Sure, children get sick. But for many parents, it seems like their child is always sick...even when they're not! Nasal Congestion often times gets brushed off and/or misdiagnosed. Today, Parents Ask expert Dr. Adam Friedman, an ear, nose, and throat specialist, answers:

Q: Why is does my child always have such bad nasal congestion?

A: As an Otolaryngologist (ear, nose, and throat specialist), I frequently see children who’s parents are concerned because their child seems to have continual nasal obstruction.  Symptoms of this problem include a constant inability to breathe through the nose, grey “bags” under the eyes, continual mouth breathing, an inability to blow the nose, frequent foul-smelling or discolored nasal discharge, and frequent sinus infections.  Obviously, if a child is ill, these are normal consequences of an infection.  If, however, a healthy child suffers from these symptoms there tends to be something else going on.  By the time I, as a specialist, see these children, they have usually already been treated with oral medications as well as nasal sprays in an attempt to treat nasal allergies.  Frequently, they have even been to an allergist to have testing for allergies, and some have even been receiving “allergy shots” for quite some time.

Although allergies can often play a role in these problems, if the allergy treatments fail to resolve the symptoms, the culprit is often enlargement of the adenoids.  The adenoids are the same type of tissue as the tonsils but are located immediately behind the nose and cannot be seen on a normal physical examination (or by a curious parent looking in the nose or mouth!).  As a child’s immune system develops, both the tonsils and adenoids will swell, which is a normal phenomenon.  If the adenoids become very large, which often happens, they can completely obstruct the back portion of the nose.  This obstruction prevents mucus from draining out the back of the nose and causes swelling of the tissues within the nose resulting in the symptoms discussed above.  So, the reason that allergy treatment does not completely resolve the problems is because there is a mechanical obstruction in the back of the nose.

Untreated adenoid enlargement can contribute to sleep apnea, abnormal facial growth, abnormal dental development, bad breath, asthma, frequent bronchitis, and generally unpleasant nasal hygiene issues.  Enlarged adenoids can be diagnosed either by an X-ray or by a specialized nasal examination done with small, flexible telescope in your E.N.T.’s office.  If your child is diagnosed with adenoid enlargement, your E.N.T. might elect to use a trial of nasal steroid sprays to see if that shrinks the adenoids but this works only a minority of the time.  More often, the adenoids are removed in surgery.  The procedure is done under general anesthesia but almost all children go home shortly after surgery.  It is relatively painless and there are no cuts or bruises anywhere on the face.  Best of all, the children feel better almost immediately after surgery and the symptoms are almost completely gone within 2 weeks. 

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