Treating Congestion in Children's Summer Colds

W. Steven Pray, Ph.D., R.Ph.


US Pharmacist. 2002;27(7) 

In This Article

Nasal Congestion in Children

Nasal congestion is the single most common manifestation of the common cold.[5] It occurs in virtually all cases, regardless of the specific viral causative agent. Nasal congestion worries parents more often than cough or sore throat, since it compromises breathing. It also hampers feeding, since infants must breathe through their noses while breast-feeding. Adults may clear their nasal passages through simple blowing of the nose. However, children below a certain age are unable to master this technique.

The adult with a cold has several pharmacological options available for nasal congestion. One is oral nasal decongestants; phenylephrine is only available in combination products, but pseudoephedrine can be purchased in several dosage forms. Topical nasal decongestants, including nasal drops and sprays, may also be appropriate for adults who do not meet labeled exclusionary criteria. However, each of these has clearly defined age limits, below which they are not proven safe and effective.

Neither oral pseudoephedrine nor phenylephrine should be recommended to children below the age of 2 years, however. They can produce central nervous stimulation that interferes with a child's sleep cycle if they are taken too close to bedtime or naptime. They may also raise the blood pressure.

In regard to topical nasal decongestants, levmetamfetamine, naphazoline, and propylhexedrine are not recommended for children under 6 years of age. Phenylephrine 0.125% was recommended for those as young as age 2, but is no longer available. Phenylephrine 0.25% is still available, but is not recommended for use in children under the age of 6. Only oxymetazoline 0.025% and xylometazoline 0.05% are considered safe by the FDA for use in those aged 2-6 years. However, Otrivin (xylometazoline) was discontinued by Novartis in January 2002. Generic versions may not be available. This leaves only oxymetazoline 0.025%, which does not seem to be available from any major manufacturer. Thus, no topical decongestant product is widely available to treat nasal congestion in those aged 2-6 years at this time.

There are two devices that may help relieve nasal congestion in children. One is the nasal aspirator. The typical aspirator is a flexible bulb with a blunt, removable clear plastic tip. The bluntness of the tip helps ensure that the parent/caregiver does not insert it too far into the child's nostril, causing mucosal damage. The tip is also able to occlude the entire nostril, increasing its effectiveness. To use this nasal aspirator, the parent places the tip well into the bulb, and squeezes the bulb. The tip is inserted into the nostril to be cleaned, and gently released. A gentle suction is applied to the nostril if the entire lumen is occluded. The parent/ caregiver may also notice visible mucus as it enters the clear plastic tip. Once the procedure is completed on both nostrils, the unit should be disassembled and thoroughly cleaned with warm, soapy water. If the parent finds that the secretions cannot be removed by this method, the baby may benefit from pretreatment with a nasal moisturizer. These non-medicated nasal sprays contain 0.65% sodium chloride. They may be gently dropped (e.g., Baby Ayr) or sprayed (e.g., Ayr Saline Nasal Mist, Breathe Right Saline Nasal Spray, NaSal Non-Medicated Spray) into the baby's/child's nasal passages. This rehydration of dry, crusted secretions allows them to more easily be removed with gentle suctioning.

Some companies market nasal aspirators that resemble ear syringes, with long, slender tips. They are not as safe for the child because of the excessive length of the tip. Also, they may not occlude the entire nostril, hampering the adequacy of suction removal.

A second safe device for easing breathing in children age 5 or older is the pediatric nasal strip (e.g., Breathe Right Children's Nasal Congestion Nasal Strips, Vicks Breathe Right Cold Relief Strips). These FDA-approved medical devices consist of an adhesive-backed plastic band that is approximately 1.6 inches long. The parent/caregiver first washes and thoroughly dries the skin of the nose to ensure proper adhesion. After removal of the adhesive backing, the parent/caregiver then bends the strip and centers it between the bridge and tip of the nose, just above the flare of each nostril. (If it is placed too high on the nose, it will be located on bone rather than the flexible portion of the nose and will be useless. If it is placed too low, it will not pull the nostrils open. Thus placement is critical in ensuring efficacy.) The strip's ends are pressed down and gently rubbed to secure the strip to the skin. When the strip is released, the plastic band attempts to straighten out to its original configuration, thereby exerting a gentle pressure on the nostril that opens it to give the patient instantaneous relief of nasal congestion. The strips are used only once, and the maximum suggested period of use is 12 hours per day. They may be used while awake, while asleep, or during exercise. The product packaging contains natural rubber latex, which may cause allergic reactions. Strips are not to be used over skin affected with dermatitis, sunburn, acne or any other lesion. If the strip is medicated, the patient activates it by scratching his or her face with a fingernail after placement. After one hour, the aroma dissipates, but the patient may re-activate as many times as needed during the 12-hour recommended wearing time. To remove the strip, shower or bathe with warm water. Then loosen the strip at each end, gently lifting each side.


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