Runny nose and sneezing are common symptoms in children, especially during cold and flu season. Most children experience these symptoms multiple times a year, particularly in the winter and early spring. In many parts of the world, sneezing and a runny nose can also be more common during allergy seasons, like spring and fall, when pollen counts are high. While these symptoms are usually harmless, they can cause discomfort and lead to visits to the doctor, so it’s helpful for parents to understand what might be causing them and how to manage them.
The anatomy of a runny nose and sneezing
The sinonasal tract includes the nasal cavity and the sinuses, which play essential roles in breathing and protecting the respiratory system. The nasal cavity is lined with a type of tissue called respiratory epithelium, which consists of several cell types, including goblet cells that produce mucus and ciliated cells that help move mucus and trapped particles out of the nose. The sinuses are air-filled spaces within the bones of the face and head that drain into the nasal cavity. The nose and sinuses are richly supplied with blood vessels, which help warm and humidify the air as it enters the body. Warm, moist air is easier on the lungs and helps protect against infections by trapping particles like dust and bacteria.
The tissues inside the nose and sinuses work together to protect the respiratory system. When the nasal lining is irritated by infections, allergens, or other environmental factors, the blood vessels in the nasal mucosa dilate, increasing blood flow to the area. This response helps deliver immune cells to fight off invaders but also causes the mucous membranes to swell, leading to the sensation of being “stuffed up.” At the same time, the goblet cells produce more mucus in an attempt to trap and flush out the irritants, resulting in a “runny nose.” The mucus produced can vary in consistency: it is usually clear and watery during allergic reactions or early viral infections but can become thicker and colored during bacterial infections or as the body fights off a virus.
Sneezing is a protective reflex triggered by irritation in the nasal mucosa. When particles such as dust, pollen, or microbes irritate the lining of the nose, sensory nerves send a signal to the brain’s sneeze center. In response, the brain coordinates a powerful and rapid contraction of muscles in the chest and throat, which forces air out through the nose and mouth. This expulsion helps to clear the nasal passages of irritants, preventing them from entering deeper parts of the respiratory system. Sneezing is a vital defense mechanism that helps clear the airways and protects the lungs from harmful substances.
What is the most common cause of a runny nose and sneezing in children?
Viral infections
The most common cause of a runny nose and sneezing in children is viral infection, also known as the common cold. Rhinoviruses are the leading cause, though other viruses such as coronaviruses, respiratory syncytial virus (RSV), and adenoviruses may also be responsible. The incidence of the common cold is highest in young children, particularly those under five years of age, who may experience up to eight colds per year. The virus spreads through respiratory droplets when a child sneezes or coughs, and it can also be spread by direct contact with contaminated surfaces.
In a common cold, symptoms usually begin with a sore throat and nasal congestion, followed by a runny nose, sneezing, and coughing. The nasal discharge starts clear and becomes thicker and yellow or green over time. Additional symptoms can include a low-grade fever, fatigue, and irritability. Diagnostic clues include the gradual onset of symptoms over several days and the absence of more severe signs such as high fever or difficulty breathing. Treatment typically involves supportive care, including plenty of fluids, rest, and saline nasal drops to ease congestion. Over-the-counter medications may be used to manage symptoms, but antibiotics are ineffective against viral infections.
How long is a child contagious after a viral infection?
After a viral infection, children can remain contagious for varying lengths of time depending on the specific virus causing the illness. For most common colds caused by rhinoviruses, children are typically contagious for about 1 to 2 days before symptoms appear and can remain contagious for up to 7 to 10 days after symptoms start. However, they are usually most contagious during the first 2 to 3 days when symptoms such as sneezing and a runny nose are at their peak.
For other viral infections like influenza (the flu), children may be contagious for about 1 day before symptoms appear and remain contagious for up to 7 days after the onset of symptoms. Young children and those with weakened immune systems may shed the virus for longer, increasing the risk of spreading it to others.
Respiratory syncytial virus (RSV), which commonly affects infants and young children, can also be contagious for several days before symptoms appear and up to a week or more after. Again, children with weakened immune systems or severe illness may continue to spread the virus for longer.
It’s important to remember that even if a child’s symptoms improve, they can still be contagious. Good hygiene, such as frequent handwashing, using tissues, and keeping children home from school or daycare when they are sick, can help prevent the spread of infections to others.
Other common medical conditions associated with runny nose and sneezing in children
Allergic rhinitis
Allergic rhinitis occurs when a child’s immune system overreacts to allergens such as pollen, dust mites, or pet dander. Children with allergic rhinitis often have a history of other allergic conditions, such as asthma or eczema. Symptoms include sneezing, clear secretions from the nose, nasal congestion, and itchy eyes. Symptoms tend to worsen in certain environments or during specific seasons. Unlike viral infections, allergic rhinitis does not cause fever. Management includes avoiding triggers and using antihistamines or nasal corticosteroids.
