Nasal Congestion

A stuffy nose, a chronic cough, or recurrent croup. These are but a few examples of common reasons why loving mothers and families bring their child to come see an ENT Specialist. Let’s just stay focused on the stuffy nose. I remember during my residency training, an attending physician (one who has already finished their training) pulled me aside after hearing that I was going to spent two more years in special training to become an ENT just for children. “Why would you do a fellowship just to do tubes and tonsils?” Thankfully, this individual was terribly wrong about what my career has been about, but never, would I have known, that the career I have chosen as a pediatric ENT could have such an impact on the lives of children and their families. A stuffy nose. What is the big deal? Who cares? Well, a mother does, every mother and father cares. The most basic and vital of physiologic function that humans depend on is the ability to breathe comfortably through our noses. If anyone has truly really listened to the mothers and families of children who have chronic difficulty breathing through their nose, then he and she may begin to understand the despair over a stuffy nose. Every clinic day, I meet loving mothers and families who share with me their experiences of what initially was just irritating, but eventually frustrating, and finally emotionally, physically, and financially exhausting journey of seeking a solution for their child’s constant stuff nose.

Here is what a child with stuff nose may look and sound like: oh, they don’t all look the same. Some may look entirely healthy and normal until they open their mouth to speak, then they sound like they have a cold, or are congested with “stuff” up in their nose. Oh, but if you ask them to blow their nose, nothing comes out. Then there are those kids whose mouth are open all the time because they are so congested that they would not be able to live nor breathe if their mouth is closed. These kids are easier to pick out. Some have what I call “Darth Vader” breathing, you can hear them from across the room. They chew with their mouth open and take forever to eat. Some of them can’t even take swimming lessons or ever put their face in the water, since the moment you ask them to close their mouth or hold their breath they panic. Yet every day I meet many who have spent years living this way before they find me or I find them. Then there are those who just seem to be not their best, but quietly suffering without fever, nothing acutely wrong, but tires easily and mothers know that their child is not “clear” in the head.

Years ago, I used to dread seeing that chief complaint of “nasal congestion” before I walk into the room. There was a voice in me which used to immediately say, “Great, another one. Probably just a cold or parents who are overreacting, I mean, who does not get congested at some time or another.” That voice has long been banished. I am so grateful that each and everyday, because of what I was trained to do, I have embraced the opportunity to be the one to tell these mothers and families what is wrong with their child. The most specific thing that I can do as a pediatric ENT physician is that in the office I can use a thin, angel hair, spaghetti- noodle like fiberoptic camera and within 5 seconds I can look into the center of the child’s head and back of their nasal passage to tell if their symptoms are due to enlarged adenoid. One adenoid, not “adenoids.” An adenoid is like a tonsil, which a doctor can see when a child opens his/her mouth wide or with the use of a tongue depressor. An enlarged adenoid is something easily reducible through adenoidectomy surgery, thus enlarging the passageway for successful nasal airflow. But that’s not the main problem causing many children their chronic nasal stuffiness. For years I dreaded seeing the word “congestion” because if on my scope exam I did not see an enlarged adenoid, then what? When they are younger than 4, it is highly unlikely that they have allergies to the environment and the stuffy nose can be blamed on “allergies”. That certainly has not stopped well intentioned physicians as almost every child who come to me has already been given and tried nasal steroid spray and some type of antihistamine. One can easily believe that chronic use of Flonase, Claritin or Zyrtec are a right of passage in an American childhood as much as dressing up for Halloween.

So what is going on when I can’t blame the adenoid? Let me give a giant pardon to this misunderstood and unseen pad of tissue when it’s not enlarged, minding it’s own business while looking like pink brain tissue with ridges. We must also pardon the “sinuses,” cavities in the bone inside our heads which are lined with living tissue thin as paper but can become thick and swollen when inflammation sets in. But I digress. I’ll talk about the sinuses another day. It is very hard to convince mothers and families that they have a healthy child, to remind them to confirm to me that they gave birth to a healthy child. So what happened to that child? Well, my book A Healthier Wei is a total reflection of what I have observed in our children over the last several years. I have truly paid attention to their diet and dietary habits and I believe the answer often lies what they are eating/drinking and what time they eat. By now if you’re reading this blog you may have already read something about my book and my thoughts. Our children are consuming way too much dairy, way too much sugar, and we have been looking for medical solutions to symptoms caused by natural physiology and responses by the body when children are not eating and drinking in a way that is good for their health. I have only begun to see this issue after having a conversation with thousands of families to find out what their child is eating and drinking throughout the day and especially at night. Our conversations have lead me to see the patterns these children share. Constipation. Daily yogurt and/or cheese in addition to a lot of milk, A LOT! Chronic wet cough. Wheezing. Frequent or chronic “colds.” Whenever I ask a mother how much milk her child drinks per day, often she will reply, he LOVES milk. Then she will take a few minutes recalling the total number of ounces as we calculate a sum together, and then we confirm my suspicion that hers is also the child who loves cheese pizza, cheese sticks, anything with cheese on it. The toddlers with chronic congestion and runny nose are whom inspired me to do better. Mothers of these children are simply exhausted as they go through endless Kleenex, and have used breathing treatments without improvement as well as live with the sadness that their child has been diagnosed with “asthma” or worse yet, something is wrong with their child but no physician is quite sure what. Some have been diagnosed with “reflux disease” so they have been prescribed chronic daily use of acid production blocking medications. Often these medications do not help. These toddlers are rarely allergic to cow milk protein, so they are not allergic to milk, yet that does not meant that they can not have lactose intolerance or are simply given too much dairy in their daily nutrition. But milk is good for you right? If some is good then more is better right? Surely such logic can not be flawed, or can it? I am here to tell you that it can, more dairy hurts our children, as does more sugar. My book shares explanations on why too much dairy and sugar simply leads to too much acidity in our children’s stomach contents and almost mandate a way to get out of those little bodies as we continual to put them in. If it can’t get out of the bottom end fast enough, it will try to get out back through the mouth again. The nose, it’s just a victim of collateral damage.

Hope. Every loving mother, father, and family will do whatever it takes to get their child healthy again. It is that indestructible and courageous commitment to find the solution to help their child that often compels them to go to just one more doctor. Maybe, just maybe, this doctor, can prescribe the right medication(s) to make this stuff nose go away. When they meet me, this doctor will not prescribe any medications. In fact, there is a great likelihood this doctor will take your child off of medications. But beware, I will spend much time asking you what your child eats and drinks, and tell you if I think your child may have the “milk and cookie disease.” This doctor will challenge you to decide whether your child can eat and drink healthier and even ask you to decrease your child’s dairy and sugar consumption. This doctor will insist you stop the bedtime and nighttime snacking, and exercise tough love when teaching your child that the “kitchen is closed” after dinner(and small dessert immediately after if you must). This doctor, has hope, and I will share that hope with you. I have been privileged to share the thousands of positive experiences gained by families and children who have tried eating A Healthier Wei. Hope is the reason that I can’t wait to meet you and your child. Hope is why I love what I do, for the chance to make a difference, to fix that stuffy nose.