The runny nose, cough, headache, fever and discomfort of acute sinusitis can be tough on your child — and on you as parents.
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The first thing many parents think of? Get the kid some antibiotics.
But sometimes antibiotics aren’t appropriate. Diagnosing bacterial sinusitis in children can be difficult. The symptoms may not be from bacterial sinusitis but from a viral illness or even from an allergy.
- New guidelines give pediatricians more options
- New guidelines allow more leeway before antibiotic therapy
- Parents and pediatricians can work together
- AAP Releases Guideline on Diagnosis and Management of Acute Bacterial Sinusitis in Children One to 18 Years of Age
- Causes of sinusitis
- Sinusitis symptoms
- Does your child need to see a doctor about sinusitis?
- Tests for sinusitis
- Sinusitis treatment
- Child-Friendly Natural Remedies for Sinus Infection Symptoms
- 1. Take Your Child Into a Warm Shower to Help Ease Congestion
- 2. Breathe in Essential Oils for Calming Relief
- 3. Try Nasal Irrigation to Wash Out Sinus Passages
- 4. Saline Spray Bottles Are More Kid-Friendly Than Neti Pots
- 5. Consider Nose Strips to Ease Breathing in Older Kids
- 6. For Long-Term Respiratory Health, Improve Your Child’s Diet and Eating Habits
- 7. Consult a Doctor if Home Remedies Don’t Help Sinus Symptoms
- How to Help Relieve Your Young Child’s Sinus Infection
- Sinus Pain
- Can Kids Use Neti Pots?
- Steps to Successful Children’s Nasal Irrigation Ages 2-3 Years Old
New guidelines give pediatricians more options
There is growing concern that antibiotics are over-prescribed and sometimes unnecessary. Antibiotics can cause side effects such as upset stomach and diarrhea, but the greater fear is the chance the child will develop antibiotic resistance.
Now there are a new set of guidelines from the American Academy of Pediatrics to help pediatricians diagnose sinusitis and determine when antibiotics are warranted, recommending an additional few days of watching and waiting. Sinusitis will often resolve on its own.
Kim Giuliano, MD, did not help develop the guidelines but is a pediatrician at Cleveland Clinic Children’s.
“What’s new about these guidelines is they also give us the option — if the symptoms aren’t too severe — to wait a few more days before starting antibiotics,” says Dr. Giuliano.
New guidelines allow more leeway before antibiotic therapy
The guidelines are updates from those developed in 2001 that stated a diagnosis of bacterial sinusitis could be made when a child with an acute upper respiratory infection has symptoms lasting more than 10 days. Or it could be diagnosed if the child has a severe onset of symptoms including fever and nasal discharge lasting at least three days in a row.
The 2001 guidelines recommended antibiotic therapy for all children diagnosed with bacterial sinusitis. The updated, 2013 guidelines allow doctors to observe children with persistent illness lasting more than 10 days for an additional three days before making the decision to start antibiotics.
Parents and pediatricians can work together
Dr. Giuliano says parents and pediatricians should work together on the decision to start a child on antibiotics or let the infection takes its course, keeping the child more comfortable through home treatment and milder medications.
“If the parents have concerns and think the child may potentially need antibiotics, by all means bring them to the doctor’s office,” says Dr. Guiliano. “We may or may not decide to do antibiotics. But it’s always good to have kids checked if parents have concerns.”
AAP Releases Guideline on Diagnosis and Management of Acute Bacterial Sinusitis in Children One to 18 Years of Age
Acute bacterial sinusitis can be diagnosed in children with an acute upper respiratory infection that persists (nasal discharge or daytime cough for more than 10 days with no improvement), that gets worse (worsening or new nasal discharge, daytime cough, or fever after improving at first), or that is severe (concomitant fever of at least 102.2°F and purulent nasal discharge for at least three consecutive days).
Plain radiography, contrast-enhanced computed tomography, magnetic resonance imaging, and ultrasonography should not be performed to differentiate acute bacterial sinusitis from viral upper respiratory infection. However, contrast-enhanced computed tomography of the paranasal sinuses or magnetic resonance imaging with contrast media should be performed in children thought to have orbital or central nervous system complications. The most common orbital complications of acute bacterial sinusitis involve children younger than five years who have ethmoid sinusitis. These complications should be suspected in a child with a swollen eye, especially if there is also proptosis or if extraocular muscle function is impaired. Intracranial complications (e.g., subdural and epidural empyema, venous thrombosis, brain abscess, meningitis) are less common, but more serious, and have higher morbidity and mortality rates than orbital complications. These complications should be suspected in a child with a severe headache, photophobia, seizures, or other focal neurologic findings.
