Are you constantly running after your child with Kleenex? Does your child seem to have a “cold” that never clears? Does your child have sore nostrils from constant wiping, shirt sleeves that you want to wash on “sanitary cycle,” and crusty material around his/her cute cheeks that is not so “cute”? As an ear, nose, and throat specialist, I am always advocating for what I consider to be the perhaps most under appreciated organ in our body, the nose. No matter how big or small, we all need the nose to work properly to breathe, smell, humidify the air, and smell is responsible for 2/3 of our perceived taste. In addition, our sense of smell let us know if we are exposed to potential dangers such as a fire or exposure to chemicals. Finally, as an Asian woman with a not-so-prominent nasal bridge, I can tell you how useful our noses are to hold up our glasses and sunglasses! For all that it is responsible for, in our children with their small noses, anytime it is runny with snot, many of these functions are impaired.
If your young toddler and preschool aged child has chronic runny nose daily or most days, and they are playing, eating, running around, going to daycare, sleeping, and act like mucus is part of their personal charm, then it is very likely that they do not have a “chronic” illness. Any or all of the following are most likely the reasons why they have a runny nose all the time:
Young children can’t blow their noses effectively, nor do they sniff snot into the back of their throat effectively like we can.
They experience many more colds in the first years of life.
They suffer from the "Milk and Cookie Disease" (MCD)—too much dairy and/or sugar in their diet, and they are drinking milk at bedtime.
Preschool aged children are known to experience at least 7-10 upper respiratory tract illnesses (URI) or “colds” per year. The great news is that only 7-13% of these URIs actually go on to result in a true and real “sinus infection” that we associate with bacteria, and therefore would benefit from a course of oral antibiotics. However, the rest of those 93-87% URIs can still result in green and snotty noses with cough even after the initial 7-10 days of cold symptoms, and not represent a true “sinus infection.” The trouble is that for parents and doctors alike, it is extremely difficult to tell when your child may be experiencing that 10% “acute rhinosinusitis” as a complication of the viral illness. As a pediatric ear, nose, and throat specialist, I think a course of antibiotics is reasonable if a child continues to have runny nose, cough, congestion, and fever for over 7 days and the cough is present both daytime and nighttime such that is disturbing their sleep. I am especially concerned if the child has poor appetite, can’t engage in fairly normal play and activities despite the runny noses and cough, and/or seem ill for longer than the week that we would expect it takes for a cold to go away. Research has demonstrated that this is an area of significant challenge. When pediatricians are surveyed, there is significant variation in the age at which pediatricians begin to consider the diagnosis of acute sinus infection with most using duration of symptoms as the most important diagnostic factor. Also found was the likelihood of pediatricians prescribing the use of systemic decongestants and antihistamines in young children, which is now being scrutinized given the recent Food and Drug Administration warnings regarding their safety. By the way, “snot” being green does not mean it’s a “sinus infection.” The discoloration naturally occurs due to an enzyme called “myeloperoxidase” found in neutrophils, a cell that fights infection, and the enzyme contains iron which causes the discoloration. This occurs due to inflammation and should not be interpreted as an indicator of true “acute rhinosinusitis” or need for antibiotics.
In A Healthier Wei, I explain the benefits of mucus and the natural physiology of why during a cold, allergies, and reflux from MCD and bad eating habits increase mucus production. While I can’t “cure” or prevent colds and true allergies, my book, philosophy, and counseling of families about their child’s diet and dietary habits has helped thousands of young children stop having chronic stuffy and/or runny noses.
It is important to understand that children CANNOT have a sinus infection of a sinus they don’t have! Babies are born with early buds of the maxillary (cheek) and ethmoid (between the eyes) sinuses, while the formation of the frontal (forehead) sinuses and sphenoid (center of the head) sinus do not usually start forming until age 7 or older, for the frontals, and age 5 or older for the sphenoid. Again, the point is, nasty snotty noses can occur without a sinus infection!
The understanding of this point by both primary care physicians and parents and caretakers is critical to reduce the overprescription, overconsumption, and inappropriate use of oral antibiotics. Furthermore, we can all reduce unnecessary visits to the emergency department, urgent care facility, and doctor’s visits for these symptoms if we share this information and support one another in how to better handle runny noses in young children. The overprescribing and overuse of antibiotics will continue to threaten our ability to treat resistant strains of organisms responsible for other infections. The overprescribing and overuse of medications in otherwise healthy children will continue to threaten our children experiencing potential side effects that we do not yet know or understand because we have not had research data showing what happens when a child has taken 20-30 years of once daily allergy medications or nasal steroid sprays.
While my own research and other clinical trials have shown how effective and safe using saline nasal irrigation is for treating true and chronic rhinosinusitis (congestion, cough, and runny nose) in resolving these symptoms, I find that children younger than 4 simply can’t tolerate the once daily irrigation using a squeeze bottle. Before we get too discouraged, the good news is that based on my clinical experience and research, true chronic rhinosinusitis typically occurs in school aged children (average age around 7) who have underlying skin-test proven allergies to multiple aeroallergens (trees, grass, pollen, mold, dust mites, etc). Therefore, I am even more passionate about making sure that our toddlers and preschool aged children do not have MCD as the cause of their chronic runny nose.
I am a strong advocate for making sure that our toddlers and preschool aged children do not receive unnecessary radiation exposure through x-rays of their sinuses and CAT scans to find out if they have “sinus infection." While both tests definitely have a role in helping primary doctors and ENT specialists to confirm whether a child has sinus inflammation, they are neither recommended nor necessary to make the diagnosis of any suspected acute problems. Based on my own published research findings, I only order CT scan in children who are sent to me for chronic rhinosinusitis AFTER they have used once daily irrigation for 6 weeks, and report no improvement in their chronic symptoms of nasal congestion, cough, and/or runny nose. Thank goodness I find this to be the case in only about 10% or less of all the children I see in my practice.
By the way, if your child’s doctor or allergist did order a CT scan, and it shows some “opacification” (gray in the sinus cavity representing thickening or swelling of mucous membrane), this is often misinterpreted by physicians, even ENT doctors, as sign of “sinus infection” and lead to the prescription of 21 days of oral antibiotics. Let me share that I have met endless number of families whose child has been so many courses of these “21 day” rounds of antibiotics and they simply do not experience long term “cure” of their symptoms. The reports of paranasal sinus CT scans usually describe such findings as “mucosal thickening” and rarely do physicians see “air-fluid levels”, a finding that would support acute infection. Opacification is only showing that there is t mucosal thickening in the sinus cavities, and usually means there has been prolonged lack of airflow through the natural “window” of each sinus from the nasal passages. Due to blockage of the “window”, there is then lack of oxygen in the sinus cavities and then inflammation results, not necessarily bacterial overgrowth.
Here is the bottom line, if you have a young child (older than 12 months) with chronic runny nose, try the following and you will likely see an incredible improvement:
- If your child drinks milk every night right before or at bedtime, STOP immediately. I promise that within 7 days you will notice that he/she will have much less congestion, nighttime cough, waking up with snot and phlegm, and sleep better. A Healthier Wei explains why undigested milk in the stomach lead to reflux and then these nasal symptoms.
- If your child has a snack every night after dinner and before bed, especially if they contain dairy and/or sugar, STOP that habit. Instead, if he/she must eat again, choose items which do not contain diary and/or sugar.
- If your child eats a great deal of dairy every day, yogurt, cheese stick, milk, chocolate milk, Mac-n-Cheese, cheese pizza, cheese, ice cream, etc, please consider cutting down on their daily dairy consumption. Find out how much dairy is truly necessary for health in A Healthier Wei.