Newborn Congestion

Dear Lisa,

MY 8 WEEK OLD BABY SNORES ALL DAY LONG AND AT TIMES IT SOUNDS AS IF HE IS TRYING TO CLEAR HIS THROAT. I THINK HE HAS A STUFFY NOSE. I GIVE HIM SALINE DROPS AND I RUB VICKS ON HIS CHEST. HE COUGHS BUT ONLY A BIT AND HIS NOSE IS NOT RUNNY.

"WORRIED MOM"

Dear “WORRIED MOM”,

Infants are obligate nose breathers which means that they only breathe through their nose. If their nose is stuffy they don’t know to open their mouth and breathe the same way that an adult would. Therefore the slightest nasal congestion, mucus strand or piece of dust tends to cause a baby to have noisy breathing. In addition, an infant’s nasal passages are narrow and the lining is very sensitive. These factors can lead to increased airway resistance which results in symptoms of snoring and nasal congestion. (1)

A baby that develops an upper respiratory infection (a cold) will have a lot of nasal congestion. If your baby’s symptoms are new, it could be a sign that he developed a cold. Certain environmental factors may also contribute to or worsen an infant’s nasal congestion. For example, heat may cause the nasal passages to swell and therefore if the house temperature is too high the baby’s nose may become congested.

I also find that Babies who sleep in a room with a fan or a ceiling fan tend to have a lot of nasal congestion. Fans collect dust and the rotating blades tend to push that dust into the air where the baby can breathe it in. The normal healthy baby’s nose will filter that dust, but the mucus that is produced in response to that dust can lead to congestion and noisy breathing.

In order to treat a newborn’s nasal congestion, I recommend a cool mist vaporizer. The cool mist helps shrink the swelling of the nasal passages and helps the baby breathe easier. A cool mist vaporizer also helps loosen or liquefy nasal secretions which make them easier to remove. You can purchase a cool mist vaporizer at your local pharmacy or children’s supply store such as Kids R US. Make sure the vaporizer is cool mist and not warm mist. The cool mist vaporizer should be placed in the room where the baby sleeps and the stream of mist should be directed towards the baby’s nose.

The purpose of coughing is to clear and protect the airway. It is normal for a baby to cough once or twice per day in order to clear normal secretions. An infant that has frequent coughing or a worsening cough should be evaluated to rule out other conditions. If your baby is coughing in response to you putting in the saline nose drops, it could mean that you are putting in too many drops.

Make sure you are using only one drop per nostril. If you instill the drops with your baby's head slightly elevated, in a partially sitting up position your baby may cough less. It is important to make sure that your baby's head is supported at all times. You can follow this with bulb syringe suctioning twice per day if you can see mucus blocking the nostril opening.

An infant may also cough in response to an irritant. An irritant could be any odor, fume or smoke in the environment. Many babies are irritated by Vicks vapor rub. The odor may be too strong for an infant. It would be a good idea to stop using the Vicks rub and see if the cough goes away. If your baby’s cough persists he should be evaluated by your Doctor or Nurse Practitioner.

Lastly, chronic nasal congestion and cough associated with back arching, irritability, excessive hiccoughing and spitting up may be a sign of Gastroesophageal Reflux. (2) If your baby has these symptoms associated with his cough it would be a good idea to have him checked. Other symptoms that would be concerning include a fever, stridor (a high pitched inspiratory sound), a change in the sound of his cry, a honking sound with crying, irritability, difficulty sucking, a decrease in formula intake or choking with feeding. If your infant displays any of theses signs an evaluation is warranted. These may be signs of something other than normal newborn congestion.

References:
(1)Betz C, Hunsberger M, Wright S. Family-Centered Nursing Care of Children. 2nd ed. Philadelphia, PA:W.B.Saunders Company. 1994: 1168-1171.
(2)Edmunds A. Gastroesophageal Reflux Disease in the Pediatric Patient. Therapeutic Spotlight. 2005. Aug:4-13.

Lisa Kelly, R. N., P.N.P., C.
Certified Pediatric Nurse Practitioner

Pediatric Advice about Keeping Babies Healthy