Antibiotics should be prescribed in children with severe, worsening, or persistent acute bacterial sinusitis. Outpatient observation for three days is also an option in children with persistent illness. Amoxicillin alone or in combination with clavulanate is the first-line antibiotic choice. Intravenous or intramuscular ceftriaxone (Rocephin), 50 mg per kg once, can be given to children who are vomiting, who cannot take oral medications, or who are not likely to take the initial antibiotic doses as prescribed. After clinical improvement, the treatment can be changed to oral therapy. Children with hypersensitivity to amoxicillin (type 1 and non–type 1) can be treated with cefdinir (Omnicef), cefuroxime (Ceftin), or cefpodoxime. Surveillance studies have shown resistance of pneumococcus and Haemophilus influenzae to trimethoprim/sulfamethoxazole and azithromycin (Zithromax), indicating that they should not be used to treat acute bacterial sinusitis in persons with penicillin hypersensitivity. Recommendations regarding the optimal duration of treatment vary from 10 to 28 days. Alternatively, it has been recommended that patients be treated for seven days after symptoms subside, which provides for individualized treatment, at least 10 days of treatment, and avoiding continued treatment in asymptomatic patients.
If acute bacterial sinusitis is confirmed in a child whose symptoms are getting worse or who is not improving after 72 hours, the antibiotic may be changed (if the child is already taking an antibiotic) or started (if the child is being observed). If a parent indicates that the child’s illness is getting worse (initial signs or symptoms progressing, or new signs or symptoms occurring) or not improving (signs and symptoms persist) after 72 hours of treatment, management decisions should be reevaluated.
There are no recommendations regarding adjuvant therapy for acute bacterial sinusitis, although intranasal corticosteroids, saline nasal irrigation or lavage, topical or oral decongestants, mucolytics, and topical or oral antihistamines may be options. One Cochrane review found no appropriately designed studies to establish the effectiveness of decongestants, antihistamines, and nasal irrigation for acute sinusitis in children.
Only a few high-quality studies on the diagnosis and treatment of acute bacterial sinusitis in children have been published since the 2001 guideline was released. Therefore, evidence on which to base recommendations is limited, and further research is needed in many areas.
Causes of sinusitis
Sinusitis is an inflammation of the sinuses around the nose and forehead.
Sinusitis can be caused by an infection or allergy. In children, it’s most likely to be a viral infection, which can become a bacterial infection.
Children with a family history of allergy are more likely to develop sinusitis.
Sinusitis is more common in older children and adults than in babies and younger children.
The sinuses are the little spaces or hollows between the bones of your skull and face. They’re all connected up, and they’re also connected by small tubes to the passages inside your nose.
If your child has sinusitis, she’ll have thick, green mucus coming out of her nose. There might be nasal fluid running down the back of her throat. This is called ‘post-nasal drip’. It might cause irritation and coughing.
Your child might feel pressure or congestion over the area of an infected sinus.
Pain and swelling are common symptoms too, especially under the eyes. Pain is usually worse on one side of the face.
Your child might also have a fever and bad breath.
Does your child need to see a doctor about sinusitis?
Yes. You should take your child to the GP if your child has:
- symptoms of sinusitis
- fever, or is generally unwell with no apparent cause
- a cough
- neck stiffness and a headache
- eye swelling during or after a bad cold.
If your child has sinusitis for a long time, or keeps getting it, he needs to see the GP.
Tests for sinusitis
Most children don’t usually need any tests to diagnose sinusitis.
If your child suffers from regular sinusitis, your GP might send her for an X-ray or a CT scan of her face to see whether the condition is chronic.
Antibiotics (usually penicillin) are the most common treatment for sinusitis.
Paracetamol in recommended doses can help ease any pain from the sinusitis.
Normal saline nasal drops or washes can help with congestion.
There’s no evidence to show that decongestant sprays, corticosteroids or antihistamines help with sinusitis.
Child-Friendly Natural Remedies for Sinus Infection Symptoms
Kids may respond better to a saline spray than a neti pot for flushing out sinuses. Andy Shell/
It’s hard to watch your child suffer with a stuffed nose and facial pain when their sinuses are inflamed. You might feel the impulse to visit the pediatrician to get an antibiotic prescription, especially if the discharge coming out of their nose is thick and pus-filled.
