“N” is for Nose!

In the second of my three articles on Ear Nose and Throat (ENT) issues affecting children, I will tackle ‘N’… which stands for Nose! GPs see many issues affecting the nasal passages, ranging from snuffly babies, to allergic rhinitis, to sinusitis. These are pretty common, can have serious consequences if not dealt with, but are fortunately, generally easy to treat!

The nasal passages are very technical tubes! Their function is to warm, moisten and filter the air that we breath. They are also designed to be the first point of detection of infections, and can mount a response directly to an attack! A lot of issues are more common in children as their tubes are smaller than an adults and their adenoids and tonsils are relatively larger.

One example of this is ‘the snuffles’, which is common in babies. If the baby is otherwise well, happy and feeding, no treatment is needed. It’s common for normal mucus to just sit in their noses, as they have not yet learnt to sniff, or blow it out! Having a nasal discharge (clear or coloured) doesn’t always mean an infection, and we like to keep an eye on other measures of wellbeing, for instance, their interest and ability to feed, the presence of a fever and if they are content and engaging or miserable and crying.

If the baby is starting to get more snuffly during feeds, there are some simple measures that may help. A bowl of water in the baby’s room will raise the humidity of the air and help loosen thick mucus. If your baby has a blocked nose when a feed is due, saline drops can help. Care is needed with these, as if they are used too much, the skin can become irritated. Nasal aspirators help to suck mucus from your baby’s nose, some parents love them, and the research available suggest they do no harm.

If an infection does try and enter our nasal passages, hopefully the adenoids will leap into action! Adenoids are lymph nodes that sit behind the nose, they are like the lymph nodes under our arms and in our neck. Their job is as a first line of defence and can become enlarged when we are fighting infections. If this happens, they can cause mouth breathing, a nasal quality to the voice, yellow or green mucus, snoring and obstructive sleep apnoea. Adenoids grow most rapidly between 2 and 7 years old. If they grow too large, or are inflamed, they can contribute to recurrent ear infections, glue ear, hearing and speech issues (see my recent article on ears!), sinus infections, snoring or sleep apnoea (you’ll have to wait for my next article to read more about this!).

Adenoids and the nasal passages can also become enlarged due to allergies to inhaled particles, for example pollen, perfumes, house dust mite and fur (this is also called allergic rhinitis). If we can identify the cause of this, we can try and reduce the child’s exposure to it. Treatments can include antihistamines and steroid nasal sprays, sometimes it take a little persistence to work out the treatment that is best for your child. If these fail, adenoids can be removed surgically.

If a child develops sinusitis, this means that one of the hollow cavities in the skull has become inflamed and possibly infected. There are four pairs of sinuses in the face, and they are lined with the same membrane that is found inside the mouth and nose. Their main function is to warm and moisten and filter air. An infection in the sinuses commonly happens after a cold, or an allergic episode (for example during hayfever season, or after spring cleaning!)

Sinusitis causes a stuffy/runny nose, it can cause bad breath, ear pain, dental pain or facial tenderness, among other symptoms. If your child has had a cold that has lasted for more than 7-10 days, or a cold getting worse after 7 days, or allergy symptoms that aren’t getting better with their usual treatment, these could all be signs they should see a doctor.


– The nasal passages are sensitive, complicated and very important

– A lot of symptoms will settle with no intervention

– Adenoids are lymph nodes that sit at the back of the nose and may become enlarged in response to infection or allergies

– Enlarged adenoids can cause snoring, sinus infections, ear infections and glue ear

– If this causes recurrent episodes, an operation may be advised to remove them

– As ever, if you are worried your child is unwell, or not getting better, you must take them for review by a doctor

About the author

Dr Samantha Pethen
Dr Pethen arrived in Australia in 2008 having worked on the South Coast of the UK since 1996. She has been with this practice ever since.
She is passionate about the art of General Practice as a whole, but particularly enjoys paediatrics, adolescent medicine and chronic disease management.

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