NASAL CONGESTION IN CHILDREN WITH DOWN'S SYNDROME

Action Sheet

(Non-evidence based practical advice originally written for parents of children attending the Oxford Down's Syndrome Service but also relevant for adults)

There is no single simple answer to the problem of nasal congestion in children with Down's Syndrome. Basically the whole skeletal structure of the head and face and of the structures behind the mouth tends to be rather cramped and drainage of normal mucous secretions is compromised. This leads to mucous pooling and stagnating in the airways and this provides a focus for infection. Once infection sets in yet more mucous is produced and a vicious cycle results. As a general rule, as children get older the situation improves as the airways behind the nose and mouth widen. There are nevertheless some adults who continue to have major problems. There are one or two lines of attack available when the problems are severe. Different things work for different children but here are a few ideas which may help.

• Mechanical decongestion: You may be able to keep the nasal airways clear mechanically by using a Nuk decongester. This is a thing like a meat baster used in reverse. It consists of a rubber bulb and moulded nozzle to fit in the nostril. You simply suck out the muck. If you can keep the airways relatively clear for a couple of weeks, then you stand a good chance of breaking into the vicious cycle of congestion, stasis, secondary infection in the presence of stasis and excessive mucous secretion in response to infection. The problem with this strategy is that many young children won't tolerate having their nose cleared in this way. However, it has been very useful for several older children and teenagers who can actually take control of keeping their nose clear themselves may benefit greatly.
  
  
• Milk-free diet: One has to approach this empirically but it does seem that more children with Down's Syndrome than in the general population have some degree of dairy food sensitivity and some at least are markedly improved if the intake of dairy products is reduced, or abolished. I usually advise parents to give a 2 week full dairy-free trial. If there seems to be improvement then I say that they should talk to a dietician about continuing with the diet as to whether calcium intake is adequate etc. They may then get to a stage where they can play around with the diet and keep the child relatively mucous free with a lesser degree of restriction.
  
  
• Low dose antibiotics - Low dose antibiotics can be enormously effective in treating chronic catarrh. If the catarrh is offensive and greenish yellow I usually start off with a full dose of an antibiotic such as amoxycillin for some days until the colour clears and then cut down to a maintenance low dose of trimethoprim (5ml daily). Your own doctor may however recommend something different. I keep the low maintenance dose going for 6-8 weeks then stop. If the condition recurs I give a further course. Some children are OK in the summer months but need low dose antibiotics in the winter.
  
  
• Nasal decongestant sprays - If there is any indication of a hay fever type association it may be worth trying either an antihistamine spray or one containing sodium cromoglycate.
  
  
• Oral decongestants. Although these are generally not advocated I have known parents who swear by a daily dose of Actifed or Sudafed as a means of keeping the airways clear.

It is often worthwhile experimenting with some of these approaches and you may need to use more than one at a time. On the whole, if the catarrh is offensive you have to start off by clearing the infection with antibiotics before trying other strategies to keep the airways clear. I think that we have tended in the past to be too accepting of the problem, regarding it as an inevitable part of the syndrome. I think that we should now try to be a little more proactive in trying to relieve children of the more severe effects of persistent catarrh which has such a detrimental effect on their general health and whole well-being. Also, in children who are very congested, reduction of the level of congestion can have an impact on the severity of breathing problems at night and on glue ear.

Dr Jennifer Dennis
August 1996 (revised November 2001)

Home | What's New | Medical Library | DSMIG Information Resources | Book Reviews | Parent Resources | Links
About DSMIG | Noticeboard | Roadshows | Support Our Work | Contact Us