Nasal irrigation in kids: safe? effective?
You have probably seen the recent videos posted all over social media of nasal irrigation (or nasal flushing) in babies.
The mucus that comes out is impressive, and the idea of something to help our congested babies is tempting.
But is nasal irrigation actually effective? And is it safe? Here’s a look at the data.
What is nasal irrigation?
Nasal irrigation, or using a neti-pot, has been around for centuries as a remedy for blocked noses. The idea is that you use a sterile solution, like saline, and flush out the mucus. There are numerous videos circulating on social media that show how much gunk it is possible to get out of the nose by doing it: you can watch one here or here.
The theory is sound
There are several reasons that nasal irrigations should (and does) work.
Anatomy: Although our nostrils are partially separated by a wall called the nasal septum, fluid can go behind the wall. So when you irrigate, water goes up one side, behind septum & out the other side. So it can theoretically clear out deeper congestion (esp in a child who can’t blow their nose).
Physics: The flow of fluid flushes out debris, allergens and old mucus from the nasal passages. The fluid stream should be steady and larger volume than a saline spray or mist, which is why it may work better.
Biology: The water moisturizes the passages and some studies also show that the irrigation improves function of the cilia (cells that move mucus).
But what does the data show?
So, first, to be clear. The research is low-quality and limited, probably because these types of studies are challenging to do well.
With that said, several studies have found a significant reduction in symptoms (& improvement in comfort) for those with chronic issues (such as chronic sinusitis, rhinitis or even allergies). The data on acute issues, such as respiratory infections that cause nasal congestion, is less impressive.
But importantly, the research also finds that there are minimal adverse effects, which means you may not have a lot to lose by trying it. Especially if your child is extremely uncomfortable with their congestion & you think they will tolerate irrigation, that may be a reason to try it and see if it helps. Interestingly, there is also data that indicates that kids do tolerate it better than we expect as parents.
Some research studies I looked at include PMID: 32312677, 25892369, 29932206, 22266167, 19786306
Safety first
If you’re going to try nasal irrigation, it is important to do it safely. Here are some practical tips.
Clear with your pediatrician first
Position your child optimally: have them lean over sink or a bowl with head tilted & make sure they are being held snugly (sometimes, it is worth wrapping them in a towel like a burrito). Remember, any sudden jerky movements with something inserted in the nostril can injure nasal passages.
Use an appropriately sized netipot or a medical syringe with an irrigation tip. Insert into nostril and push fluid (see below for important info about which fluid to use). Remember, you should aim for the back of head and not the top of head.
Repeat on the other side.
Other things to remember:
Make sure you sterilize syringe/netipot between uses
Use only use distilled or sterile water or saline solution. If you want to use tap water, follow instructions from FDA & CDC. Premixed packets are also available (eg from neilmed). There have been cases of severe infection (eg from brain-eating parasites) when tap water has been used.
This can be done 1-2 times per day but frequent use can cause irritation of the nasal passages and nosebleeds, so monitor closely and decrease frequency if you see anything like this.
The Pediatrician Mom Tip: Remember, our goal as always is to focus on comfort. Do this only if your child is uncomfortable, not because you just want to remove the nasal discharge.
So what do I think?
Personally, I have not tried this for my kids. I find that old school methods (steamy showers, saline mist) and the saline nebs (see the video below for details on this) are sufficiently effective. Remember, I have medicine cabinet faves on my Amazon page for the neb machine I use below as well as the saline — to be clear, these are affiliate links.