Sinusitis
Sinusitis is inflammation of the sinuses, usually caused by infection following a cold. Acute sinusitis may cause prolonged nasal congestion, thick yellow or green nasal discharge, facial pain, and headache in children. Sinusitis can be distinguished from the common cold by the duration of symptoms, often lasting more than 10 days without improvement. Treatment may include nasal saline irrigation, nasal corticosteroids, and, in some cases, antibiotics if a bacterial infection is suspected.
Acute otitis media
Acute otitis media is a middle ear infection that often follows an upper respiratory illness in children. Symptoms include nasal congestion, a runny nose, fever, and ear pain or tugging. Nasal congestion can lead to a blockage of the Eustachian tubes, allowing fluid and bacteria to accumulate in the middle ear. Treatment may include pain relief and, in some cases, antibiotics.
Adenoid hypertrophy
Adenoid hypertrophy occurs when the adenoids enlarge, causing chronic nasal congestion, mouth breathing, and recurrent infections. Children with adenoid hypertrophy may have a persistent runny nose and nasal obstruction, leading to difficulty breathing through the nose. Diagnosis is often based on physical examination, and management may include nasal corticosteroids or surgery in severe cases.
Viral bronchiolitis
Viral bronchiolitis, commonly caused by respiratory syncytial virus (RSV), affects infants and young children. It leads to inflammation of the small airways in the lungs. Symptoms include nasal congestion, a runny nose, coughing, wheezing, and difficulty breathing. The condition often starts with symptoms similar to the common cold but progresses to more severe respiratory distress. Treatment focuses on supportive care, including fluids, oxygen, and, in some cases, hospitalization.
Pertussis (whooping cough)
Pertussis is a bacterial infection caused by Bordetella pertussis, characterized by severe coughing fits followed by a “whooping” sound. Early symptoms may mimic a cold with a runny nose, sneezing, and mild fever, but the condition progresses to prolonged coughing spells. Diagnosis is confirmed through laboratory testing, and treatment involves antibiotics.
Foreign body in the nose
A foreign body in the nose can cause a unilateral (one-sided) runny nose, often with foul-smelling discharge. This condition typically affects young children and can be distinguished from infections by the localized nature of the symptoms. Removal of the foreign body is necessary, and medical attention is required.
Measles
Measles is a highly contagious viral infection that starts with cold-like symptoms, including a runny nose, sneezing, and cough, followed by a characteristic rash. The rash typically begins on the face and spreads down the body. Diagnosis is based on clinical presentation and confirmed with laboratory tests. Vaccination is the primary method of prevention.
Influenza (flu)
Influenza, or the flu, is a viral infection that affects the respiratory system. Symptoms include a runny nose, sneezing, fever, body aches, and fatigue. The flu tends to cause more severe symptoms than the common cold. Treatment involves antiviral medications in some cases, as well as rest and hydration.
Croup
Croup is a viral infection that causes swelling of the vocal cords and leads to a barking cough, hoarseness, and sometimes a runny nose. Children with croup may also have difficulty breathing, especially at night. Treatment includes cool mist or corticosteroids in more severe cases.
Less common but medically important causes of runny nose and sneezing in children
Nasal polyps
Nasal polyps are soft, painless growths inside the nasal passages or sinuses. They are more common in older children or those with conditions such as cystic fibrosis or chronic sinusitis. Symptoms include chronic nasal congestion, a persistent runny nose, and loss of sense of smell. Although rare in young children, nasal polyps can cause recurrent infections and breathing difficulties. Diagnosis is often made through imaging or nasal endoscopy, and treatment may involve nasal corticosteroids or surgery in severe cases.
Primary ciliary dyskinesia
Primary ciliary dyskinesia is a rare genetic disorder where the cilia, the tiny hair-like structures in the respiratory tract, do not function properly. This leads to impaired mucus clearance from the nasal passages and sinuses. Children with this condition often have chronic nasal congestion, a persistent runny nose, and frequent respiratory infections. Diagnosis requires specialized testing, such as a biopsy of the cilia or genetic testing. Management includes airway clearance techniques and sometimes antibiotics to prevent infections.
Choanal atresia
Choanal atresia is a congenital condition in which one or both nasal passages are blocked by bone or tissue. Infants with choanal atresia may present with difficulty breathing, especially when feeding, and chronic nasal discharge. This condition is usually diagnosed soon after birth and may require surgical correction to open the blocked nasal passages.
