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Prolonged Runny Nose

Last week, a one year child was seen at our office because the child had been having runny nose for one and half month with bad breath according to the mother. There was no fever. The mother said that their previous doctor attributed the runny nose to teething and frequent RSV.

A child with prolonged runny nose is a common problem that both parents and pediatricians face everyday. And it is not an easy problem to sort out or solve.

The three conditions that clinicians think about when face with a child with runny nose are:  Common cold (URI), Allergy, and Sinusitis.

In the Common cold or URI (viral) the runny nose is usually less than 10 days. The nose discharge can be thin, thick, or whitish. Fever may or may not be present. In older children, headache, facial pain, or tooth ache are sometimes present. Coughing, nose congestion, and sneezing are frequently present.

In Allergy, the runny nose can vary from few days to longer than 10 days. The nasal discharge is usually clear, thin, and watery. Fever is absent. In older children, usually there is no headache, facial pain, or tooth ache. Coughing, nose congestion, and sneezing can be present sometimes.

In Sinusitis (bacterial) the runny nose is longer than 10 days. The nose discharge can be thick, yellow-green. Fever is sometimes present. In babies and young children, they sometimes rub their eyes. Sometimes there is eye discharge and slight redness of the conjunctiva. Occasionally, some children have slight swelling of the lower eye lids. In older children, headache, facial pain, and tooth ache are sometimes present. Bad breath can be appreciated in both young and older children at times. Nose congestion is always present. Coughing at night is frequent. Sneezing is absent.

Sometimes one sided chronic runny nose especially with bad breath is an indication of a foreign body.

According to the combined Task force of the American Academy of Pediatrics (AAP) and the Center for Disease Control and Prevention (CDC), should have these characteristics:

   One: Prolonged nonspecific upper respiratory signs and symptoms (cough and nasal drainage) without improvement for more than 10 to 14 days.

   Two: More severe upper respiratory tract signs and symptoms (fever, facial swelling, facial pain.)

To Be Continued ...

Leo Leonidas, MD, FAAP, Assistant Clinical Professor in Pediatrics, Tufts University School of Medicine, Boston; Attending Pediatrician, Eastern Maine Medical Center, Bangor, Maine

I wrote and designed this web site for parents of our practice. Before you use ideas from this web site, please discuss it first with your clinician if you are not with our practice.

copyright Leo Leonidas 2002

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