But in most cases, it is better to stifle that “see the doctor” impulse.
Antibiotic Drugs Probably Won’t Help Your Child’s Sinus Infection
“Parents often think their child has a bacterial sinus infection, but the majority of the time the pain and discharge are caused by a virus, which antibiotics don’t treat,” says Barbara Rolnick, MD, a pediatrician at the Children’s Hospital of Philadelphia Primary Care Practice Network.
That’s why doctors are often reluctant to prescribe antibiotics right away. The guidelines pediatricians follow say in most circumstances it is equally effective to wait several days to see if the sinus problem improves on its own as it is to write an Rx. And avoiding unnecessary antibiotics, and the subsequent increase in antibiotic-resistant germs, is good for your child.
Don’t Give Your Child a Decongestant Drug, Either
Reaching for drugstore products to relieve your young child’s discomfort should also be avoided, researchers now say. A study published in October 2018 in the British Medical Journal found there is no evidence that commonly used decongestants do anything to help nasal symptoms in children. The authors say kids under age 6 should never be given these medicines, while those 6 to 12 should take them with caution because any benefit might be outweighed by side effects like upset stomach or drowsiness.
So what actually does work? Not much has been proved scientifically, the BMJ study found. But pediatricians say their experience shows home remedies often ease your child’s discomfort until the immune system clears it up.
1. Take Your Child Into a Warm Shower to Help Ease Congestion
Because steam moistens the sinus passageways, which both helps your child feel better and may cause mucous clumps to pass, warming up your child’s sinus passages is a wonderful treatment, Dr. Rolnick says.
Rolnick doesn’t recommend leaning over a pot of steaming water as adults sometimes do, because the child might touch or knock over the water and get burned. Instead, she suggests placing the child in a warm shower, accompanying them if the child is young.
An alternative is to have your child lie on the bed while you place a warm washcloth over their nose and cheeks. The best way to heat up the washcloth is to run it under warm water, then squeeze the liquid out. Have a second washcloth handy so you can replace it as it cools.
2. Breathe in Essential Oils for Calming Relief
Although the BMJ review says there is no scientific confirmation that inhaling oils improves sinus inflammation, many children find oil of eucalyptus does help them breathe, Rolnick says.
You never want to put essential oils directly on the skin. Instead, place a few drops of eucalyptus oil on a ball of cotton (you can also add a drop of lavender or other relaxing oils) and hold it a few inches from your child’s nose.
3. Try Nasal Irrigation to Wash Out Sinus Passages
Nasal irrigation is the only remedy where there is evidence in children that it lessens the severity of a plugged nose, although the authors of the BMJ review note the studies were small.
Irrigation is a method of using a sterilized saltwater solution to force out germs and plugged-up mucous residing in the sinus passages. Other terms for this are “nasal wash” or “nasal douche.”
Adults sometimes get the water into the nose via a device called a neti pot, so this method is sometimes known by that name.
4. Saline Spray Bottles Are More Kid-Friendly Than Neti Pots
However, most children do not like the sensation of the neti pot, so it’s best not to use the device with them. A saline spray bottle, or, for very young children, an eyedropper, is best, Rolnick says. Fine mist saline sprays from brands such as Simply Saline and Little Noses are sold in most drugstores.
Alternatively, you can make your own solution. Begin by buying water labeled “distilled” or by boiling tap water for three to five minutes, then cooling to room temperature. This will avoid the rare possibility of introducing a parasite into your child’s sinuses.
The American Academy of Allergy, Asthma & Immunology suggests this recipe: Mix 1 cup of the cool sterilized water with 3 teaspoons (tsp) of non-iodide salt (iodide may irritate the nasal lining), and 1 tsp of baking soda.
Fill the spray bottle or eyedropper with the liquid and either squirt it into your child’s nose or lie your young child on the back and drip the liquid in. Keep tissues nearby to catch the liquid after it drains out.
5. Consider Nose Strips to Ease Breathing in Older Kids
Although Rolnick says even older children typically pull off those drugstore nose strips as soon as you place them on, when they do stay on they open the passageways enough to help your child breathe easier.
If you have an older child you think might allow the strips to remain, especially when they are sleeping, this could be worth a try.
