This pre-referral guideline covers Rhinorrhoea/nasal congestion in children of all ages.

Initial work-up

Surgery for problems with the nasal mucosa is rarely indicated as it does not correct the underlying cause.

• Rule out allergic rhinitis.
• History of atopic dermatitis or a strong family history.
• Allergy testing if indicated.

Pre-referral treatment

• Topical corticosteroid nasal sprays (e.g. beclomethasone or budesonide) for perennial and seasonal allergic rhinitis, as well as perennial non-allergic rhinitis. Long term use has not been shown to cause suppression of the hypothalamic-pituitary-adrenal axis.
• In seasonal rhinitis – commence spray one month prior to the relevant pollen season and continue over the symptomatic period.
• Allergen avoidance measures i.e. animal hairs, dust.
• Antihistamines – not first line treatment. May be used for seasonal rhinitis. Second generation, non-sedating antihistaminics are well tolerated – Loratidine and cetirizine.

When to refer

• Assessment by allergist if strong history of atopy
• Assessment by otolaryngologist if adenoidal hyperplasia suspected
• Bring any x-rays done.
• Documentation of clinical course and treatment and response to date.

Referral form (pdf)

Parent handout (pdf)

Resources

Kids Connect (RCH Primary Care Liaison)

Kids Health Info (Parent fact sheets online)

Contact information

References

Paediatric Handbook Ear, Nose and Throat Conditions, Chapter 21 (pp312-324); Robert Berkowitz and Michael Marks; Seventh Edition, Blackwell Publishing. By the staff of the Royal Children's Hospital, Melbourne, Australia