You know what’s Snot cool? Boogers!
No More Worries Blog
Written by: Kelly Cotaleen Todd CPNP, AC/PC
So. Much. Snot! We all know it, we hate it, how can we help our babes through it? What is it you ask? The dreaded Upper Respiratory infection, AKA the cold. There are many different varieties of viruses that cause colds, such as Respiratory Syncytial Virus (RSV), Human Metapneumovirus, Rhinovirus/Enterovirus and many more. Bottom line, the name is not as important as the symptomatic care, what to do, and when to seek care.
I want to remind you my response was formed by many years of training with physicians, and extra in-services by specially trained Pediatric Ear, Nose and Throat (ENT) physicians as well. If your child has received care contrary to my teaching, it doesn’t necessarily mean it was wrong, medicine is an art we all paint with a different brush. If you ever feel your provider is guiding you in a direction you are not agreeing with or do not feel comfortable with, it’s your job as a parent to challenge the provider gently, and respectfully, even if that provider is me. We know from several studies the more antibiotics a child has prior to age 3 the higher the chance of their gut microbiome being disrupted, subsequently affecting their brain development, causing learning issues, ADHD, and so on. Therefore, I am very strict with antibiotic use in my personal practice. Here is a link to one of the many studies.
The Basics
Snot, boogers, mucus, rhinorrhea, congestion, whatever you call it, everyone and everyone’s children have experienced it. Mucus build up in the nasal/sinus cavity is caused from irritation such as allergies or viruses. Everyone’s sinus cavities develop over time as they grow. The Ethmoid (behind nasal bridge), and Maxillary (cheek bones) are what we are born with, and they start very small and grow with us. Over time closer to age 8 years the frontal sinus develops (forehead) and finally the sphenoid in our teen years (sits behind the ethmoid). That being said, the tiny little ethmoid and maxillary sinuses don’t have enough room for mucus to sit in one spot long enough to get a true bacterial sinus infection like in older kids, teens and adults, especially when you are frequently clearing them. Sinusitis infections occur when mucus has sat in those passages 10-14 days and started to grow a bacteria causing pain, pressure, sometimes fever and dizziness. Good news is in any age you can prevent this by doing sinus rinses.
It is also important to mention infants are what medical providers call obligatory nose breathers, meaning they only know how to breathe through their nose. This is all part of their normal growth process. However, if you see your baby mouth breathing, you should bring it up to their provider for further investigation. Just one more another reason it’s so important to keep their nasal passages clear of mucus!
With that anatomy lesson down, I wanted to also touch base on one more thing, the color of nasal mucus. Contrary to popular belief, the color of nasal mucus, AKA snot, does not correlate to what type (viral vs bacterial) of infection one has. The color of snot changes due to the number of enzymes and cells in the mucus. Here is a link to a great article further explaining mucus color.
The Down and Dirty and the how
Ok, I know I’m ready for remedies, how about you?
Snot removal, we know it, we have a love/hate relationship with it! Boogers are babies worst enemy, when their tiny nasal passages are clogged with snot, they do not realize they can open their mouths to breathe, so they start breathing harder and faster to compensate. So, we need to remove it for them, frequently and effectively.
There are a lot of different booger suckers (nasal aspirators) on the market today, some more effective than others. Some work with self-suction such as the old school bulb syringe, some self-suction with the parents using their own suction power, and some are automatic. There are a huge variety on the market to choose from, just find one that works best for you and your family. Once you have chosen your weapon, I mean tool, grab some nasal saline before leaving the store. In terms of nasal saline, I prefer the kind that comes in an aerosolized can, as it has more power behind the spray, as with most things you can get the cheapest generic version and it will work perfectly. You can also make your own with warmed distilled, bottled or cooled boiled water and a saline packet you can purchase. Once all supplies are gathered grab that booger baby!
I’m going to link a few YouTube videos on a couple different versions of nasal aspirator use and then go over additional tips and tricks.
Bulb Syringe Style nasal aspirator
I like this video because it shows baby upright so gravity can help. In this position you can also use your head and shoulder to steady baby’s head, and your other arm to hug baby tight. If you have two people available, you can have one hold and one do the saline and suctioning which is obviously easier. Single person use I would suggest spraying the aerosolized saline into each nostril for a few seconds and then suctioning each side several times.