6. For Long-Term Respiratory Health, Improve Your Child’s Diet and Eating Habits
Many kids are finicky eaters, passing the day with crustless PB&J or fish-shaped crackers. But a healthy, varied diet is crucial for allowing the body to mount the best immune defenses, Rolnick says. You may not be able to get your child to eat their veggies in the midst of their sinus flare-up, but once the child feels better, this is something to work on.
Similarly, ensure that your child drinks enough healthy liquids, which not only aids the immune system, it keeps their sinuses lubricated. Because many children have only periodic access to water during day care or school, be sure to give them plenty of water or milk during breakfast and after school at home, and pack a water bottle (not sweetened juice drinks) in their lunch.
7. Consult a Doctor if Home Remedies Don’t Help Sinus Symptoms
If symptoms persist without improvement for more than 10 days, you should consult your pediatrician.
You should also call the doctor before that time if your child’s sinus pain is accompanied by fever and a discharge for several days, or if their symptoms significantly worsen. In these cases, antibiotics may be appropriate.
How to Help Relieve Your Young Child’s Sinus Infection
When your child’s cold has lasted the better part of two weeks and doesn’t seem to be getting any better, he may have a sinus infection. Because sinuses aren’t yet fully developed in young children, sinusitis symptoms are much like those of the common cold: a runny nose, post-nasal drip, a low-grade fever, irritability and fatigue, the occasional daytime cough, a frequent nighttime cough and swelling around the eyes. Your pediatrician can tell you whether your child’s sinus infection is bacterial, which calls for antibiotics, or viral, which does not. In the meantime, here are a few way to help relieve your child’s symptoms.
Adding some humidity to dry air is an easy way to give your child major relief. Because breathing dry air irritates the nasal passage, increasing inflammation and sinus pressure, running a humidifier or vaporizer can ease her symptoms with every breath. Breathing moist air helps calm inflammation and thin mucus, allowing it to drain more easily. Use a cool-mist humidifier for younger children to avoid the potential of scalds or burns that can happen with a warm-mist humidifier. If you don’t have a humidifier, try sitting with your child in the bathroom for several minutes while running a hot shower. Breathing steamy air like this two to four times a day can help relieve congestion.
Unlike older kids, children younger than six years don’t typically experience headaches when they have a sinus infection, simply because their sinuses are still relatively small. That doesn’t mean that holding a warm compress across the bridge of your child’s nose and cheeks won’t help — it can relieve pressure from ongoing congestion and help loosen mucus. If your child feels achy or has a fever that makes her uncomfortable, the age-appropriate dose of acetaminophen or ibuprofen can ease her pain and help her feel less irritable. A pain reliever isn’t necessary, however, if your child doesn’t seem to be uncomfortable or experiencing any discomfort from their symptoms.
If you’ve ever had a bad cold or a sinus infection, you may know how just how comforting a cup of hot tea with honey can be. Warm liquids may provide immediate relief for a sore throat, and help thin and loosen mucus in the process. Although young children shouldn’t have hot drinks, a warm cup of tea or a small bowl of clear broth can have the same effect. If your child isn’t interested in a warm drink, don’t fret — cold liquids like ice water or juice can be just as soothing on his throat. More importantly, getting enough to drink will help him stay hydrated and prevent his mucus from getting thicker.
It’s only natural to want to give your child an over-the-counter (OTC) cough or cold medicine when her cough gets worse at night, or her congestion makes it hard for her to breathe. But OTC cough and cold medicines aren’t recommended for any children under the age of four, and some pediatricians don’t recommend giving them to children younger than six. For a child who’s too
young for traditional OTC cough medicines, concentrate on doing the things that help keep her mucus flowing, like running a humidifier and promoting hydration. If your child is old enough to take an OTC cough or cold medicine, get a green light from your pediatrician first, and follow dosing instructions exactly.
- American Academy of Otolaryngology—Head and Neck Surgery: Pediatric Sinusitis
- Stanford Children’s Health: Sinusitis in Children
- Kids Health: Sinusitis
- Kids Health: When Sinuses Attack!
- HealthyChildren.org: The Difference Between Sinusitis and a Cold
- Medline Plus: Sinusitis
- Centers for Disease Control and Prevention: Symptom Relief
- What You Should Know About Sinus Congestion:
- Sinus congestion is a normal part of a cold.
