Congenital nasal congestion in children causes symptoms and effective treatment

Congenital Nasal Congestion in Newborns: Causes, Symptoms, Diagnosis, and Treatment The nose is the primary pathway for a newborn to breathe from the moment of birth, and any blockage can lead to breathing difficulties and issues with feeding, especially in newborns. Congenital nasal congestion is a condition that occurs from birth, often caused by a congenital deformity or blockage in the nasal passages. If not detected and treated early, it can affect the baby's health and growth. In this article, we will explore the causes of congenital nasal congestion, its symptoms, diagnostic methods, treatment options (both medication and surgery), and important tips for parents to help reduce the congestion, all in a simple and easy-to-understand way.

Congenital Nasal Congestion in Infants: Causes, Symptoms, and Treatment

What is Congenital Nasal Congestion?
Congenital nasal congestion refers to a blockage or difficulty in air passage through a newborn's nose since birth, caused by congenital defects or partial or complete blockages in the nasal passages.
Does Nasal Congestion Appear Immediately After Birth?
It often appears right after birth, especially in cases of bilateral posterior nasal obstruction. In some cases, it may appear mildly and progressively worsen, leading to difficulty in breastfeeding or increased secretions.
Is All Nasal Congestion in Newborns Congenital?
No, some nasal blockages are temporary due to neonatal mucus or mild infections. A pediatrician or ENT specialist's diagnosis is essential to confirm the cause.
Can It Be Detected Before Birth?
Some severe cases can be detected through prenatal scans or ultrasound. However, most cases are discovered after birth when breathing difficulties or feeding problems appear.
Is Nasal Congestion Permanent?
Simple blockages or neonatal mucus usually resolve within a few days. Anatomical blockages (such as posterior nasal septum obstruction or congenital cysts) typically require surgical intervention.
Is Surgery Safe for Newborns?
Yes, with a specialized team and precise instruments, the surgery is very safe. The risks are minimized when the appropriate surgical method, such as endoscopic nasal surgery or laser treatment, is chosen depending on the type of blockage.

Post-Operative Care

Does the Baby Require Follow-Up After Surgery?
Yes, post-operative follow-up is crucial to ensure the success of the treatment, including:
- Regular nasal cleaning with saline drops or a nasal aspirator.
- Removal of any stents placed during surgery.
- Monitoring the nasal passages for new blockages or adhesions.
Could the Baby Need More Than One Surgery?
Some cases, particularly bilateral posterior septal obstruction or adhesions after surgery, may require a second procedure to fully open the nasal passages.
How to Differentiate Congenital Nasal Congestion from Cold-Related Congestion?
Congenital congestion appears from birth and is not typically associated with fever or frequent sneezing. Cold-related congestion typically appears weeks or months after birth and usually resolves within a few days.
Does Nasal Congestion Affect the Baby’s Growth or Weight?
Yes, severe nasal blockage may lead to:
- Poor feeding.
- Slow weight gain or growth problems if not treated early.

Stages of Congenital Nasal Congestion in Infants

Stage 1: Birth to a Few Days After Birth

Nasal congestion appears immediately after birth.
Common symptoms:
- Difficulty breathing through the nose, especially during feeding.
- Crying with wheezing or snoring sounds.
- Mucus or accumulated fluids.
- In some cases, the blockage is temporary due to neonatal secretions and resolves within a few days.

Stage 2: Early Feeding

Infants with partial or complete nasal obstruction:
- Persistent feeding difficulty, especially with bilateral obstruction.
- Temporary cessation of breathing during feeding.
- Slow weight gain or poor nutrition in severe cases.

Stage 3: First Few Weeks to One Month

If the obstruction persists without treatment:
- Wheezing during breathing becomes more noticeable.
- Snoring during sleep.
- Cyanosis (bluish skin around the lips or face) may appear when the infant struggles to breathe.
- In cases of bilateral posterior septal obstruction, the baby may need urgent intervention to remove the blockage or place a temporary breathing tube.

Stage 4: Complications If Not Treated

Growth and weight issues due to feeding difficulties.
Sleep apnea or frequent breathing pauses during sleep.
Recurring nasal infections or middle ear problems due to poor ventilation.

Causes of Congenital Nasal Congestion in Infants

Choanal Atresia (Nasal Passage Obstruction)
- The baby is born with partial or complete blockage at the back of the nasal passage, preventing airflow.
- The obstruction can be bony, cartilaginous, or a combination of both.
- Surgery is often required to correct the blockage.
Deviated Nasal Septum
- Some infants are born with a deviated nasal septum, causing partial obstruction of one of the nasal passages.
Congenital Nasal Masses/Cysts
- Conditions like dermoid cysts or nasal gliomas may partially or completely block the nasal airway.
Small or Narrow Nasal Passages
- Some infants, especially preterm babies or those with low birth weight, may have naturally small or narrow nasal passages, making it difficult to breathe.
Craniofacial Anomalies
- Conditions like cleft lip or cleft palate can cause partial nasal blockage or difficulty in air passage.
Nasal Mucus or Fluid from the Womb
- Sometimes, mucus or fluids leftover from the womb can temporarily block the nasal passages at birth, typically improving with time.

Types of Congenital Nasal Congestion

Choanal Atresia (Posterior Nasal Passage Obstruction)
- One of the most common causes of congenital nasal congestion.
- Types of obstruction:
  - Bony: Abnormal bone growth blocking the nasal passage.
  - Cartilaginous: Obstruction due to cartilage tissue.
  - Mixed: Combination of bone and cartilage.
- Characteristics:
  - Often bilateral, causing severe difficulty in breathing right from birth.
  - Infants rely on mouth breathing.

