Melanie Cole, MS (Host): There's no handbook for your child's health, but we do have a podcast featuring world-class clinical and research physicians covering everything from your child's allergies to zinc levels. Welcome to Kids Health Cast by Weill Cornell Medicine. I'm Melanie Cole. And joining me today is Dr. Nicolina Wawrin. She's an Assistant Professor in Pediatrics at New York Presbyterian Weill Cornell Medical Center, and she is here to tell us about treating a baby's runny nose.

Dr. Wawrin, welcome back. I'm so glad to have you join us. This is one of those things no matter what we do, no matter who we are, we have to deal with this with our little kiddos. It's something that happens. So in this day of allergies, colds, RSV, flu, COVID, I mean, we parents get nervous at the slightest runny nose, what are some of the most common causes that you see?

Nicolina Wawrin, MD: That's a great question. Runny noses can be caused by a few different things. the most common cause of a runny nose in a baby is the fact that they have a viral infection, especially since their immune systems are developing. Viruses are so common in society and they're just more vulnerable. So, viral causes of runny nose are the most common. Sometimes too, unfortunately, babies will develop bacterial infections that can cause runny noses. This is typically something that you'll see after a baby has had a viral infection and the secretions are just taking a while to clear up. Bacterial sources will take advantage and cause more mucus and, therefore, more runny nose. And then, the third most common cause of a runny nose in a baby is potentially an allergy, an environmental allergy. This isn't so common in infants, but it can be common in children who are over the age of one and particularly over the age of two.

Melanie Cole, MS: Okay. So, there's a lot of causes. How do we tell? How do we differentiate between the symptoms of all of these causes? If a baby gets a runny nose, we're going to get nervous, but how do we know whether it is a cold or COVID?

Nicolina Wawrin, MD: Right. It can be really difficult to know whether or not it's a cold or COVID. Most of the time a doctor isn't going to know either whether it's a cold or COVID unless we do a test, because symptoms can be very mild with the common cold, but they can also be very mild too with COVID in young children.

The major things that we look for in terms of it being a virus versus a bacterial infection is the duration of time in which a child is sick. So if a child has a runny nose for one to two weeks and the symptoms are about stable, if not improving, it's much more likely to be a viral infection. However, in some kids if they're having a runny nose or congestion or cough for over two weeks, or the symptoms are really starting to pick up during that time, or they're developing fever, that's when we're a little bit more concerned that it could be a bacterial cause for the runny nose, and that's when it's a really good time to see your pediatrician.

Melanie Cole, MS: That's excellent advice that that's the time to see because we are never quite sure. We don't want to bother your pediatrician with every little runny nose, but there are times when that's what you all are for. And you are just incredible. You guys are the ones helping us raise our babies healthy and safe, and that's really what it's all about. Is there a myth to the green runny nose, the stuff coming out, does that always mean it's bacterial or if it's yellow? I mean, sometimes it's different colors with babies.

Nicolina Wawrin, MD: That's a really good question. I do think that a lot of people tend to think that green discharge from the nose or even coughing up green discharge is synonymous with a bacterial infection. It's actually not though. It's more of where a person is in terms of their infection. Our immune system is trying to protect us when it's exposed to any kind of germ, and sometimes it could just be a virus and all of the white blood cells that we have in our body are trying to protect us and that can cause just green mucus in itself. So, it's more really just looking at the fact that a child has been sick for a while or that their symptoms aren't Improving where we start to consider the bacterial source. So, one thing I really like people to know is that just because you bring your child in for green mucus coming out of their nose, it's not an automatic trip to the pharmacy for antibiotics.

Melanie Cole, MS: I'm so glad that you said that, because that is really what we've always thought for so many years. And I'm sure so many parents come to you and say, "Oh, he had green mucus. I need an antibiotic right away." But we're really trying to look towards stewardship and not using these things quite so often. So, what are we supposed to do for our little babies? Are we trying to dry up that runny nose or just care for the redness because they get the sweet little redness around their nose? I mean, I don't want to gross the listeners out, but are we sucking it out with the bulb? What are we doing for our little guys?

Nicolina Wawrin, MD: That's a good question too. I mean, it really does depend on the comfort level of the child. Some of my thought is it's actually a good thing for that mucus to run out of their nose rather than it sitting behind their nose and potentially making them uncomfortable, or it just sitting there for a longer period of time and maybe becoming infested by the bacteria that we have in our head and neck that just love it. So if a child's nose is running, I think that's a good sign. It's more just work for you in terms of wiping it and trying to keep the area from not getting irritated.

