When Should My Toddler See a Doctor for a Runny Nose?

As parents of young children, it can seem like second nature to grab a wipe or tissue to remove mucus from your child’s nose. While serving as an annoyance to both you and your child, a runny nose is usually tied to an acute illness and will resolve in a week or two.

But what happens when that pesky nasal discharge turns chronic and becomes more than a nuisance? In this blog, we speak to Taylor Couch, M.D., a board-certified pediatrician with INTEGRIS Health Medical Group Miami, to provide insight and pointers on why your toddler’s runny nose won’t go away and when you should see a doctor.

What is rhinorrhea? 

The human body, including the nose, contains soft tissue called mucosa (also called the mucous membrane) that lines organs and cavities to help keep them moist, lubricated and safe from foreign invaders.

Mucosa has three layers, with epithelial cells making up the surface layer. These cells secrete a gel-like substance called mucus. In the nose, mucus traps germs and tiny particles and also keeps the nasal cavity from drying out.

For many reasons, the nose can produce excess amounts of mucus, leading to nasal discharge in the form of a runny nose (medically known as rhinorrhea). 

In children, you may notice rhinorrhea as snot dripping or running from your child’s nose. For many infants and toddlers, this results from a condition caused by inflamed nasal tissues called rhinitis. As a result of this irritation and inflammation, more mucus is produced to trap and clear out whatever is causing the issue.

How the drainage appears will vary in each child. Some children may have thick mucus, while others have thin drainage. Additionally, it may be clear or a yellowish green. For some children, the drainage is constant but in others it can be intermittent. 

When does rhinorrhea become chronic?

Young children, especially toddlers in daycare, are constantly sick. Rhinorrhea is one of the most common symptoms of viral or bacterial infections. These cases of rhinorrhea are acute and will resolve in a week or 10 days as the infection clears.

However, a runny nose can persist for weeks or months due to chronic nasal inflammation. Allergens, including seasonal triggers such as pollen, may also trigger a running nose.

In general, a running nose that lasts 12 weeks is considered chronic and should be evaluated by a doctor – either a pediatric ENT or a pediatric allergist – to find the root of the issue.

When to see a doctor

“Contact your child’s pediatrician if your child’s runny nose doesn’t improve after a week or 10 days,” Couch advises. “Sometimes snot that is persistent may be a sign of something more than a typical virus if it’s chronic.” 

Additional signs to consider include refusing to drink milk or water for more than a day or two. Infants and toddlers can’t drink from a bottle unless the nose is open, so excess mucus or congestion that occurs due to a runny nose will impact their ability to eat.

Aside from a runny nose, your child may experience a chronic cough. Excess mucus can run back down the throat (called postnasal drip) and cause a persistent cough. The cough tends to be worse at night when your child is lying down. This can also make it difficult to breathe.

A chronic runny nose that produces pain or a fever for several days may be a sign of a sinus infection. Children with chronic rhinorrhea are more prone to sinusitis – an infection of the sinuses – because it’s harder to clear mucus from the nose which allows pathogens to linger.

What causes chronic rhinorrhea?

The nose and sinuses produce about a liter of mucus per day. Normally, the mucus mixes with saliva and moves down the back of the throat unnoticed. However, there are many conditions that can cause excessive mucus production that drips from the nose.

• Viral and bacterial infections: Children who are constantly sick may have a persistent runny nose, especially in the fall and winter during cold and flu season.
• Allergies: Known as allergic rhinitis, any type of allergen can cause the immune system to release histamine that results in inflammation of the nose.
• Non-allergic rhinitis: Anything from medications (using decongestant sprays for too long) or environmental factors can cause nasal inflammation. For example, a child who lives with parents who smoke may develop chronic rhinitis that leads to a runny nose.
• Recurrent sinus infections: Excess mucus or any issues with sinus drainage increases the risk of mucus becoming infected and causing a sinus infection.
• Enlarged adenoids: Young children are more likely to have large adenoids, a patch of lymphatic tissue at the back of the nasal cavity. Large adenoids can cause a runny nose, postnasal drip, congestion and ear infections. Adenoids usually shrink after the age of five.
• Nasal polyps: Benign growths the size of grapes can line the nose and cause increased mucus production.
• Foreign object in nose: If your child only appears to have a runny nose from one nostril, there may be an obstruction due to a foreign object that is stuck. For example, a small bead could cause excess drainage.
• Large turbinates: The nose has bony structures called turbinates that help filter air. Turbinates can become enlarged or swollen due to allergies or infections and cause a runny nose.
• Deviated nasal septum: Some children are born with a deviated nasal septum, which occurs when the bone and cartilage in the middle of the nose is crooked and makes one nasal passage smaller.

Evaluation for chronic runny nose

“Typically, your child’s pediatrician will evaluate for other problems, such as secondary bacterial infection or allergic rhinitis (commonly called environmental allergies). Both of these may require additional treatment. In some cases, he/she may even consider referring you to an allergist or an ear, nose and throat (ENT) specialist,” Couch says. “An allergist may do allergy testing – both environmental and food – to see if your child is being exposed to anything that is causing a runny nose.”

If an allergen isn’t the culprit, a pediatric ENT can perform two types of tests to examine for any blockages or structural issues inside the nose. 

A nasal endoscopy uses a thin, flexible camera to view the nasal cavity. This allows the doctor to evaluate the mucosa, check for enlarged adenoids or turbinates, rule out an obstruction from a foreign object and capture images of any inflammation. The in-office procedure is quick and doesn’t require any numbing agents or anesthesia. 

Alternatively, a CT scan can examine nasal anatomy to check for structural issues related to bones or soft tissue. This type of exam is less common compared to a nasal endoscopy. 

How to treat a chronic runny nose

Ultimately, whatever is causing a chronic runny nose will determine the appropriate treatment. In other words, if your child has a runny nose due to pollen or pet dander allergens, treatment will revolve around either removing or reducing exposure to the allergen or using medications for symptomatic relief.

Medications: Steroid nasal sprays are the most common treatment to reduce inflammation. Oral antihistamines may also provide relief if allergies are causing nasal discharge.

Nasal irrigation: Saline sprays (a mix of salt and water) can help clear out the nasal passages to reduce excess mucus.

Antibiotics: If a sinus infection is suspected as the cause of the runny nose, a short course of antibiotics can help clear up the issue. Amoxicillin is the most common choice to treat ear or sinus infections in children. The medication, which comes in liquid form, is typically used for five days.

Surgery: If a chronic runny nose doesn’t respond to conservative treatments, your child’s doctor may recommend surgery. Surgery is used for structural issues or if adenoids become enlarged. An adenoidectomy is a common procedure that involves removing the adenoids through the mouth. Functional endoscopic sinus surgery (FESS) is a less common option. This type of procedure uses an endoscope and tiny tools that allow an ENT to remove growths, polyps, bones or tissue that may be blocking the sinuses. Finally, for children who have a runny nose due to chronic sinusitis, balloon sinuplasty involves the placement of a small balloon to dilate the sinus openings.

“While a runny nose may not seem like a major issue, it can cause long-term issues in children such as breathing issues, lack of sleep and chronic sinus or ear infections,” Couch says. “That’s why it’s important to see a doctor if your child’s nasal drainage becomes chronic and does not improve after seven to 10 days.”

Contact your child’s pediatrician and inquire about a referral to an allergist or an otolaryngologist. 

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