Six reasons why newborns have stuffy noses

By Howard J. Bennett, MD

If I asked a group of first-time parents if their baby has a cold, more than half of them would say yes. If I asked the same group of parents if their newborn has a runny nose, almost all of them would say no. What many first-time parents don’t realize is that newborns usually sound stuffy when they breathe.

If a newborn gets a cold, she will develop a runny nose just like older kids. The baby will be very congested and a moderate amount of nasal secretions will be produced throughout the day.

If colds don’t explain why newborns have stuffy noses, what does? Rarely, a baby can be born with a medical problem that results in significantly narrowed nasal passages. Doctors can recognize this because the baby will have distress with breathing or won’t be able to feed well enough to gain weight.

Most babies sound stuffy in the first few months for the following reasons:

  1. Fetuses float in amniotic fluid. Some of this fluid gets into their nasal passages during birth, and it may take a few days for it to be cleared.
  2. Newborns don’t breathe regularly. Instead, they commonly take shallow breaths followed by pauses and deeper inspirations. The deeper breaths create turbulence in their nasal passages, which makes their breathing sound stuffy.
  3. Babies often reflux (spit up) in the first few months of life. Although most of the milk they regurgitate comes out their mouths, some of it may pass into their nasal passages from the back. This can cause mild swelling of the nasal passages that increases their stuffiness.
  4. A baby’s nasal passages (like ours) is equipped with tiny hairs and mucus-producing glands to trap dust and other floating matter thereby keeping it out of the baby’s lungs. This process may increase the stuffy sounds of a newborn’s breathing.
  5. Babies are too young to snort or sniff. As a result, they are less able than older children to clear their nasal passages. They can sneeze, of course, but this does little to relieve the stuffiness parents notice.
  6. Newborns are “obligate nose breathers.” This means they can’t breathe through their mouths in the first few months of life. Because babies have small nasal passages, they sound stuffy when they breathe. This is one of the reasons why you should never use drugs like Neosynephrine on newborns. Although the medicine will shrink the baby’s nasal passages, when it wears off, the nasal passages may become more swollen than they were before the medicine was used. This can cause severe respiratory distress because the baby can’t compensate for the “rebound” nasal congestion by breathing through her mouth.

Doctors and nurses get lots of calls about what to do with a newborn’s stuffy nose. Here are my usual answers to those questions. Saline drops? No. Nasal aspirator? No. Leave them alone? Yes.

If your baby is feeding well, there is no reason to irritate her sensitive nasal passages with salt water or a blunt plastic object. However, if your baby is having trouble breathing, especially with feeding, you should make an appointment to see the doctor.


© 2014 Howard J. Bennett. All Rights Reserved.

 (Originally published in the Washington Post)

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