However, if a baby is having a hard time drinking or breathing because they're so congested, then that's where I recommend trying to dry up the secretions, or in particularly for young children like infants, that's when we want to be suctioning them, using steam to help loosen the secretions, maybe even using like a Baby VapoRub to help some of the snot come out, but it's more just what the child is experiencing and how that nasal congestion is getting in their way of their day to day.

Melanie Cole, MS: I remember those days of the steam, sitting in the bathroom holding my little babies. What about nasal lavage? I mean, it's not easy to get a baby to hold still, or a toddler for that matter, to try and do something to clear that out. But do we want to do anything like that?

Nicolina Wawrin, MD: Nasal lavage isn't something that I tend to recommend until when children are a bit older. I think it can be pretty traumatizing for children.

Melanie Cole, MS: So traumatizing.

Nicolina Wawrin, MD: Yeah. And I think, if anything, like the utility of it and making a child feel better is probably not any more than just going in and suctioning their nose.

Melanie Cole, MS: What about products, Dr. Wawrin, over-the-counters for their little noses? You know, there's so many things, all these things, and even some of them say for babies to dry up or stop the runny nose, or if there's a fever that goes along with it. And listeners, there's going to be a podcast coming soon just strictly on over-the-counter medications. So be sure to stay tuned for that one. But Dr. Wawrin, do we want to use any products for this?

Nicolina Wawrin, MD: Using products for colds is where we have to be very careful. Pharmacies carry so many different cold medications for children, but most pediatricians don't feel comfortable with children under the age of six using over-the-counter medications for congestion and cough. Some of these medications can have alcohol in them. They can also have different ingredients that could potentially cause behavioral changes in children too, so obviously not ideal or safe.

Most of the time what you're going to hear from your pediatrician is just the basic supportive care stuff at home. Once again, the suctioning, the steam, using a baby VapoRub. If babies are older than one year of age, there are some more homeopathic cough syrups that have really just agave or honey for children one and above and agave for babies six months to 12 months of age. And these can naturally just soothe the upper respiratory tract and prevent the child from coughing to the point where it's like disruptive for sleep. The jury's also out on whether or not these are super effective, but they are safe. However, it also would be totally fair to just hydrate your child to thin the secretions down, use the steam, the suction, the VapoRub. And then if your child is also having any kind of discomfort from the congestion or having fever, if your baby is over six months, you can do Tylenol and Motrin. If your baby is over the age of, I would still say about six months, you could give Tylenol. However, if your baby is less than six months, it's probably a good idea to be talking to your pediatrician about whether or not you should be using Tylenol or Motrin, because we'd like to keep an eye on those children more rather than just medicating them and seeing if their symptoms improve. It actually might be a good idea for them to come into the office for a checkup first.

Melanie Cole, MS: That's really great advice, and that is when we call our pediatricians if we ever have questions. And I just love those days when they're little babies. And we worry about them so much, but VapoRub is such a great idea and using a little Aquaphor around their little nose for that chafing, but that VapoRub really does help a lot to clear them up. And Dr. Wawrin, you just are such an excellent guest. Thank you so much for joining us today. And do you have any final thoughts you'd like to leave parents with about when babies aren't feeling well and their nose is running and what do we do?

Nicolina Wawrin, MD: Sure. We get so many calls about babies and having colds, and I think the most important thing is that if you have any concerns, you're letting us know. Because sometimes parents will think that their child is doing fine with their cold symptoms, they run their concerns past us, and we actually realize that maybe the child needs to come in for an appointment. So, just a very low threshold to be calling us. Hopefully, we can reassure you and just give the tips that I just gave and we can monitor from home. But every now and then we do hear something that is more concerning and we want the child to come in for a checkup. It's also totally fair to just schedule an appointment with your pediatrician for a lung, breathing, ear check to make sure that they're doing okay, as respiratory symptoms and pain discomfort can be difficult in really young children to discern without a checkup.

Melanie Cole, MS: Thank you so much again for joining us. And Weill Cornell Medicine continues to see our patients in person as well as through video visits and you can be confident of the safety of your appointments at Weill Cornell Medicine. That concludes today's episode of Kids Health Cast. We'd like to invite our audience to download, subscribe, rate and review Kids Health Cast on Apple Podcasts, Spotify and Google Podcasts.

For more health tips, go to weillcornell.org and search podcasts. And don't forget to check out Back to Health. We have so many great podcasts there. Thank you so much for listening. I'm Melanie Cole. Have a great day.

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