Wednesday, December 20, 2006

Stuffy Nose

Dear Lisa,

My son is 1 month old and has a stuffy nose and seems congested. I brought him over to my mother’s house and he was breathing fine. Could it be that my house is too dry?

“Sunshine13”

Dear “Sunshine13”,

Nasal stuffiness in an infant is a very common problem. In most cases it is a benign condition not caused by infection or allergy. (1) The anatomy of the nose of an infant lends itself to becoming easily congested. The diameters of the nasal passages are so small that it only takes a small amount of mucus to cause a lot of upper airway congestion and noise. In addition the lining of the nasal passages are very sensitive and easily swell in the response to environmental conditions.

Newborn nasal congestion tends to become more pronounced during the winter months due to the heat in the environment. The heating system in most homes causes drying of the nasal passages in the newborn. (1) In order to combat this problem it is recommended to keep the heat set in the home below 72 degrees Fahrenheit. A thermostat temperature setting between 68 to 70 degrees Fahrenheit is sufficient as long as the infant is clothed in a warm outfit such as terrycloth pajamas.

It is also recommended to use a cool mist vaporizer in the infant’s bedroom. (1) The cool mist from the vaporizer shrinks the swelling of the nasal passages and helps the infant breathe easier. When using a cool mist vaporizer it is important to follow the company instructions regarding cleaning in order to prevent the build up of mold in the system. (1)

Avoidance of irritants in the home also helps prevent an infant’s nasal passages from becoming irritated and congested. Refraining from the use of candles, incense, ceiling fans, air fresheners, powder and perfume in the house will ensure the air in the home is clean and easier for the infant to breathe. Exposure to Cigarette smoke, especially in a closed winter home not only exacerbates a newborn’s nasal congestion but also has been linked to Sudden Infant Death. (1,2)

Since your infant had nasal congestion in your home that seemed to be relieved by a trip to your mother’s house it could mean that the environment in your house is contributing to the problem. If your thermostat setting is set above 72 degrees or if you have forced hot air heat, your house may be too hot and dry. You also should consider that simply taking your child out into the cool air during the visit may have cleared his nasal passages. Temporary exposure to cold air can shrink the swelling of a child’s airway. So the relief that your child experienced may have nothing to do with the environment in your mother’s house, but instead had to do with going outdoors.

There are other reasons for nasal congestion in a newborn besides environmental factors. An infant can develop nasal congestion because of an upper respiratory infection, Otitis Media (Middle Ear Infection) or Gastroesophageal reflux. (3,4) Sinusitis is a concern in older children, and is usually not found in infancy. An infant’s sinuses are not fully developed and therefore sinusitis is typically not a consideration.

In some cases, chronic or persistent nasal congestion in infancy can be due to an anatomic obstruction. One of the common causes of obstruction is enlarged adenoids. The adenoids are lymphoid tissue located superiorly in the midline of the posterior wall of the nasopharynx. The purpose of the adenoids is to trap infection from the upper respiratory tract. During early childhood, it is normal for the adenoids to enlarge when exposed to an infection. Sometimes this enlargement blocks drainage and leads to nasal symptoms and Otitis media. (5)

Choanal atresia is another potential cause for nasal obstruction in the newborn period. Each nasal cavity connects to the nasopharynx by posterior nasal openings called choanae. Choanal atresia is an obstruction of one or both of these openings due to an anatomic anomaly. An infant with bilateral Choanal atresia develops problems breathing at birth. This condition is readily identified when a newborn infant’s respiratory distress is alleviated by the opening of its mouth.

Unilateral or one sided Choanal atresia on the other hand, may be overlooked. Unilateral Choanal atresia is typically asymptomatic (without symptoms) until the child develops a respiratory tract infection. When an infant is well, he is able to compensate for this partial airway obstruction because the problem occurs only on one side. When an infant with Unilateral Choanal atresia develops a cold, their body can no longer compensate for the partial obstruction and as a result respiratory distress occurs. The symptoms of unilateral Choanal atresia are pronounced nasal obstruction and nasal discharge from the involved side.

In most cases, newborn congestion is normal and does not represent an underlying problem. If a newborn’s congestion interferes with the child’s eating, suckling or sleeping this warrants further investigation. These signs as well as nasal congestion associated with a cough or fever need to be evaluated by a Physician.

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

Newborn Congestion

Baby with Cold Symptoms

Nasal Congestion

Gastroesophageal Reflux

References:
(1)Schwartz M, Charney E, Curry T, Ludwig S. Pediatric Primary Care. A Problem Oriented Approach. 2nd Ed. Littleton, Mass:Year Book Medical Publishers, Inc. 1990:30-31.
(2)The United States Department of Health and Human Services. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. June 27, 2006. Available at:
www.surgeongeneral.gov/library/secondhandsmoke/. Accessed: Dec 2006.
(3) Kontiokari T, Koivunen P, Niemela M. Symptoms of Acute otitis media. Pediatric Infectious Disease J. 1998;17:676-679.
(4 )Strople J, Kaul A. Pediatric Gastroesophageal reflux disease-current perspectives. Curr Opin Otalaryngol Head Neck Surg. 203. 11:447-451.
(5)Betz C, Hunsberger M, Wright S. Family-Centered Nursing Care of Children. 2nd ed. Philadelphia, PA:W.B.Saunders Company. 1994:1211-1214.

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

Pediatric Advice For Parents with Infants

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