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Provided by Evan Tobin, MD
and Roger Friedman, MD

Young children are more susceptible to upper respiratory infections (aka “URI” or “common cold”) because they are still growing, their immune systems are still maturing, and they are exposed to more viral infections through daycare and early school years.

The symptoms of a cold are well known to all of us. The symptoms include cough, runny nose, nasal congestion and sometimes a low-grade fever.

Some children, however, seem to have a “never ending cold”. They may mouth breathe, snore loudly and have a constant runny nose.

  • What is the cause for these symptoms?
  • As a parent, should you be concerned?
  • What can be done?

Two common problems of childhood can explain these nasal symptoms that simply won’t go away.

  1. Allergies
  2. An enlargement or infection of the adenoids


There are similarities between these two conditions. Both can cause chronic congestion and runny nose. These two problems can also overlap, both being present in the same patient.  If left untreated, the child may develop sleep and behavior problems and alteration in facial or dental development from long-term mouth-breathing.

Allergies can be seasonal or can be year-round. Seasonal allergies can include reactions to grasses, trees and ragweed, to name a few. Year-round allergies include allergies to pets, dust and mold. In addition to nasal congestion and runny nose, which is usually clear drainage, there can be sneezing, itchy eyes and sensitive skin. Children with allergies are also at higher risk to develop asthma. Initial treatment involves use of antihistamines and sometimes nasal steroid sprays, under the guidance of the patient’s pediatrician.

If the patient is not responding to medical treatment, consideration should be given to other potential causes, the most common of which is enlargement or chronic infection of the adenoids. The adenoids are a collection of immune system tissue - called “lymphoid tissue”. The adenoids are present in the location where the nose joins the throat, called the “nasopharynx”. This tissue helps to fight infection, but can itself become infected and enlarged. When that occurs, symptoms such as nasal congestion, mouth breathing, snoring, restless sleep and runny nose can occur. These symptoms can become severe enough that they can mimic or even cause a sinus infection.  Ear problems can also occur.

When adenoid enlargement is suspected by the pediatrician, nasal steroids can be tried. This medication will sometimes decrease the size of the adenoids and improve symptoms. The use of nasal saline may also help. Antihistamines typically will not work if there are no allergies present.

If your child has tried antihistamines and/or nasal steroids but their symptoms did not improve, the pediatrician may send a referral to a specialist.

(July’s BLOG will have the continuation of this article,  focusing on when it might be time to see a specialist for these continued symptoms.)