7.
- The combination of intranasal corticosteroid and oxymetazoline has been found to result in higher nasal volume and superior improvement of nasal congestion compared to control groups 7.