Nasal suction. Miraculous simplicity

It is bronchiolitis season my friends. Even I have a bit of the URI. When we’re talking bronchiolitis, the conversation is almost always about: do steroids or bronchodilators work, what to do with a touch of hypoxia. Important conversations to be sure, but the highest yield pearl I have ever received about bronchiolitis (or any pediatric URI for that matter) was given to me by pediatric emergency physician Andy Sloas. Wash it out, suck it out.


Direct Download

 

We know that babies are obligate nose breathers. When that nose is plugged, breathing is harder and they don’t eat. When they don’t eat, they get sicker. They cycle continues until they get dehydrated and REALLY sick.

Sometimes a baby with a stuffy nose who isn’t eating just needs a little nasal clean out. They breathe easier, they start to eat, or drink (which is usually the case) and often can go home without any other treatment.

So if a child has a URI with a runny nose and isn’t feeding, squirt in some saline and suction out the boogers. The key is in the home care. Most parents will tell you that they’re suctioning with the little bulb suction, but they can benefit from a structured approach.

Home care

How often to suction?

Breakfast, lunch, dinner and right before bed.

Saline drops

Before suctioning, squirt in some saline drops. You can give the parents some drops or they can buy them from the pharmacy.

Squirt in the saline drops. The child might cough. They might cough, swallow mucus, and vomit after some saline drops. All that nasal goo getting swallowed can make kids vomit, and that’s expected. Not desirable, but it happens. First saline drops, then suction. The parents might not be able to get mucous with each suction and that’s OK. It’s the repeated attention that matters.

Here is an example of a discharge instruction for runny nose treatment. 

To help clear nasal secretions (nasal mucus and runny nose) spray over-the-counter saline nasal spray (or drops) into each nostril morning and night and with each feeding. After this, suck out each nostril with a bulb suction. Spraying in the saline spray will help clear the nasal mucous and loosen it up so that it can be better suctioned. Your child may gag or cough after the saline is sprayed in the nostrils, this is not unexpected. Keeping your child’s nasal passage open will help them breathe easier and make it easier for them to eat and drink.

 

Disclaimer: This is only an example of phrasing for discharge instructions. It is not meant as medical advice. Please see site disclaimer for further details.

Comments

  1. Dean Tanner

    Great summary! Also, if parents feel that suction bulbs are not doing the trick at home, you can make them a makeshift nasal aspirator by connecting a ~2ft piece of suction tubing to a nasal suction tip (respiratory or nursing use these frequently and can find them for you). Caregiver then puts the tubing end in their mouth and sucks the secretions out. Rinse and repeat. Sounds gross, but works very well. There are commercial options available as well with filters if you get funny looks. This will sometimes validate their efforts and give them a new trick to try out.
    Dean, EM Resident, Carolinas Medical Center

  2. Ali El-Khidir

    In the old days when there were no suckers,or even no normal saline on the counter,our grandmothers used to put their lips on the small nose of her grandchild,suck it out and spit it off.And her grandson starts sucking the breast,or drink or eat,while her daughter was turning her head away during the procedure. NOTE:using excess normal saline may lead to hypernatraemia in very small babies

Awesome article, I know - please share your erudite thoughts...