Complaints about nasal symptoms are very common. Luckily, most of these are symptoms of normal childhood development.
This summary is intended to give guidance to management of nasal complaints according to age group:
- Neonates and infants
- Pre-school
- School-age.
It can be difficult to distinguish polyps v turbinates:
- Polyps are insensate and look gelatinous
- Polyps are soft and mobile, turbinates have a bony core, so are not.
C.M & G.T – 27-10-26
Please see Primary Care Management as most can be managed with advice and medical management.
Neonatal rhinitis
Refer if struggling to feed and failure to thrive after appropriate medical management.
Pre-school
Adenoids
Refer if:
- signs of significant Obstructive Sleep Apnoea (OSA) or
- otitis Media Effusion (OME) with hearing loss and/or recurrent infections and failed appropriate medical management (see other RefHelp pages)
- chronic symptoms (>3 months).
School Age
Mostly are allergic and require medical management (see other RefHelp pages): consider referring to medical team if that fails.
Unilateral expanding lesion – refer urgently to ENT
Neonates
Neonatal rhinitis is very common:
- reassure – benign, self-limiting
- saline / suction
- rarely topical steroids/decongestants short course.
- refer if struggling to feed and failure to thrive after appropriate medical management.
Pre-School
(See RefHelp advice on Adenoids / Otitis Media Effusion / Obstructive Sleep Apneoa)
- Allergy
- uncommon
- treat medically if troublesome: nasal salt water sprays / rinses bilateral bd, oral antihistamine, nasal steroid spray
- Adenoids
Reassure: - hypertrophy 1.5 – 5 yrs (physiological)
- snoring
- rhinorrhoea
- hyponasal voice.
Treat medically if troublesome: Nasal salt water sprays/rinses bilateral bd, oral antihistamine, nasal steroid spray
School Age
- Adenoids usually atrophied
- Allergy common
- Chronic sinusitis rare
- Nasal polyps almost exclusively in children with cystic fibrosis-bilateral
- Refer to medical paediatrics
- Malignancy very rare-unilateral mass suspicious
- If unilateral mass (that is not a polyp or turbinate) refer ENT urgently.
A reminder that polyps are insensate and look gelatinous, they are soft and mobile; turbinates have a bony core, so are not.
Chronic rhinosinusitis in children | ENT UK – useful information for patients and families.
