Blocked Nose in Children

Nasal blockage is one of the commonest problems I assess in children. In most cases, the main causes are enlarged adenoids, allergic rhinitis, or a combination of the two. Because the symptoms often overlap, careful assessment is important.

This is something I see frequently in my practice. I regularly assess and treat children with persistent nasal obstruction, mouth breathing, snoring, enlarged adenoids, and childhood allergic rhinitis. The key is to work out whether the dominant problem is adenoidal enlargement, nasal allergy, or a mixture of both, because that is what determines which treatment is most likely to help.

Non-allergic rhinitis is much less common in children than in adults, so in a child with long-standing nasal symptoms I am usually thinking first about adenoids, allergy, or both.

What are adenoids?

Adenoids are pads of tissue at the back of the nose. They form part of the immune system in young children, but when they become enlarged they can block the space behind the nose and make nasal breathing difficult.

This can lead to:

  • a persistently blocked nose

  • mouth breathing

  • snoring

  • noisy breathing at night

  • disturbed sleep

In some children, enlarged adenoids also affect the opening of the Eustachian tube at the back of the nose. That can contribute to glue ear, recurrent ear problems, or hearing difficulties, which is why hearing and ear symptoms sometimes need to be considered as part of the overall picture.

What is allergic rhinitis in children?

Allergic rhinitis means the lining of the nose is reacting to allergens such as pollen, house dust mite, animal dander, or mould. In children it commonly causes a blocked or runny nose, sneezing, itching, and sometimes itchy or watery eyes.

For some children the symptoms are mainly seasonal, especially during the pollen season. In others they occur throughout the year, particularly where house dust mite or pets are relevant triggers.

Allergic rhinitis can also have a wider impact than many parents realise. It may affect sleep, concentration, school performance, and general day-to-day wellbeing, and it often overlaps with asthma or eczema.

How can I tell the difference between enlarged adenoids and allergic rhinitis?

There is often overlap, which is exactly why children benefit from proper assessment.

As a general guide:

  • enlarged adenoids are more likely to cause mouth breathing, snoring, noisy sleep, and a persistently blocked nose

  • allergic rhinitis is more likely to cause sneezing, itching, a clear runny nose, eye symptoms, and fluctuating congestion

  • some children have both problems at the same time

A child with chronic mouth breathing and snoring does not necessarily just have “big adenoids”, and a child labelled as having “allergies” does not necessarily have allergy as the whole explanation.

What symptoms do enlarged adenoids cause?

Typical symptoms include:

  • a blocked nose

  • mouth breathing

  • snoring

  • noisy breathing during sleep

  • restless sleep

  • dry mouth on waking

  • nasal-sounding speech

  • persistent catarrh or a runny nose

In some children, enlarged adenoids can also contribute to disturbed breathing at night, daytime tiredness or irritability, and problems with ear ventilation and hearing.

What symptoms suggest allergic rhinitis?

Typical symptoms include:

  • sneezing

  • itching in the nose

  • a clear runny nose

  • nasal blockage

  • itchy or watery eyes

  • postnasal drip

Children with allergic rhinitis may also snore or mouth breathe, particularly if the nose is chronically inflamed and congested. That is one reason allergy can sometimes look very similar to adenoid problems.

How do I assess a child with nasal blockage?

When assessing a child with nasal blockage, I usually want to understand:

  • the main issue — blockage, sneezing, itching, or a runny nose

  • if symptoms are seasonal or present all year round

  • if there is snoring, noisy sleep, or pauses in breathing

  • if there is mouth breathing during the day

  • if there are eye symptoms

  • if there is asthma, eczema, or a strong family history of allergy

  • if pets, dust, pollen, or other triggers seem relevant

  • if there are ear problems, glue ear, hearing concerns, or recurrent infections

  • how much symptoms are affecting sleep, concentration, behaviour, or school

In older children, I can often pass a very thin camera called a nasoendoscope to assess the nose and adenoids properly. This gives a much clearer view of what is actually causing the blockage. In younger children this is not always tolerated, so assessment often relies more on the history, examination, and the overall pattern of symptoms.

The aim is not simply to label the child with “rhinitis” or “adenoids”, but to understand which factor is dominant and how much each is contributing.

Do children need allergy testing?

Not always.

