Blocked and discharging noses are a common presentation for clinicians who care for children. Modern management involves a progressive evaluation of relevant symptoms and signs with appropriate medical treatment. Surgical intervention may be of benefit when medical therapy fails.
- A snotty nose in a child is a common presentation to the GP, and the problem is usually chronic. The most common causes are ‘the two As’: adenoids and allergy.
- Chronic rhinosinusitis may exist alone or in combination with adenoid hypertrophy or allergy.
- A clinical history and examination are the cornerstones of diagnosis, appropriate treatment and exclusion of atypical causes.
- Treatment for allergy is conservative, involving allergen avoidance as well as use of intranasal saline and/or corticosteroids and nonsedating antihistamines. Appropriate courses of antibiotics are given when infective rhinosinusitis is suspected.
- Referral to an ENT specialist is appropriate for children with likely adenoid enlargement, recurrent or chronic rhinosinusitis that has failed medical treatment, or unusual clinical findings.