I love this video! This is the goal with sinus rinsing for adults through infancy. I did a search on Amazon for “syringe tip for sinus rinse” and was able to find a similar device to what she uses in the video. You can use boiled tap water cooled and add a saline packet to 8 oz of water, or warm bottled/distilled water with a saline packet works as well. Water should be just warm to touch. You can use this on any age, you will just need to support younger babies more than independent sitters. The trick is to lean them forward. This method can be used up to 3 times daily during sick days, with regular nasal aspiration in between. This style helps really rinse all the germs out and soothes the inflamed mucosa. Another thing that I find very helpful is saline rinse with added Xylitol. This is an all-natural product safe for all ages that helps decrease viral and bacterial load in the nasal/sinus passages and is very soothing, so when available opt for that instead of plain saline packets.
This is like the first one but with different products and a fun French accent! I would not recommend squirting saline in the baby’s mouth like they do in the end. However, I would follow up with an empty bulb syringe suction to both nostriles to get the remaining mucus out.
The when
Now that we discussed some versions of how to clear the snot out of baby’s nose, I wanted to discuss the when. It’s important to clear baby’s nose when you think you hear wheezing, you see them flaring their nostrils and or pulling in the skin around their ribs when breathing and breathing faster than normal with a lot of boogers. You should do this with colds at least prior to feedings, and sleep time. The big sinus rinses can be done morning, noon and bedtime, followed by simple nasal aspiration in between with the aerosolized saline to aid in loosening stubborn boogers. If you hear a cough and/or wheezing noise and do not see any boogers draining out of nose, often this can mean it’s draining back down the throat so it’s important to attempt a sinus rinse/suction at that time as well.
Other natural remedies
There are a few different brands that offer natural remedies for infant/child colds. Always avoid anything containing Honey in babies under 12 months, Honey can have botulism in it and children under a year of age do not have the ability to fight it off like older children/people do. Most of the all-natural remedies for under 12 months contain Agave and Ivy leaf extract, over 12 months contains Honey and Ivy Leaf extract. These are all safe and can be effective in some cases. They are worth a try. Please read and follow age recommendation on the box of any remedy or medications. There are no safe cough/cold medications for children under age 4 years regardless of dose.
When to seek care
Ok, so you have been busy clearing, suctioning, rinsing all the boogers out of your baby’s nose and you notice they are having fewer wet diapers than normal, feeding for shorter periods of time on breast, or taking less ounces in bottles. Something that helps in terms of feeding infants with a lot of boogers is increasing frequency and decreasing volume of bottles. So, if baby usually takes 4 oz every 3-4 hours, decrease to 2 oz every 2-3 hours, and see if they are tolerating that better. Breast fed babies tend to self-regulate well, you may just have to offer the breast more frequently to ensure they are staying hydrated. Your goal is at least one wet diaper every 6-8 hours at the very bare minimum, ideally, we like to see 6-8 wet diapers in 24 hours so make sure you keep track to tell your provider.
If you have done the frequent suctioning and baby is still working hard to breathe, flaring their nostrils, pulling in at their ribs and has a decreased intake of fluids please get seen by a pediatric provider. Some babies require a little extra support in terms of pressurized air into their nostrils to decrease their work of breathing for a short time during a severe respiratory illness.
I do not recommend any sort of home oxygen monitoring of babies with no previous chronic oxygen use at home. The number you see on that monitor is not nearly as important as how your baby looks and how hydrated they are staying. If your baby has a home oxygen reader and you see 88% while they are sick, sleeping and they are not working hard to breath and have had good intake and wet diapers, I suggest you remove the monitor and take a nap yourself. 😉 These monitors can cause unnecessary alarm and panic and unnecessary hospitalization, in my opinion. Technology is amazing and I love advancements to care and monitoring, but we need to remember the basics first, to assess the patient (your child). Is your child pink around their lips/mouth, fingernails and not blue? Is your child comfortably breathing, drinking well enough to pee every few hours? Then keep on keeping on. Touch base with your provider to let them know they have a URI after a few days of increased suctioning, and always get them seen in person with increased work of breathing and/or decreased wet diapers. If they have a fever please refer to my previous blog on fevers here.
No worries takeaways:
- Sinus cavity development is slow, they start out with less and smaller than adults
- Saline sinus rinses can help your child breathe easier throughout illness and prevent bacterial formation
- Increase frequency of feedings and decrease volume of bottle-fed infants, breast fed infants increase frequency of offered feedings
- Touch base with your provider after a few days on increased boogers, or with increased work of breathing not relieved with suctioning
