Long-Term Runny Nose

     From nine months of age until about three years old, it seems like every child’s nose is runny. Rather than being “just a snotty-nosed kid”, most of the time there is actually an explanation for it.

     The most common reason is, of course, a viral cold. The first thing that happens when a child gets a cold is that he gets a fever and feels miserable (See article on “Fever”). That is when the nasal discharge is thin and clear.The confusing thing for parents is that, in about three days, when the child loses the fever and feels better, the nose really starts to get bad - green, yellow or brown mucous – all colors and thickness. The child is eating and feeling fine, but the snot doesn’t stop coming. Usually there is a cough along with it.  This second, runny-nose phase of a cold can last up to two weeks and parents often begin to believe “he must have a sinus infection” just because the nasal discharge is so gross.  I’ll usually tell them to wait at least two weeks before spending money on doctor visits and antibiotics because most runny noses clear without treatment if the child is otherwise well. If it goes on longer than two weeks, Grandma will probably sneak him out of the house and take him to the doctor, anyway. If the child develops a new fever or seems more irritable he needs to be examined. Don’t worry if the child won’t blow his nose. When he sniffs, the mucous doesn’t go back in his head, it ultimately goes into his esophagus, he swallows it and it comes out - just  from a different end. Teaching him how to wipe his nose is good, though.

     Another cause for nasal congestion lasting over two weeks is allergy. These children usually have a family history of allergy, eczema or asthma and the nasal drainage is usually thin and clear.  This is not accompanied by fever or feeling ill - the child just “sniffs” and “coughs” a lot. He may have a crease across the lower part of his nose from rubbing up on his nose with the palm of his hand – the “allergic salute”. If the runny nose starts when you have had a change in the environment – a new living place, the #100 stuffed animal just got added to the collection or you have a new hairy pet (especially a cat!)– think allergy. Sometimes allergy will manifest as just a long-term cough or throat clearing. You get so used to hearing the sniff, you don’t hear it any more. If a one to two week course of daily children’s antihistamine (not decongestant) improves the symptoms, think allergy.

     Sometimes the chronic cough and congestion can be a sinus infection. This is a secondary infection. It comes on after the mucous has been in the nose long enough for the bacteria to grow. So a sinus infection occurs after over two weeks of runny nose symptoms from either a cold or allergies. The nasal discharge can be very thick and nasty and it is coming out of both nostrils. The child could have a headache or just not feel good. The diagnosis is usually made from the history and exam - X-ray studies are worthless. As I have mentioned in previous articles, any time your child has had any illness for a while and then takes a turn for the worse, the child needs to be seen.

     Finally, if a child has long-term thick nasty nasal discharge that smells very bad and is only coming out of one nostril, have your caregiver take the bean, rock or whatever it is out of your kid's nose.