If the history is straightforward and symptoms improve with sensible first-line treatment, formal allergy testing is not always necessary. It becomes more useful when:

  • the pattern is unclear

  • symptoms are more severe or persistent

  • symptoms are not settling with treatment

  • there is a need to clarify likely triggers

What are the main treatment options?

Treatment depends on whether the main issue is enlarged adenoids, allergic rhinitis, or both.

1. Saline sprays and rinses

Saline can be very helpful in children, particularly for congestion, mucus, crusting, irritants, and postnasal drip. It also helps clear the nose before using medicated sprays.

Ready-made saline sprays such as Sterimar are often the easiest option for children and are commonly used. NeilMed can be helpful in some older children, but bottle-based rinses are often more challenging in younger children. Many pharmacies also sell their own similar versions.

2. Antihistamines

If allergy is a significant part of the picture, non-sedating antihistamines can be helpful, particularly for sneezing, itching, a clear runny nose, and eye symptoms.

For some children with mild intermittent hay fever-type symptoms, antihistamines may be enough. Where blockage is more persistent, they are often helpful but not usually the whole answer.

3. Nasal steroid treatment

For persistent allergic rhinitis, nasal steroid treatment is often one of the most useful parts of management.

These sprays can help settle inflammation in the lining of the nose, and they may help when allergy is playing an important part. They are often worth trying first, but if the adenoids are clearly enlarged and the child remains symptomatic, the adenoids usually remain the main issue and need to be addressed.

Technique matters. I usually advise:

  • clear the nose first if possible

  • keep the head upright

  • use the opposite hand to the opposite nostril

  • aim the spray towards the ear

  • breathe in gently as you spray

  • avoid sniffing hard afterwards

In selected children, particularly where allergy and asthma overlap, montelukast may sometimes be considered as part of treatment, but it is not usually a routine first-line option.

4. Allergen reduction and trigger control

Where allergy is clearly contributing, practical trigger reduction can help. The details depend on the likely trigger. For some children that may mean focusing on pollen exposure, and for others pets, house dust mite, smoke, or other irritants.

The aim is not to make family life impractical, but to reduce the factors that are repeatedly driving symptoms.

5. Surgery

Not every child with nasal blockage needs surgery, and in children less is often more.

If symptoms are mild, it is sometimes reasonable to monitor things, particularly because adenoids often shrink as children get older. However, if the adenoids are clearly enlarged and the child is significantly symptomatic — especially with persistent mouth breathing, snoring, nasal obstruction, disturbed sleep, or associated ear and hearing problems — treatment usually needs to focus on the adenoids.

There is a separate page on this website with more information about adenoidectomy.

If medical treatment has been used properly, and the adenoids have already been addressed, but significant nasal blockage still remains, it may sometimes be necessary to consider the turbinates as well. The turbinates are normal prong-like structures inside the nose that help warm, humidify, and regulate the air as you breathe. If they become swollen or enlarged, they can contribute to ongoing blockage. When they are prominent, they can sometimes be mistaken by non-ENT specialists for nasal polyps. True nasal polyps are uncommon in children, and if a child does have polyps it can sometimes be a sign of an underlying systemic condition. In selected children, a turbinoplasty may occasionally need to be considered, but only after the wider picture has been assessed carefully.

Does surgery cure everything?

Not always.

Adenoid surgery can be very effective when enlarged adenoids are a major contributor to nasal blockage, snoring, disturbed sleep, or ear and hearing problems. But if a child also has allergic rhinitis, surgery does not remove the allergic tendency. Those children may still need ongoing medical treatment for the nose even if surgery helps the obstructive element.

That is why it is so important to decide whether the main issue is adenoids, allergy, enlarged turbinates, or a combination of these.

When is further assessment important?

I would usually want to assess a child more carefully if there are:

  • persistent mouth breathing

  • regular snoring

  • observed pauses in breathing during sleep

  • ongoing blocked nose despite treatment

  • significant daytime tiredness, poor sleep, or behavioural change

  • recurrent ear problems, glue ear, or hearing concerns

  • symptoms strongly suggesting allergy that are not settling

  • mainly one-sided symptoms

  • recurrent nosebleeds or other unusual nasal symptoms

Helpful resources

Disclaimer

This page is intended as general information only. It does not replace a consultation, examination, or individual medical advice.