Nasal obstruction in infancy

Nasal obstruction is common in infancy, a problem which is compounded by the fact that infants tend to be obligatory nasal breathers. Most frequently such obstruction is associated with non-specific rhinitis, episodes of which are fortunately not usually severe, are of short duration, and respond to conservative measures such as instillation of saline or sodium bicarbonate solutions and aspiration of secretions. This latter manoeuvre is awkward at the best of times but is said to be made easier by using a small bulb syringe. Sometimes addition of topical decongestants is required to reduce mucosal oedema but use of these should be short term and intermittent and if persistent mucosal swelling is the problem, topic nasal steroids such as beclomethasone should be substituted. However, there are infants in whom obstruction is severe enough to present a difficult management problem, others in whom it is so persistent as to be a significant factor in failure to thrive, and the occasional infant in whom it is life threatening. Disorders that contribute to these states are discussed in this article.