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Runny Nose

Decoding the Possible Cause of Your Child's Runny Nose

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Updated June 14, 2014

Caucasian girl on couch blowing her nose
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It can seem like some kids always have a runny nose, can't it? A runny nose (rhinorrhea) is a common symptom of childhood illnesses, but many parents often get confused by what could be causing their child's sniffles.

Is it a cold?

Does your child have allergies?

Could it be a sinus infection?

Let's dig into the possible culprits:

Allergies

Allergic rhinitis, or hay fever, is a common cause for a runny nose in children.

Allergy symptoms usually include:

  • runny nose with clear discharge
  • stuffy nose (congestion)
  • sneezing
  • itchy nose
  • red eyes, with tearing and itching

As allergies worsen or linger, children may also develop a sore throat, headaches and coughing, and their allergies may interfere with their sleep, leading to daytime irritability. It is these allergy symptoms that are often confused with having a cold or sinus infection, as many parents don't believe that allergies should get "so bad."

In addition to these allergy symptoms, children with allergies often have dark circles under their eyes (allergic shiners) and may have a crease near the bottom of their nose (allergic crease) from rubbing their nose so much; this is often called an 'allergic salute.'

If a child also has asthma, uncontrolled allergies may also trigger asthma symptoms, leading to coughing, wheezing, and trouble breathing.

Children with uncomplicated allergies will not usually have a fever or a runny nose that expels yellow or green discharge, though.

Infections

Although parents often first think of allergies when their kids have a runny nose, infections are likely an even more common cause, especially for younger children.

Most of these children have viral upper respiratory tract infections or the common cold, with symptoms that can include:

  • runny nose, which starts clear but may turn to a thick yellow or green discharge
  • congestion
  • cough
  • sore throat
  • headache
  • fever, which is usually low grade, but may go up to 102

When cold symptoms linger for more than 10 to 14 days, or when the symptoms are severe, including 3 to 4 days of fever (over 102 degrees) in a child that appears ill, then the child might have a sinus infection. Keep in mind that just because your child has a runny nose with green drainage doesn't mean that he has a sinus infection and needs antibiotics.

A runny nose can also be a symptom of the flu. In general, these flu symptoms will be more severe than cold symptoms though, including a high fever, body aches, and fatigue.

Other Causes of a Runny Nose

Although most children with a runny nose have either allergies or an infection, there are some other causes for a runny nose, including:

  • deviated septum
  • nasal polyps
  • enlarged adenoids
  • vasomotor rhinitis, which can be triggered by exposure to smoke, odors, foods, or changes in temperature and humidity
  • rhinitis medicamentosa - often occurs with the long-term use of topical decongestants

Stopping a Runny Nose

To stop your child's runny nose, you would usually choose a treatment that targets the underlying cause, whether it is allergies or an infection. Treatments that target specific nasal symptoms can also offer some relief.

Treatments that are often used to help stop a runny nose can include:

  • Oral or topical decongestants - can help unclog a stuffy nose and relieve congestion, although topical decongestants should usually not be used in children under age 12 years and only for a few days at a time for teens.
  • Nasal washes - can relieve congestion and may prevent sinus infections
  • Antihistamines - can stop a runny nose and sneezing caused by allergies
  • Leukotriene antagonists (like Singulair) - can decrease runny nose, congestion, and sneezing caused by allergies
  • Steroid nasal sprays - can decrease runny nose, congestion, and sneezing caused by allergies
  • Antihistamine nasal sprays (like Astelin) - can decrease runny nose, congestion, and sneezing caused by allergies and irritants
  • Antibiotics - can treat sinus infections

Keep in mind that an FDA public health advisory about children's cold and cough syrups states that "questions have been raised about the safety of these products and whether the benefits justify any potential risks from the use of these products in children, especially in children under 2 years of age."

New warnings on cold and cough syrups now even say that they shouldn't be given to children under age 4.



Sources:

American Academy of Pediatrics Technical Report: Evidence for the Diagnosis and Treatment of Acute Uncomplicated Sinusitis in Children: A Systematic Overview. Pediatrics 2001 108: e57.

Ferdman, RM. The Runny Nose in the Emergency Department: Rhinitis and Sinusitis. CPEM - June 2007; 8(2); 123-130.

Pappas, DE. Symptom profile of common colds in school-aged children. Pediatr Infect Dis J - 01-JAN-2008; 27(1): 8-11.

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