Children's nasal mucosa is delicate and their immune system is not yet fully developed, making them more susceptible to air pollution, allergens, or viral infections, leading to symptoms such as nasal congestion, runny nose, and sneezing. Saline nasal irrigation, as a safe and effective physical therapy, can not only clear nasal secretions and allergens but also relieve mucosal edema and improve breathing patency. However, children have low cooperation levels and unique nasal structures, and improper operation may cause choking or injury.
Key Preparations Before Operation
Tool Selection: Adapted to Children's Physiological Characteristics
Dedicated Nasal Irrigator:
Age Suitability: For children under 3 years old, a misting nasal spray device (such as an electric spray type) is recommended, as the pressure is gentle and avoids choking; for children over 3 years old, a squeeze-type nasal irrigation bottle or nasal irrigation pot can be used, and a children's version (small water volume, slow flow rate) should be selected.
Material Safety: Medical-grade silicone or soft plastic materials are preferred to avoid sharp edges scratching the nasal cavity.
Types of saline solution:
Isotonic saline (0.9%): Suitable for daily cleaning, with the same osmotic pressure as human body fluids, causing no irritation.
Hypertonic saline (2%-3%): Only for short-term use (no more than 3 days) when nasal congestion is severe and secretions are thick. It can quickly relieve edema, but long-term use may damage the mucous membranes.
Commercially available physiological seawater spray: Contains minerals (such as zinc and magnesium), which can help repair the mucous membranes. Suitable for use when out and about or in emergencies.
Auxiliary tools: Thermometer (to ensure water temperature is 35-37℃), soft towel (to wipe the face), trash can (to catch secretions).
Environmental setup: Reducing children's resistance
Timing: Avoid when the child is hungry, sleepy, or emotionally agitated. It is recommended to use the device 1 hour after meals or 1 hour before bedtime.
Positioning assistance: For children under 3 years old, a parent can hold them on their lap with their body leaning forward; children over 3 years old can stand or sit in a chair with their body slightly leaning forward. Psychological reassurance: Distract the child with toys, cartoons, or storytelling to avoid forcibly pressing the nostrils and causing fear.
Step-by-Step Operation Guide
Saline Preparation and Temperature Control
Preparation Method:
If using nasal irrigation saline packets: Dissolve according to the instructions (usually 250 ml of warm water per packet), stirring until smooth.
If using commercially available saline solution: Heat directly to 35-37℃ (can be heated in a water bath or in a microwave on low power for 10 seconds).
Temperature Test: Drop 1-2 drops of saline solution onto the inside of the wrist; it should feel warm but not hot.
Rinsing Posture and Action Standards
Position Adjustment: The child should lean forward at a 45-degree angle, with their head slightly turned to one side (e.g., when rinsing the left nostril, turn the head to the left), making the external auditory canal parallel to the ground. This posture ensures that the water enters from the upper nostril and flows out naturally from the opposite nostril or mouth, preventing backflow into the middle ear.
Breathing Coordination: Breathe through the mouth during rinsing; avoid inhaling through the nose to prevent choking. Parents can mouth "ah" or "ha" to help the child understand.
Rinsing Procedure:
Spray Type:Gently insert the nozzle into the nostril and press the nozzle 2-3 times, alternating between nostrils.
Squeeze Type:Place the nasal irrigator nozzle firmly against one nostril and gently squeeze the bottle to allow the saline solution to slowly flow into the nasal cavity and out through the opposite nostril. Recommended rinsing volume per nostril is 50-100 ml (approximately half to one full bottle of children's size).
Rinsing Time: Each rinse should not exceed 1 minute, with a total rinsing time of 3-5 minutes.
Post-Rinsing Care
Clean Secretions: Gently wipe the child's face and neck with a soft towel, avoiding vigorous rubbing.
Observe Reaction: Ask the child if they experience ear fullness, stinging, or other discomfort. If symptoms are mild, a short rest is sufficient before continuing; if discomfort persists, discontinue use and consult a doctor.
Tool Sterilization: After use, disassemble the nasal irrigator, boil it in boiling water for 5 minutes, air dry, and store in a dry place.
Key Precautions
Contraindications and Special Circumstances
Absolute Contraindications:
Acute phase of nasal bleeding (stop the bleeding first, and rinse 48 hours after the bleeding stops);
Acute phase of otitis media (rinsing pressure may push secretions into the Eustachian tube, worsening the infection);
Within one month after nasal surgery (use oily nasal drops as prescribed to keep the nasal cavity moist).
Relative Contraindications:
Severe nasal septum deviation (structural stenosis may cause rinsing fluid retention, leading to headache or ear fullness);
Coagulation disorders (such as hemophilia, long-term anticoagulant use, bleeding risk assessment is required first).
Frequency and Concentration Management
Frequency:
Acute rhinitis (e.g., cold): 2-3 times daily for 3-5 days;
Chronic rhinitis/allergic rhinitis: once daily, reduce to 2-3 times per week after symptom relief;
Daily prevention: 1-2 times per week is sufficient. Concentration: For long-term use, isotonic saline (0.9%) is recommended; hypertonic saline (2%-3%) is only for short-term use when nasal congestion is severe and secretions are thick, and must be diluted before use (e.g., one packet of hypertonic saline should be diluted to make 500 ml of saline solution).
Correction of Common Parental Misconceptions
Misconception 1: Squeezing the nasal irrigation bottle forcefully
Correct practice: Squeeze gently, to a degree that the child can tolerate without choking. Excessive pressure may cause secretions to be forced into the middle ear or damage the mucous membrane.
Misconception 2: Making the child blow their nose after rinsing
Correct practice: After rinsing, let the child breathe naturally through their mouth; secretions will flow out with gravity. Forcibly blowing the nose may force secretions into the sinuses or middle ear, causing infection.
Misconception 3: Sharing nasal irrigation tools
Correct practice: Each family member should use their own nasal irrigation device to avoid cross-infection.
Handling Common Problems
What to do if the child resists rinsing?
Step-by-step guidance: First, familiarize the child with the nasal irrigator (e.g., touch, observe), then try spraying the spray onto the arm or face to reduce fear.
Gamified operation: Design the rinsing process as a game of "defeating the snot monster," using reward mechanisms (e.g., stickers, small toys) to encourage cooperation.
Pause and attempt: If the child strongly resists, do not force it. Pause for 1-2 days before trying again, or switch to a saline nasal spray.
Ear stuffiness or headache after rinsing?
Ear stuffiness: This indicates that the rinsing solution may have entered the middle ear. Stop the procedure immediately and keep the head upright for 15 minutes. If symptoms persist, seek medical attention.
Headache: This may be due to excessive rinsing pressure or a deviated nasal septum. Reduce the pressure or consult a doctor to adjust the treatment plan.
How to handle nosebleeds?
Minor bleeding: Gently press the nostrils with a sterile cotton ball or clean gauze for 5-10 minutes, while having the child tilt their head down (to prevent blood from flowing into the mouth). Recurrent or heavy bleeding: Nasal septum deviation or coagulation abnormalities should be ruled out, and immediate medical attention is necessary.
Nasal irrigation with saline solution is a safe and effective nursing method for children, but strict adherence to operating procedures is crucial. From tool selection and posture adjustment to frequency management, every step affects both effectiveness and safety. Parents should patiently and attentively accompany their children through each irrigation, while simultaneously implementing comprehensive nasal health management measures such as indoor humidification (maintaining humidity at 50%-60%) and avoiding allergens (such as dust and cold air).
