Nasal Congestion

Dear Lisa,

My 4 year old daughter breaks out in pimples after a cold. Why is this? She seems to have very stuffed sinuses long after the rest of her cold symptoms disappear and has a very stuffy sound to her voice and even some drooling, as if it's hard to talk with her nose so clogged. However, blowing her nose gets no results, like it's all in her head. I know the stuffiness must be harboring some bacteria that spreads to her face and causes the breakouts. How can I help her with this and why does it happen?

“My Kids”

Dear “My Kids”,

The inside of a person’s nasal passages contain many microorganisms. This nasal colonization does not cause any harm to the person and is considered normal. These germs can spread to other people or to other parts of the person’s body. In some cases, these microorganisms in the nose can be transported to the person’s skin. Children who touch or pick their nose and then scratch or pick at their skin can spread the germs from their nose to their skin and cause an infection. Recurrent skin infections, pimples and boils are thought to be spread in this manner.

Your daughter’s pimples probably occur after a cold because during a cold her nasal secretions are more abundant and there is a greater chance that the secretions can spread to other parts of her face and body. The best way to prevent this from happening is frequent hand washing, face washing and encouraging your daughter not to pick or touch her nose.

I have taken care of many children who experienced this problem and the Dermatologists that I referred them to recommended applying an antibiotic ointment such as Neosporin or Nasal Bactroban around the nose and inside the rim of the nostrils to prevent this from occurring. Although I have seen younger children prescribed this medication, according to the PDR, Nasal Bactroban is recommended for children 12 years old and older. You can discuss measures that you can take to alleviate your daughter’s symptoms with her Physician.

It is important to note that pimples around the nose and mouth can be found in children with Streptococcal Pharyngitis (Step Throat). Therefore, if you notice that your daughter has pimples around her mouth and nose when she has symptoms of throat pain, difficulty swallowing, decreased appetite and fever, an evaluation for Step Throat should be performed.

In regards to your daughter’s nasal congestion, there are many potential causes. It is normal for a child to have a stuffy nose for approximately 10 days with each new cold or virus. It is also expected that a child will develop approximately 6 to 10 viruses per year. Children that attend daycare tend to develop more colds and respiratory illness than children not attending daycare.

In some cases a child’s nose may seem to chronically congested, but instead the child is actually developing recurrent respiratory infections. This is particularly prevalent during the winter months, when most colds and viruses occur. Since there is a short time between colds during the winter months a child’s nasal symptoms may be mistaken to be a chronic problem.

On the other hand, children with chronic nasal complaints, with no relief from their symptoms may be experiencing another condition. Chronic nasal congestion can be due to a variety of conditions. Sinusitis, Allergies, Adenoid hypertrophy (enlarged adenoids) and Gastroesophageal Reflux are all potential causes of chronic nasal congestion.

The National Institute of Allergy and Immunology estimates that 37 million Americans are affected by Sinusitis each year. (1) Sinusitis is defined as the inflammation of the lining of the sinuses due to an infection. The symptoms of Sinusitis include fatigue, cough, a low-grade fever, sinus headache, toothache, facial pain, colored nasal discharge, foul-tasting post-nasal drip, worsening cold symptoms or cold symptoms that last more than 7 days. (2)

Sinusitis occurs when mucus from the sinuses cannot drain normally to the back of the nose and throat. Usually this occurs when there is an obstruction such as thickening of the lining of the sinuses, a polyp or enlarged air cells within the inner folds of the nose. Allergies are a common cause of this thickening of the lining of the sinuses. Sinusitis is more likely to develop in patients with allergies.(3) Therefore a child with allergies who has worsening of her symptoms should be evaluated for Sinusitis.

If a child has Sinusitis and is not treated, Chronic Sinusitis can develop. Chronic Sinusitis is defined as a Sinus infection that lasts more than 30 days. The symptoms of Chronic Sinusitis may be more subtle. Symptoms of Chronic Sinusitis in children include nasal discharge, postnasal drip, nasal obstruction, cough, behavior changes and acting out.(3) Adults on the other hand may complain of chronic fatigue and general malaise at work. A study by Benninger found that 54% of patients diagnosed with Chronic Sinusitis also had Allergic rhinitis.(4)

Allergies or Hay fever can also cause nasal congestion. Allergy symptoms include allergic shiners, watery eyes, sneezing, an allergic crease (on the nose), sneezing, the allergic salute (upward wiping of the nose with the child’s hand) and itchy eyes. A child with allergies should not have a fever. Allergies can be described more as an annoyance than an acute illness. The difference between Allergies and a cold or Sinusitis is that allergy symptoms intensify after exposure to the offending item.

Tonsillar and Adenoid hypertrophy (enlarged tonsils and adenoids) are other conditions that can result in nasal symptoms. Enlarged tonsils and adenoids prevent the proper drainage of nasal secretions which can lead to infections. Signs of Tonsillar and Adenoid Hypertrophy include mouth breathing, difficulty swallowing food, snoring and failure to thrive.(5)

Gastroesophageal reflux (GER) does not only cause heartburn, but can also cause symptoms outside of the esophagus (food tube). These symptoms include chronic cough, Sinusitis, nasal congestion, sore throat, hoarseness, pharyngitis (throat infection), Otitis media (Middle ear infection), wheezing and Asthma. (6) The acidic gastric contents refluxed beyond the esophagus causes damage that leads to these problems. In addition, GER indirectly affects the common neural pathways between the lower esophagus and the respiratory tract that lead to respiratory symptoms.

Children with GER develop Sinus infections and ear infections more often than children without GER. If a child has chronic nasal congestion that cannot be attributed to another cause, GER should be ruled out.

I hope this information helps.

If you are interested in reading other Pediatric Advice stories covering these topics:

Hay Fever

Snoring

References:
(1)Mackey T. The best therapies for bacterial rhino sinusitis. The Clinical Advisor. 2006 July:59-64.
(2)Smart B. What you Need to Know about Sinusitis. Asthma Magazine. 2002. Sept/Oct:38.
(3)Huang S. Nasal Allergy and Sinus Infection. Consultant for Pediatricians. 2006.June:345-352.
(4)Benninger M. Rhinitis, Sinusitis, and their relationship to allergies. Am J Rhinol. 1992.6:37-43.
(5)Schwartz M, Charney E, Curry T, Ludwig S. Pediatric Primary Care. A Problem Oriented Approach. 2nd Ed. Littleton, Mass:Year Book Medical Publishers, Inc. 1990:855.
(6)Christensen M, Gold B. Clinical Management of Infants and Children with Gastroesophageal Reflux Disease: Disease Recognition and Therapeutic options. Presented at: ASHP Midyear Clinical Meeting;Dec 9, 2002:Atlanta.

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

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