- Nasal discharge normally changes color during different stages of a cold. It starts as clear, then cloudy, turns yellow-green tinged, then dries up.
- Yellow or green-tinged discharge. This is more common with sleep, antihistamines or low humidity. (Reason: decrease the amount of normal nasal secretions.)
- Usually, nasal washes can prevent a bacterial sinus infection.
- Antibiotics are not helpful for the sinus congestion that occurs with colds.
- Here is some care advice that should help.
- Nasal Saline to Open a Blocked Nose:
- Use saline (salt water) nose spray (such as store brand). This helps to loosen up the dried mucus. If you don’t have saline, you can use a few drops of water. Use bottled water, distilled water or boiled tap water. Teens can just splash a little water in the nose and then blow.
- Step 1: Put 3 drops in each nostril.
- Step 2: Blow each nostril out while closing off the other nostril. Then, do the other side.
- Step 3: Repeat nose drops and blowing until the discharge is clear.
- How often: Do saline rinses when your child can’t breathe through the nose.
- Saline nose drops or spray can be bought in any drugstore. No prescription is needed.
- Saline nose drops can also be made at home. Use ½ teaspoon (2 mL) of table salt. Stir the salt into 1 cup (8 ounces or 240 mL) of warm water. Use bottled water or boiled water to make saline nose drops.
- Reason for nose drops: Suction or blowing alone can’t remove dried or sticky mucus.
- Other option: use a warm shower to loosen mucus. Breathe in the moist air, then blow each nostril.
- Fluids – Offer More:
- Try to get your child to drink lots of fluids.
- Goal: Keep your child well hydrated.
- It also will thin out the mucus discharge from the nose.
- It also loosens up any phlegm in the lungs. Then it’s easier to cough up.
- If the air in your home is dry, use a humidifier. Reason: Dry air makes nasal mucus thicker.
- Decongestant Nose Spray (Age 12 years or Older):
- Use this only if the sinus still seems blocked up after nasal washes. Use the long-acting type (such as Afrin).
- Dose: 1 spray on each side. Do this 2 times per day.
- Always clean out the nose before using.
- Use for 1 day. After that, use only for symptoms.
- Don’t use for more than 3 days. (Reason: Can cause rebound congestion).
- Decongestants given by mouth (such as Sudafed) are another choice. They can also open a stuffy nose and ears. Side effects: They may make a person feel nervous or dizzy. Follow the package directions.
- Pain Medicine:
- To help with the pain, give an acetaminophen product (such as Tylenol).
- Another choice is an ibuprofen product (such as Advil).
- Use as needed.
- Cold Pack for Pain:
- For pain or swelling, use a cold pack. You can also use ice wrapped in a wet cloth.
- Put it over the sinus for 20 minutes.
- Caution: Avoid frostbite.
- Allergy Medicine:
- If the child also has nasal allergies, give an allergy medicine (such as Benadryl).
- No prescription is needed.
- What to Expect:
- With this advice, the viral sinus blockage goes away in 7 to 14 days.
- The main problem is a sinus infection from bacteria. This can occur if bacteria multiply within the blocked sinus. This leads to a fever and increased pain. It needs antibiotics. Once on treatment, the symptoms will improve in a few days.
- Return to School:
- Sinus infections cannot be spread to others.
- Your child can return to school after the fever is gone. Your child should feel well enough to join in normal activities.
- Call Your Doctor If:
- Sinus pain lasts more than 24 hours after starting treatment
- Sinus congestion lasts more than 2 weeks
- Fever lasts more than 3 days
- You think your child needs to be seen
- Your child becomes worse
Can Kids Use Neti Pots?
If your child suffers from seasonal allergies, you’re familiar with the feeling of wanting to do just about anything to help your kiddo breath easier. When it comes to nasal congestion, could a neti pot be your new secret weapon?
Good news: Experts say neti pots are safe for kids as long as your child’s pediatrician is on board! These teapot-like devices designed to rinse mucus and allergens out of nasal passages can be safe for kids as young as 2, according to the FDA.
RELATED: 5 Ways to Soothe Your Kids’ Seasonal Allergies — For Good
Widely available at drugstores, neti-pot kits come with saline packets that you mix with 4 to 8 ounces of sterile or distilled water. Using tap water to make the solution can cause life-threatening infections, cautions Elizabeth Matsui, M.D., chair of the American Academy of Pediatrics section on allergy and immunology. Let your child watch a YouTube video of another kid using a neti pot so she can see how the solution goes in one nostril and comes out the other one.
