Nasal Obstruction in Children

Nasal obstruction is one of the most common reasons children are referred to a pediatric ENT specialist.

When the nasal passages become partially or fully blocked, it can affect far more than just breathing — it can disrupt day-to-day quality of life. In infants, even a mild blockage can make feeding difficult, while in older children, chronic nasal obstruction may lead to mouth breathing, snoring, and poor sleep.

There are many possible causes, and identifying the right one is the first step toward effective treatment.

What Is Nasal Obstruction?

Nasal obstruction occurs when one or both of the nasal passages become partially or completely blocked. The nasal cavity is the airway that begins at the nostrils and extends to the back of the throat, allowing air to move freely in and out of the nose.

Because the nose plays an important role in breathing, even a partial blockage can affect your child’s comfort, sleep, feeding, and overall quality of life.

What Are the Symptoms of Nasal Obstruction?

The symptoms of nasal obstruction can vary depending on your child’s age and the underlying cause.

In infants, nasal obstruction is often noticed soon after birth. Because babies primarily breathe through their noses, any blockage can cause:

  • Noisy or difficult breathing
  • Increased breathing difficulty during feeding
  • Improved breathing when crying
  • Trouble feeding comfortably

In older children, symptoms may include:

  • Noisy breathing through the nose
  • Snoring
  • Chronic mouth breathing
  • Nasal congestion or stuffiness
  • A runny nose
  • Poor sleep quality or restless sleep

Mouth breathing can sometimes be difficult to recognize because it develops gradually. Take a look at family photographs to see if your child frequently keeps their mouth open, even when resting.

When Should My Child See an Ear, Nose and Throat Specialist?

Many causes of nasal obstruction can initially be managed by your child’s primary care physician. However, if symptoms persist, worsen, or do not improve with treatment, an evaluation by an ear, nose and throat (ENT) specialist may be recommended.

An ENT specialist has specialized training in diagnosing and treating conditions that affect the nose and upper airway and can help determine the underlying cause of your child’s symptoms.

What Causes Nasal Obstruction?

There are many possible causes of nasal obstruction in children. Some conditions are present at birth, while others develop later in childhood.

Rhinitis

Rhinitis refers to inflammation or swelling of the lining of the nose. It may be caused by allergies, infections, environmental irritants such as smoke or pollution, or other factors.

Swelling of the nasal lining can make breathing through the nose difficult and may be particularly distressing in infants.

Enlarged Adenoids

Enlarged adenoids, also called adenoid hypertrophy, are one of the most common causes of nasal obstruction in children.

The adenoids are located at the back of the nose and can become enlarged enough to block airflow, resulting in chronic congestion, mouth breathing, and snoring.

Foreign Objects in the Nose

Young children are naturally curious and may place small objects such as beads, food particles, or pieces of cotton into their noses during play. A foreign object in the nose often causes:

  • Persistent blockage on one side
  • Foul-smelling nasal drainage
  • Ongoing congestion that does not improve

Many foreign objects can be removed in the office, although occasionally a brief procedure under anesthesia may be necessary.

Deviated Nasal Septum

The nasal septum is the wall that separates the two nasal passages. Some children are born with a crooked, or deviated, septum, while others develop one following an injury to the nose.

If the septum is significantly displaced, it can block airflow through one side of the nose. In some cases, surgery called a septoplasty may be recommended.

Nasal Polyps

Nasal polyps are soft growths that develop from the lining of the nose or sinuses and extend into the nasal passages. They are often associated with chronic inflammation or infection and can cause ongoing congestion and difficulty breathing through the nose.

Additional testing is often needed to determine the cause and extent of the problem.

Nasal Hematoma

An injury to the nose can sometimes result in a hematoma, which is a collection of blood inside the nasal tissues. This condition can obstruct the nasal passage and requires prompt treatment to prevent damage to the structures that support the nose.

Choanal Atresia

Choanal atresia is a congenital condition in which the back of the nasal passage is blocked by tissue or bone.

If both sides are blocked, symptoms are usually noticed shortly after birth because newborns rely heavily on nasal breathing. This situation often requires prompt treatment.

When only one side is affected, symptoms may be milder and diagnosis may occur later in childhood. Children may experience:

  • Persistent congestion on one side
  • One-sided nasal drainage
  • Recurrent sinus infections on the affected side

Tumors

Although uncommon, both benign and malignant tumors can cause nasal obstruction.

Symptoms may include:

  • Persistent blockage on one side
  • Nosebleeds
  • Nasal drainage
  • Swelling around the nose or face

Further testing is often required to determine the cause and appropriate treatment.

How Is Nasal Obstruction Evaluated?

Evaluation begins with a detailed discussion of your child’s symptoms, medical history, and when the symptoms first started. The age at which symptoms developed can provide important clues about the underlying cause.

A thorough physical examination of the ears, nose, and throat is then performed. In many cases, your ENT specialist may use a small, flexible camera called an endoscope to look further inside the nasal passages and examine areas that cannot be seen during a standard examination.

Depending on the findings, imaging studies may also be recommended. These may include:

  • Standard X-rays
  • Computed tomography (CT or CAT) scans
  • Magnetic resonance imaging (MRI)

These studies provide detailed information about the nose, sinuses, and surrounding structures and can help guide diagnosis and treatment recommendations.

How Is Nasal Obstruction Treated?

Treatment depends on the underlying cause of the blockage. Some children improve with medications that reduce inflammation or treat allergies and infections. Others may require procedures to remove a foreign body, correct structural problems, or address enlarged adenoids or other conditions affecting the nasal airway.

The goal of treatment is to restore normal breathing, improve sleep and feeding, and help your child breathe comfortably through their nose.

If your child has chronic congestion, mouth breathing, noisy breathing, snoring, or persistent difficulty breathing through the nose, Michigan Pediatric Ear Nose and Throat Associates (MPENTA) can help.

Our specialists provide comprehensive evaluations for nasal obstruction and work closely with families to identify the underlying cause and develop personalized treatment plans.

Contact MPENTA today to request an appointment and learn more about the options available to help your child breathe easier.