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We are in a period where the common cold, or upper respiratory infection with main symptoms of rhinitis and cough, is one of the main reasons for visits to the Pediatrician. Generally caused by viruses, the common cold is treated symptomatically. Antibiotics are not effective.

I will mention some findings so that we do not abuse nasal pharmaceutical preparations or excessive nasal irrigation.

• Because the nasal mucosa absorbs very easily, special care is needed when administering anything.
• Some medications are abused without reason or cause.
• Rinse irrigation with saline, seawater, or ready-made medications is best for newborns and infants.
• The use of pharmaceutical medications in the nose depends on age. Thus, they are not administered to children <2 years of age. The American Academy of Pediatrics (AAP) reports its use in children >4 years old.

  A few more words about the most used nasal decongestant:

  Xylometazoline – Sympathomimetic / vasoconstrictor action brings very fast results.

  CAUTION, however, in the days of administration (3-5 days) and in the repeatability during the episode and over time. Thus, the pediatric nasal decongestant is contraindicated in atrophic and vasomotor rhinitis, in rhinitis due to dryness of the mucous membrane, hypertension, diabetes mellitus and angle-closure glaucoma.

  It should be used with caution in patients who show a strong reaction to adrenergic substances, with manifestations of insomnia, dizziness, vertigo, tremor, cardiac arrhythmia or increased blood pressure. Prolonged or excessive use can cause swelling of the nasal mucosa and hypersecretion due to increased sensitivity of the cells, i.e. the phenomenon of rebound congestion.

  The AAP made recommendations to avoid preparations with vasoconstrictor action and only topical use of preparations in the area around the nose. Nasal drop mixtures have no proven effectiveness.

  In most cases, the cause of rhinitis is the viral agent. In persistent cases of rhinitis, we must also look at other causes, such as: gastroesophageal reflux, unilateral atresia of the nasal funnels, foreign body and more rarely congenital infections (chlamydia together with neonatal ophthalmia, syphilis, etc.)

  • The use of nasal suction devices (aspirator) is not recommended, it causes unpleasant situations in children (“child abuse”), injures the mucosa, causes edema (let the mucosa function normally).
  • Of course, the use of saline is not “forever”, only for a few days and if necessary – check how the newborn or infant breathes when sleeping (e.g. snoring).

  Method of administration and amount of saline saline:

  • With a syringe or ampoule at gentle pressure – “gentle pressure”, the aim is to liquefy nasal secretions.
  • Special nasal irrigation systems for older children.
  • Normal saline nasal spray or hypertonic solution.
  • Quantity: Small amounts (2.5-5ml) to liquefy mucus.
  • Administration should be done on demand.
  • Administration position: In newborns and infants, not in a supine position. Lay your baby down and turn his head slightly to the side. In older children, the appropriate position is with the head tilted forward.

  Patience and persistence in controlled nasal irrigation in children, by parents, will have a good result for the benefit of both.