Cystic fibrosis
Cystic fibrosis is a genetic disorder that affects mucus production, leading to thick, sticky mucus in the lungs, digestive system, and sinuses. Children with cystic fibrosis often have chronic nasal congestion, a persistent runny nose, and frequent sinus infections. Diagnosis is made through genetic testing or sweat chloride testing, and management involves airway clearance techniques, medications, and sometimes surgery for sinus problems.
Wegener’s granulomatosis (granulomatosis with polyangiitis)
Wegener’s granulomatosis is a rare autoimmune condition that causes inflammation of the blood vessels in the respiratory tract, including the nose. Symptoms may include chronic nasal congestion, a bloody or crusted runny nose, and sinus pain. Diagnosis is made through blood tests and tissue biopsy. Treatment involves immunosuppressive medications to reduce inflammation.
Immune deficiency disorders
Children with immune deficiency disorders, such as severe combined immunodeficiency (SCID) or common variable immunodeficiency (CVID), are more prone to frequent and severe respiratory infections. These children may present with a chronic runny nose, sneezing, and recurrent sinus infections. Diagnosis involves specialized immune testing, and treatment may include immunoglobulin replacement therapy or bone marrow transplantation in severe cases.
Viral infections versus allergies: How to tell the difference
Parents can struggle to determine whether their child’s sneezing and runny nose are caused by a viral infection or allergies, as the symptoms often overlap. However, several key differences can help distinguish between the two.
Viral infections, such as the common cold, typically develop more suddenly. Children may start with a sore throat, mild fever, and fatigue, followed by sneezing and a runny nose. The nasal discharge in viral infections often starts clear but can become thicker and yellow or green as the illness progresses. Symptoms usually last for a week to 10 days and improve over time. Viral infections can also be associated with additional symptoms like coughing, body aches, and general discomfort.
In contrast, allergies are caused by an overreaction of the immune system to harmless substances like pollen, dust mites, or pet dander. Children with allergies often experience persistent sneezing, a clear runny nose, itchy eyes, and nasal congestion. Unlike viral infections, allergies do not cause fever, fatigue, or body aches. Specific environmental factors usually trigger allergies and tend to flare up in certain seasons (such as spring or fall) or in particular settings (like being around pets). Allergies also tend to be more prolonged and may persist as long as the child is exposed to the allergen.
One important thing for parents to know is that frequent episodes of sneezing and a runny nose in children do not always indicate allergies. Viral infections are very common in young children, who may experience multiple colds each year, especially during the winter months. If your child’s symptoms are temporary, vary with the seasons, and are accompanied by fever or other signs of illness, it is more likely due to a viral infection. If the symptoms persist for weeks or worsen in specific environments without fever, allergies could be the cause.
Advice for parents
Should a child who is sneezing and has a runny nose see a doctor?
A child with a runny nose and sneezing does not always need to see a doctor. Most cases are caused by viral infections, such as the common cold, which typically resolve on their own with supportive care. However, you should seek medical advice if the child has a high fever, difficulty breathing, or symptoms lasting more than 10 days without improvement. Other warning signs that may warrant a doctor’s visit include ear pain, a persistent cough, rash, or if the nasal discharge has a foul smell, which could indicate a foreign body or bacterial infection.
What is the most appropriate treatment for a child with a runny nose and sneezing?
Treatment for a runny nose and sneezing in children generally focuses on relieving symptoms, as most cases are due to viral infections that do not require antibiotics. Providing plenty of fluids, using saline nasal drops or a nasal aspirator to clear mucus, and ensuring the child gets adequate rest are simple but effective strategies. Over-the-counter medications for children may ease discomfort, but always consult a healthcare provider before administering any medication. Nasal corticosteroids or antihistamines may be prescribed if allergies are suspected.
Tips for helping your child avoid getting sick again
Preventing future episodes of runny nose and sneezing can involve good hygiene practices and avoiding common triggers. Please encourage your child to wash their hands frequently, especially before eating and after touching shared surfaces or other children. Avoid exposing your child to secondhand smoke or known allergens like pet dander or dust mites. Keeping up with vaccinations, including the annual flu vaccine, can also reduce the risk of respiratory infections. In environments where infections are more likely, like daycare centers or schools, reinforcing healthy habits like using tissues and sneezing into the elbow can help prevent illness.
Summary
Runny nose and sneezing in children are common symptoms usually caused by viral infections like the common cold. These symptoms occur when the nasal passages produce excess mucus or become inflamed in response to irritation or infection. While most cases resolve on their own, certain conditions, such as allergic rhinitis, sinusitis, and foreign bodies, may require medical evaluation and specific treatment. Understanding the cause of a child’s runny nose and sneezing can help guide appropriate care and management.