Young children get a lot of runny noses. This is not a reflection of inadequate care; it is a consequence of the number of respiratory viruses circulating in communities that babies and toddlers encounter for the first time without prior immunity. Most of these episodes are self-limiting and need only gentle management while the immune system does its work.
This guide covers why children get so many runny noses, how to manage nasal congestion and discharge at different ages, which treatments are useful and which are not, and when a persistent or unusual runny nose warrants a GP review.
Healthbooq (healthbooq.com/apps/healthbooq-kids) covers common childhood illnesses across the early years.
Why Children Get So Many Runny Noses
The upper respiratory tract – nose, sinuses, throat, and ears – is the first point of contact for airborne respiratory viruses. Children in the first years of life are encountering most of these viruses for the first time, and each encounter produces an immune response that builds lasting protection. The common cold is caused by over 200 different viruses, of which rhinovirus is the most prevalent. Research by Iossifova and colleagues and broader epidemiological data suggest that children under 5 have on average 6-8 respiratory infections per year, more if they attend nursery. This frequency is normal and reflects healthy immune development rather than susceptibility.
Allergic rhinitis (hay fever and perennial allergies) is an increasingly common cause of chronic or recurrent runny nose in children. The prevalence of allergic rhinitis has increased over recent decades; estimates suggest around 10-15% of UK children are affected. It typically presents with clear nasal discharge, sneezing, nasal itching, and often associated watery eyes. Seasonal patterns (worse in spring and summer) suggest pollen allergy; year-round symptoms suggest house dust mite, pet dander, or mould.
Other causes include teething (which can cause increased nasal secretions), foreign body in the nose (classically unilateral, foul-smelling discharge in a toddler), and less commonly, structural causes such as enlarged adenoids.
Managing a Runny Nose at Home
Saline nasal drops or spray. Isotonic saline drops or spray (available without prescription) loosen and thin mucus, making it easier for the child to clear. In young infants who breathe predominantly through their noses, congestion can interfere with feeding; saline drops used before a feed, followed by a nasal aspirator (bulb syringe or Nosefrida-type device), can provide significant practical relief.
Positioning. Slightly elevating the head of a crib or bed can help reduce congestion during sleep in older infants and toddlers, though for infants under 12 months, safe sleep guidance recommends a flat sleeping surface.
Hydration. Extra fluids help thin mucus. For breastfed infants, continuing to breastfeed frequently is usually sufficient. Additional water can be offered to older infants and toddlers.
Steam. Sitting in a bathroom with a hot shower running is a traditional approach that many parents find helpful. There is limited formal clinical evidence but no harm, and the humidified air may ease congestion. Purpose-built humidifiers have mixed evidence.
Nasal aspirators. Bulb syringes and suction devices designed for infant use can effectively remove mucus from a young baby's nose before feeds or sleep. The Cochrane Collaboration has not formally reviewed these for evidence of benefit, but the practical benefit for feeding in congested infants is well recognised in clinical practice.
What to Avoid
Over-the-counter cough and cold medicines. The MHRA in the UK prohibits the sale of OTC cough and cold medicines for children under 6. For children aged 6-12, guidance advises consulting a pharmacist. A Cochrane review by Smith and colleagues (updated 2014) found limited evidence that OTC cold medicines reduce symptom duration or severity in children. Antihistamines in cold medicines may cause drowsiness or, in young children, paradoxical excitability. The risk-benefit balance does not support routine use.
Nasal decongestants. Decongestant nasal sprays (containing oxymetazoline or xylometazoline) can cause rebound congestion with extended use and are not recommended in children under 12 in most guidance.
When to See a Doctor
Most runny noses need no medical review. However: a runny nose lasting more than 10-14 days, particularly with coloured (yellow or green) discharge and facial pressure or pain, may represent acute bacterial sinusitis requiring antibiotic treatment. A unilateral runny nose – only one nostril – with foul-smelling discharge in a toddler should raise suspicion for a nasal foreign body. Associated high fever, ear pain, reduced hearing, or significant deterioration warrants assessment. Persistent allergic symptoms that are affecting the child's sleep or daily functioning are worth discussing with a GP.
Key Takeaways
A runny nose (rhinorrhoea) is one of the most common symptoms in children and is most often caused by a viral upper respiratory infection or allergic rhinitis. Colds cause an average of 6-8 respiratory infections per year in children under 5. Most runny noses resolve without treatment; saline nasal drops and nasal aspirators are useful for young infants who cannot blow their noses. Over-the-counter cough and cold medicines are not recommended for children under 6 and have limited evidence of benefit in older children. A runny nose lasting more than 10-14 days, or accompanied by fever, facial pain, or thick discoloured discharge, may indicate sinusitis and warrants clinical review.