Congenital Nasal Congestion in Children: Causes, Diagnosis, Treatment, and Care

Causes of Congenital Nasal Congestion

Congenital Septal Deviation

The nasal septum is deviated from birth.
Causes partial blockage in one nostril.
Symptoms are usually milder compared to posterior septal obstruction.

Congenital Nasal Masses or Cysts

Examples include:
- Dermoid cyst
- Nasal glioma
These can partially or completely block the nasal airway and affect breathing.

Narrow Nasal Passages

Some children are born with a very small nose or naturally narrow nasal passages.
Common in preterm infants or low birth weight newborns.

Craniofacial Anomalies

Examples:
- Cleft lip
- Cleft palate
These cause partial nasal obstruction, affecting airflow during feeding and sleep.

Temporary Blockage Due to Birth Fluids

Sometimes mucus or fluid remaining from the womb temporarily blocks the nasal passages.
Usually resolves within a few days after birth.

Diagnosis of Congenital Nasal Congestion in Children

Medical History and Physical Examination

Questions the doctor may ask:
- Breathing difficulties since birth
- Feeding problems such as choking or temporary pauses while drinking
- Crying with wheezing or snoring sounds
Physical examination:
- Inspecting nostrils with a light or small endoscope
- Checking airflow through each nostril
- Looking for visible anomalies such as septal deviation or masses

Simple Airflow Test

A thin cotton swab or small tube may be used to test nasal airflow.
Failure of air to pass indicates complete blockage.

Imaging Tests

X-ray: Assesses bone and cartilage in the nose.
CT scan: Best for determining the type of obstruction (bony, cartilaginous, or mixed) and detecting any masses or congenital cysts.
MRI: Used if there is suspicion of nasal or intracranial congenital masses.

Nasal Endoscopy for Children

A small nasal endoscope allows direct visualization of the posterior nasal passages.
Helps pinpoint the exact location of obstruction before surgery.

Additional Tests

For infants with severe breathing difficulty or cyanosis:
- Blood oxygen saturation (SpO2)
- Heart and lung assessment to rule out associated conditions

Risks of Congenital Nasal Congestion

Breathing Difficulty

Especially in bilateral obstruction, the infant relies on mouth breathing.
Untreated cases may lead to oxygen deprivation and cyanosis.

Feeding and Growth Problems

Nasal obstruction during feeding may cause:
- Choking or temporary pauses while drinking
- Poor weight gain or delayed growth in severe cases

Recurrent Infections

Reduced ventilation of sinuses and middle ear increases the risk of:
- Otitis media
- Chronic sinus infections

Sleep Difficulties and Respiratory Disturbances

Snoring or intermittent pauses in breathing during sleep
Persistent congestion may lead to fatigue and impaired neurodevelopment

Psychological or Social Issues

Some nasal or facial anomalies may affect appearance
Can impact self-confidence later in life

Complications from Delayed Surgery

Severe cases, such as bilateral posterior septal obstruction, may require urgent intervention with a temporary breathing tube
Delay can worsen health or cause serious respiratory complications

Treatment of Congenital Nasal Congestion

1. Medical Treatment

Saline Nasal Drops/Spray:
- Loosens mucus and helps clear nasal passages
- Useful for newborns with partial blockage or thick secretions
- Usage: 2–3 times daily as needed, followed by gentle suction
Decongestants or Airway-Opening Medications:
- Rarely used in infants due to potential side effects on heart and blood pressure
- Only under strict medical supervision if partial blockage is linked to swelling or inflammation
Anti-inflammatory Medications or Antibiotics:
- Antibiotics are used only for secondary bacterial infections
- Nasal steroids are rarely used in infants and only under close supervision
Supportive Medications for Sleep or Breathing:
- For infants with severe sleep disruption due to congestion
- Temporary until surgical evaluation

2. Surgical and Laser Treatment

a. Traditional Surgery

Correction of Choanal Atresia:
- Removal of bone and cartilage causing obstruction to open the posterior nasal passage
- Approaches:
  - Transnasal approach: Opening the nasal passage with precise instruments
  - Endoscopic surgery: Most common, reduces bleeding and speeds recovery
- Goal: Restore normal airflow and improve breathing and feeding
Removal of Congenital Cysts or Masses:
- Such as dermoid cysts or nasal gliomas
- Removed to prevent obstruction and growth-related complications
Correction of Septal or Palatal Deformities:
- Deviated septum or cleft palate causing partial obstruction or feeding/breathing difficulties

b. Laser Treatment

Used for minor tissue obstruction or thin membrane removal
Advantages:
- High precision
- Reduced bleeding and swelling
- Faster recovery compared to traditional surgery
Limitations:
- Effective only for thin tissue obstructions
- Not suitable for complete bony obstruction

Pre-Operative Instructions

Full Medical Evaluation:
- ENT pediatric specialist visit
- CT scan or nasal endoscopy to determine obstruction type and location
- Cardiac and lung function evaluation for infants with breathing difficulty or cyanosis
Fasting Before Surgery:
- Food and breastfeeding restrictions as instructed to reduce anesthesia risks
Temporary Medication Adjustments:
- Discuss any drugs affecting blood clotting or causing bleeding
Parental Preparation:
- Guidance for post-operative care at home