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Children with leaky nose (Rhinorrhoea)

 

How does it impact on the child’s routine life?

It is associated with reduced quality of life because of its impact on sleep. Such children can have reduced school attendance and academic performance. Some studies show that children who suffer rhinitis are at increased risk of developing asthma.

 

What are the causes for rhinorrhoea in children?

Allergic rhinitis is due to allergy to house dust, house dust mites, trees and grass pollens, cat & dog dander and moulds. It is estimated that up to 40% of children are affected by allergic rhinitis.

Infective rhinitis is usually caused by respiratory viruses. Other causes are bacterial and fungal. 

Non-allergic rhinitis can be idiopathic (unknown cause), vasomotor, hormonal, medications related, ciliary problems (Primary Ciliary Dyskinesia), cystic fibrosis, immune deficiency etc.

 

What are the symptoms of rhinitis in children?

Nasal discharge - clear, yellowish/greenish. In children, yellowish secretions from only one side of the nose can mean that something is stuck in the nose such as plastic bead, lego, paper bits etc. If these symptoms are observed, seek an ENT doctor for examination.

Nasal blockage - very rarely in children rhinorrhoea could be due to nasal polyps. However presence of nasal polyps in children raises suspicion of cystic fibrosis.

Sneezing, stuffy nose, post nasal drip, itchy eyes - associated with allergic rhinitis (Hay fever). Post nasal drip is the sensation of mucus trickling down the back of throat and can cause children to cough at night.

Fever, headache and cough in case of bacterial rhinitis (Often called rhinosinusitis)

Snoring and sleep apnoea - possibility of enlarged adenoids

 

What are the available tests?

If the child has associated snoring and sleep apnoeas, there could be adenoid enlargement.

Adenoids are tonsil like tissues which sit at the back of nose. They can harbour bacteria and cause nasal discharge. This is diagnosed using a camera test in outpatients clinic (flexible nasal endoscopy).

There are blood tests for allergy (RAST IgE). For children older than 6 years, skin prick testing is available. For skin prick testing, it is important that they do not use any antihistamines up to 5 days before the test.

Blood tests for checking immune function (IgG, IgA, IgM levels, complement levels, functional antibodies to H. Influenza/Pneumococcus), 

Vitamin D levels - Vitamin D has been shown to have an immunomodulatory effect with a significant impact on immune function. 

 

Treatment:

Majority of children with runny noses are well in themselves. They carry on with their normal activities. It is usually the parents or teachers that get concerned about this condition as they see the children often run around with leaky noses.

Avoiding all common allergens by implementing the below measures:

  1. House dust mite reduction measures

Removing all soft toys from bed (Don’t be so harsh…may be leave one toy in bed which is

machine washable or after freezing them in plastic bags overnight) 

Regularly vacuuming carpets (HEPA filter vacuum cleaner, exhaust filtered vacuum cleaner) and wet mopping wooden floors

Washing bed linen at 60 degrees

Use anti house dust mite covers for pillows, blankets and mattress

  1. Pollen avoidance measures 

This is very difficult as tiny pollen spores are windborne and travel for miles on air currents. Monitor pollen forecasts daily and stay indoors whenever possible. Allergen barriers are available as balms or gel nasal sprays. Apply them around edge of each nostril to trap or block pollens. Keep windows closed when indoors especially in the early mornings and in the evenings (refer to allergy uk website).

  1. Cat and Dog dander

Avoid cats and dogs entering children’s bedroom. If found to be allergic on blood tests, best is to avoid contact with dogs and cats.

  1. Mould (fungus) 

You may be allergic to spores of fungi. Some spores spread in dry weather and others during humid conditions. Indoors, fungi are often found in bathroom, kitchen, basement and laundry areas.

Invest in a de-humidifier

Use exhaust fans in bathrooms

 

Medical treatment:

Paediatric saline nasal spray (Sterimar nasal spray / Neilmed Sinurinse) - This helps to eliminate inflammatory proteins, bacteria and allergens from within nose and sinuses.

Regular antihistamines (cetrizine, Loratidine etc)

Antibiotics if there is active bacterial infection

Steroid nasal sprays (Avamys, Nasonex). Over the counter decongestant nasal sprays are not recommended. Latest addition to nasal spray (Steroid plus antihistamine) - Dymista (only for children over 12 years of age)

Immunotherapy - (Oral/Sublingual) This is desensitisation and it involves administration of gradually increasing doses of allergen extracts over a period of years, given by injection or drops/tablets under the tongue

 

Surgical treatment: 

Adenoidectomy if child has enlarged adenoids (please refer to Patient Information Leaflets

Minimal endoscopic sinus surgery (Paediatric FESS) if associated with rhinosinusitis

In some cases Coblation Turbinoplasty is recommended to help with breathing.

 

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Date: 04/04/2017
By: Mr Prince Modayil
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