RELATED: 8 Home Remedies for Nasal Allergies
- By Kara Thompson
Please read full instructions before use!
The health benefits to regular nasal irrigation for children can be numerous and as long as you keep that nose consistently clean, their allergies, infections and discomfort will be minimal. Unlike chlidren’s nasal spray or the neti pot for children, nasal irrigation for your child is as comfortable as it is effective. However, it might be a bit of an undertaking to teach them how to wash their nose since It can be difficult to get toddlers to do anything they think is suspect. But coming from a mother that has endured the same challenge I can tell you that the effort is absolutely worth it.
Steps to Successful Children’s Nasal Irrigation Ages 2-3 Years Old
- Begin by feeling comfortable using your own nasal wash, so that your child will see and feel your comfort level.
- Next, allow plenty of bathtub play involving the nasal wash bottle allowing your child to get comfortable holding and squirting the bottle.
- The little squirt nasopure bottle is structured much differently than a children’s nasal spray or neti pot and the shape allows you to use it as a fun ‘squirty’ game for you and your child. Suggest, Let’s wash her tummy – squirt! Let’s wash her ears – squirt! Let’s wash her knees – squirt! Let’s wash her nose – squirt! Make this game a nightly routine.
- Once comfortable, slowly and gently add your child’s face parts to your squirty games as you continue to squirt the cheeks, lips, outer nose don’t forget to giggle and laugh with your child, and be sure to avoid the eyes. Be very matter of fact and make it a natural part of the game. Say ‘This is fun!’ Do not say, ‘See, that doesn’t hurt.’
- After your child is comfortable having water in her face, she may want to wipe it off with a wash cloth each time she is squirted, and that’s okay too. It is time to start washing the inside of her nose. Begin with a mild saline solution and a full bottle of warm water. The solution temperature should be the same as the bath water temperature. Keep playing the same games – squirt the baby doll, squirt your child’s belly button, ears, etc. Then say, ‘Let’s wash inside your nose a little, too,’? and ask her to place the tip near her nose and squeeze. She may need a bit of guidance with your hand to make sure the bottle is held correctly but allow her to have all the control. Don’t squeeze the bottle for her. Move right on and say, ‘Let’s wash your big toe -squirt! Giggle! Let’s wash your belly button -squirt! Giggle! ‘Let’s wash your OTHER nose – squirt! Giggle!
- The idea is to keep moving, keep your child distracted and keep it a game. If your child backs away, go back to the point of comfort in the squirty games for several days. Once she is calm and playful, begin advancing the process again, but slower.
- Allow your child to have control by letting her squirt you a lot more. Eventually move back to her ears, nose, forehead, etc. Realize that for naturally fearful children this process may take weeks of two steps forward, one step back progress. Do not become discouraged, but remain upbeat.
- It is important to allow game-playing, rewards, clapping and positive reinforcement to rule your behavior.
- Allow your child as much autonomy as possible; which may mean choosing which doll, the color towel to dry off with, or the sticker she is going to put on her chart – because this will decrease the struggles you encounter.
It may take some trial and error on your part but as a result your child will breathe easier, sleep better and an overall improved health which means less doctor appointments and money spent on medications that treat the symptoms and not the cause. Unlike allergy medications, shots or antibiotics, nasal rinsing goes straight to the root of the problem to stop anything before it starts and at a much lower cost.
In my professional experience, I haven’t found anything that works as well as this nasal wash for kids and although it takes some effort, the rewards are well worth it- much like most parenting.
Please consult your physician first when teaching a young child to wash. Always consult a physician before allowing a child to wash if the child is fully congested (blocked) on both sides; has blocked ears or an ear infection; has recurrent ear or sinus problems; is disabled; or has difficulty tolerating the wash.
- Use 1/2 packet of Nasopure buffered salt in the 4 oz bottle. Fill with purified, distilled, or previously boiled water. Close cap and shake until salt dissolves.
- Encourage child to hold bottle as directed, but don’t squeeze the bottle for your child. Allow the child to wash on their own, gently squeezing a small amount of solution (approx. 1 tsp.) into each nostril.
- Encourage the child to blow gently.
- Note: Allow your child to watch you wash first, while they play with the bottle, getting accustomed to the feel of the spray.
- Never wash for a child or force a child to wash.