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Are Nasal Sprays Safe For Kids?

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Nasal sprays are often used for children with decongest the nose and provide them relief from the blockage. There are various types of nasal decongestant sprays with different medications, available at pharmacies as over-the-counter (OTC) drugs.

However, with any medicine that is used for children, it is good to consult a doctor about the nasal sprays too. In this post, we tell you about the types, safety, mode of administration, benefits, and side effects of nasal sprays for kids.

What Is Nasal Congestion?

Nasal congestion is a condition characterized by difficulty in breathing due to the blocked nasal passages. It is also called nasal obstruction. Nasal congestion can occur due to various reasons. Rhinorrhea (runny nose) is one of the common causes (1).

Any inflammation in the nasal lining can also cause nasal congestion. Inflammation leads to swelling of the blood vessels in the nasal lining, thus reducing the space within the nasal airway and making it difficult to breathe (1).

The following are common causes of nasal obstruction (1) (2):

  1. Viral or bacterial infections
  2. Seasonal allergies like those in the flu season
  3. Common cold and flu
  4. Infections of sinuses and adenoids
  5. Allergic rhinitis
  6. Non-allergic rhinitis
  7. Pollution
  8. Chemical irritants such as perfume or tobacco smoke
  9. Deviated nasal septum
  10. Some medications
  11. Certain medical conditions like nasal polyps, nasal cysts, and tumors

What Is A Nasal Spray?

Nasal sprays are solutions or suspension of medicines used for the local administration of a drug by spraying it into the nostrils.

Depending on the underlying condition, the doctor may prescribe a nasal spray that may contain steroids, antihistamines, mast cell inhibitors, or other compounds.

Are Nasal Sprays Safe For Children?

The American Academy of Pediatrics (AAP) recommends against using OTC cough and cold medicines for children. Instead, it recommends saline nasal drops, among various other safe treatment modalities (3).

Saline nasal drops or saline spray is usually considered to be safe for kids (4). The Calpol saline nasal spray is one such commonly used brand. However, it is good to consult a doctor before using any saline nasal spray.

Oxymetazoline nasal sprays are not recommended for children under the age of six years unless prescribed by the doctor. The spray should also be used as per doctor’s prescription (5).

Nasal sprays for kids are usually recommended to be used as a single dose per day.

Types Of Nasal Sprays

The following are the different types of nasal sprays available for congestion (6) (7).

1. Nasal steroid sprays

They are often the first line of therapy for allergies and work by decreasing inflammation of the nasal passages. Most of them are available over-the-counter, but it is recommended to use them only as suggested by the doctor. Do not use them beyond the permitted time.

In the case of nasal allergies of the nose, such as hay fever or long-standing rhinitis, the doctor might prescribe a steroid nasal spray. Local application of steroids in the form of the nasal spray works well by reducing the inflammation in the nose (8).

The following drugs are usually present in the nasal steroid sprays:

  • Flunisolide
  • Fluticasone Propionate
  • Ciclesonide
  • Budesonide
  • Beclomethasone Diproprionate (dry nasal spray)

2. Nasal antihistamine sprays

These sprays are usually prescribed for allergies and mostly used for runny nose. They often leave a bitter taste in the mouth after administration.

The following drugs are present in the antihistamine sprays.

  • Azelastine
  • Olopatadine

3. Anticholinergic nasal sprays

Used for treating runny nose in children with both allergic and non-allergic rhinitis, the medicine reduces nasal discharge but may cause dry mouth and bad taste. Ipratropium Bromide is the commonly used drug in anticholinergic nasal sprays.

4. Mast cell inhibitors

Cromolyn sodium is a mast cell inhibitor and helps in reducing symptoms of nasal congestion, sneezing, and runny nose. Nasal burning and a bad taste in the mouth are the commonly seen side effects.

5. Nasal saline sprays

These are commonly available and are relatively safe for children. However, consult a doctor before buying any OTC saline drops since they may contain added medicines.

Do not use any non-prescription drugs or sprays for your kids. Use a prescribed nasal spray as per doctor’s prescription. Extended usage beyond the prescribed duration can cause complications.

How To Administer Nasal Spray To Kids?

Parents can follow these steps while administering nasal spray to children (9).

  • Wash your hands.
  • Shake the bottle well before use.
  • Get your child in the correct position by making them sit with their head tilted back. Alternatively, the child can lie on the floor and keep their head tilted back. If needed, place a pillow under the child’s neck to make it easier for them to tilt their head.
  • You may wrap younger kids in a blanket or a sheet to keep their hands and feet still. You may also take the help of someone to hold the child in position.
  • Spray the recommended quantity of nose spray by aiming the nozzle towards the outer wall of the nostril. Clean any excess medicine outside the nose with a tissue.
  • Let the child remain in the same position for a few minutes.
  • Tightly cap the bottle of the spray and keep it safely away from the child’s reach.

If your child’s doctor recommends an alternative method of administration, follow their instructions.

Read all instructions on the spray and the ones given by the doctor before administering the spray. Be gentle while inserting the nozzle into the nose to prevent any injuries. Talk the child through the process to make them more comfortable and compliant.

Side Effects Of Nasal Spray For Children

The following are the possible side effects of nasal sprays in kids (10).

  • Medication dripping down the throat and causing throat irritation
  • Bad taste
  • Dry nose
  • Nosebleeds
  • Headache
  • Burning sensation

Bitter taste and medicine dripping down the throat can be managed by keeping the child in the correct posture when administering the nasal spray.

Nasal sprays usually do not have any side effects. However, if the child develops allergic symptoms such as rash, itching, breathlessness, swelling, severe dizziness, or nosebleeds, or any other unusual symptoms, then discontinue the use and contact your healthcare provider.

Can Allergic Nasal Sprays Affect A Child’s Growth?

A few studies have been done to check the effects of nasal decongestant sprays on skeletal growth and adrenal activity. One randomized control study done on a group of children using mometasone steroid nasal spray for a year showed no adverse effect on their skeletal growth (11).

Another study conducted over a long period concluded that nasal corticosteroid did not affect the growth of kids, who used it over a period of three years (11). However, research on about 90 children of the age group of six to nine years yielded different results. They were treated with a steroid called beclomethasone and showed suppressed growth when compared to children who were not taking the drug (11).

There are mixed results regarding the use of steroid-based nasal sprays for children. Therefore, these medicines should only be used under medical supervision and only for the prescribed period. Your child’s pediatrician will weigh the risks versus the benefits before prescribing these sprays for any underlying medical conditions.

References:

1. Nasal Obstruction; Stanford Children’s Health
2. Congestion, Stuffy Nose, & Nasal Obstruction; Medical University Of South Carolina
3. Take Care with Nasal Sprays; University of Rochester Medical Center Rochester
4. Use Caution When Giving Cough and Cold Products to Kids; U.S. FOOD AND DRUG ADMINISTRATION
5. Oxymetazoline Nasal Spray; US National Library Of Medicine
6. AAAAI ALLERGY & ASTHMA MEDICATION GUIDE; American Academy of Allergy, Asthma & Immunology.
7. You Want Me To Spray What Up My Nose?;  The American Academy Of Otolaryngic Allergy
8. HOW TO USE A NASAL SPRAY – FOR CHILDREN; The National Health Service
9. How to give your child nose drops or spray – video podcast; Great Ormond Street Hospital For Children
10. Eli O. Meltzer et al, Burden of allergic rhinitis: Results from the Pediatric Allergies in America survey; the Journal Of Allergy and  Clinical Immunology
11. DENISE K. SUR, MD, and STEPHANIE SCANDALE, Treatment of Allergic Rhinitis; American Family Physician

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