Nasal Obstruction in Children — Causes, Symptoms and What to Do

What is nasal obstruction and why does it occur in children

Nasal obstruction refers to the partial or total blockage of airflow through one or both nostrils. In children, this problem is particularly common due to anatomical particularities: the nasal cavities are smaller, the mucosa is more reactive, and the immune system is still maturing.

Unlike adults, young children do not know how to blow their nose effectively, which means nasal obstruction significantly affects their sleep quality, feeding, and general well-being. In infants, breathing is predominantly nasal, so any obstruction can cause significant difficulties with breastfeeding.

Common causes of nasal obstruction in children

Viral infections of the upper respiratory tract

The common cold (acute rhinopharyngitis) is the most frequent cause of nasal obstruction in children. A healthy child may experience between 6 and 10 episodes of viral infection per year, especially if attending daycare or school. Symptoms include rhinorrhea (nasal discharge), sneezing, and nasal congestion that usually lasts 7-10 days.

Adenoid vegetations (adenoids)

Adenoid vegetations are formations of lymphoid tissue located in the nasopharynx (back of the nose). In children between 2 and 7 years of age, they can increase in size and partially or completely block the airway. Hypertrophic adenoid vegetations represent one of the most common causes of chronic nasal obstruction in young children.

Allergic rhinitis

Nasal allergy can begin from the age of 2-3 years and presents with nasal obstruction, repeated sneezing, nasal pruritus (itching), and watery nasal discharge. The child frequently rubs their nose (allergic salute) and may have dark violet circles under the eyes.

Sinusitis

In young children, the paranasal sinuses are not fully developed, but ethmoidal and maxillary sinusitis can appear from the first years of life. Sinusitis presents with persistent nasal obstruction, purulent nasal discharge (yellowish-green), productive cough especially at night, and sometimes fever.

Other causes

• Nasal septal deviation — can be congenital or post-traumatic
• Nasal foreign bodies — common in children between 2 and 5 years who insert small objects into their nose
• Nasal polyps — rare in children, but possible in the context of cystic fibrosis or severe allergies
• Inferior turbinate hypertrophy — often occurs secondary to allergies or repeated infections

Symptoms of nasal obstruction — How to recognise the problem

Not all children can verbally express that their nose is blocked. Therefore, it is important to watch for the following signs:

• Mouth breathing — the child keeps their mouth open during the day or during sleep
• Nocturnal snoring — regular snoring, especially in young children, is not normal
• Halitosis (bad breath) — occurs due to mouth breathing and drying of the oral mucosa
• Restless sleep — the child wakes frequently, changes positions, sweats excessively
• Feeding difficulties — the infant frequently stops sucking to breathe
• Nasal voice — the child speaks "through their nose"
• Nocturnal cough — caused by postnasal drip

Mouth breathing in a child is not simply a habit. It is a sign that there is a nasal obstruction that needs to be investigated and treated. In the long term, mouth breathing can affect craniofacial development, dentition, and sleep quality.

What you can do at home — Proper nasal hygiene

Nasal hygiene with saline solution is the first step in managing nasal obstruction in children, regardless of the cause. When performed correctly and consistently, it helps to:

• Remove secretions and allergens from the nasal cavities
• Moisturise the nasal mucosa
• Reduce local inflammation
• Prevent complications (otitis, sinusitis)

For a detailed guide on how to properly perform nasal hygiene according to the child's age, see the article How to properly clean your child's nose — A practical step-by-step guide.

Other helpful measures at home

• Humidify the air in the room — a cool mist humidifier helps during the cold season
• Slightly elevate the head of the bed — promotes nasal drainage during sleep
• Ensure adequate hydration — fluids thin nasal secretions
• Avoid cigarette smoke — a strong irritant for the child's nasal mucosa

When you should see an ENT specialist

Consult an ENT specialist if you notice:

• Nasal obstruction persisting for more than 10-14 days
• Regular snoring or breathing pauses during sleep (apnoea)
• Purulent or foul-smelling nasal discharge, especially unilateral
• Repeated nosebleeds
• Exclusive mouth breathing during the day
• Recurrent middle ear infections or hearing loss
• Persistent fever associated with nasal symptoms

The ENT specialist can perform a nasal endoscopy to directly visualise the nasal cavities and nasopharynx, precisely determining the cause of the obstruction. Based on the diagnosis, appropriate treatment will be recommended, which may be medical or, in selected cases, surgical (for example, adenoidectomy).

Conclusion

Nasal obstruction in children is a common problem that should not be neglected. Early identification of the cause and appropriate treatment prevent complications and ensure normal development of the child. Regular nasal hygiene is essential, but if symptoms persist, consultation with an ENT specialist is recommended.