Child's Nasal Congestion and Unpleasant Odor: Possible Causes and Solutions

Nasal congestion during sleep with an unusual odor in the left nostril?

Doctor, my child is currently 2 years and 10 months old.
For the past two weeks, he has been experiencing nasal congestion during sleep.
Today, before his nap, I helped him clear his nostrils and noticed an unusual odor coming from his left nostril.
I'm concerned that there might be something lodged inside (he has a history of this).
He has not had a cold recently and there has been no nasal discharge (only a little when he cries).
Does he need an X-ray? Additionally, could this be sinusitis?
Secondly, over the past month, he has developed many small skin lesions on the back of his hands.
They are skin-colored.
Initially, they appeared in localized areas and would resolve, but recently they have spread into a patch and do not itch.
However, the back of his hands feels rough to the touch.
Could this be atopic dermatitis? I have seen a dermatologist who insisted that treatment is necessary, or it may spread.
However, I am reluctant to use steroid medications on my child.
Aside from the back of his hands, there are no other abnormalities on his body, but his face has also become slightly rough, although it does not itch and there are no rashes.
Does this require treatment?

Mami, 30~39 year old female. Ask Date: 2009/12/24

Dr. Xiao Kaiwen reply Pediatrics

If there is long-term unilateral nasal congestion, runny nose, or even nasal odor, the presence of a foreign body in the nasal cavity is a possibility.
X-rays can only detect metallic objects; non-metallic objects are not visible on X-rays.
Therefore, an examination for nasal foreign bodies should be conducted by an otolaryngologist using a nasal endoscope.
Sinusitis may also cause nasal odor, so it is advisable to have an evaluation by an otolaryngologist as well.
Skin rashes are best assessed in person (written descriptions are less suitable), and it is recommended to seek a professional diagnosis and consultation from a dermatologist.

Reply Date: 2009/12/24

More Info

When it comes to your child's nasal congestion and the unpleasant odor you noticed in the left nostril, there are several potential causes to consider. Given that your child is only 2 years and 10 months old, it is essential to approach this situation carefully.

Possible Causes of Nasal Congestion and Odor
1. Foreign Body Obstruction: One of the most common causes of unilateral nasal symptoms in young children is the presence of a foreign body lodged in the nasal cavity. This can lead to nasal congestion and an unpleasant odor due to localized infection or tissue irritation. Since you mentioned that your child has a history of inserting objects into their nose, this is a strong possibility. If you suspect this, it is crucial to seek medical attention promptly. An ENT specialist can perform a thorough examination and, if necessary, remove the foreign object.

2. Sinusitis: While your child does not currently have a cold or runny nose, it is still possible for them to develop sinusitis, particularly if there has been a recent upper respiratory infection. Sinusitis can cause nasal congestion, facial pain, and sometimes a foul smell due to the presence of pus in the sinuses. If the symptoms persist or worsen, imaging studies such as X-rays or a CT scan may be warranted to assess for sinus involvement.

3. Allergic Rhinitis: Allergies can also lead to nasal congestion, although they typically present with clear nasal discharge. If your child has been exposed to allergens (like dust mites, pet dander, or pollen), this could be a contributing factor. Allergic rhinitis can sometimes lead to secondary infections, which may cause odor.

4. Nasal Polyps or Other Structural Issues: In some cases, structural abnormalities in the nasal passages, such as nasal polyps, can lead to chronic congestion and odor. These are less common in young children but should be considered if other causes are ruled out.

Recommendations
- Medical Evaluation: Given the presence of an odor and the history of nasal congestion, it is advisable to consult an ENT specialist. They can perform a nasal examination and determine if further imaging is necessary. If a foreign body is present, it should be removed as soon as possible to prevent complications.

- Home Care: In the meantime, you can help alleviate nasal congestion by using saline nasal drops or sprays. These can help moisten the nasal passages and may assist in clearing any mucus.

- Avoid Irritants: Ensure that your child is not exposed to irritants such as smoke, strong odors, or allergens that could exacerbate nasal congestion.

Regarding the Skin Condition
As for the skin condition on your child's hand, it is essential to consider the following:
1. Eczema (Atopic Dermatitis): The description of small, skin-colored bumps that feel rough could suggest eczema, especially if it is not itchy. Eczema can appear in patches and may require treatment to prevent it from spreading or worsening.

2. Contact Dermatitis: If your child has been exposed to any new soaps, detergents, or materials, this could also cause localized skin irritation.

3. Treatment Options: While you are hesitant to use topical steroids, it is important to discuss this with a pediatric dermatologist. There are non-steroidal options available, such as calcineurin inhibitors (e.g., tacrolimus or pimecrolimus), which can be effective for treating eczema without the side effects associated with steroids.

4. Moisturization: Regularly applying a good moisturizer can help manage dry skin and prevent flare-ups. Look for fragrance-free and hypoallergenic products.

Conclusion
In summary, your child's nasal congestion and the unpleasant odor warrant a thorough evaluation by an ENT specialist to rule out foreign bodies or sinusitis. For the skin condition, consulting a dermatologist is advisable to determine the best course of treatment while considering your concerns about steroid use. Early intervention can help manage both issues effectively and improve your child's comfort and health.

Similar Q&A

Managing Headaches in Children: When Nasal Congestion is the Cause

Hello, my daughter is six years old and has been frequently complaining of headaches for the past six months, with no fixed pattern for the episodes. After a recent cold, we consulted a doctor who mentioned that the headaches were caused by nasal congestion. I suddenly recalled t...

Dr. Gu Qingxian reply Pediatrics
Based on your description of your daughter's condition, she may be suffering from chronic rhinitis or sinusitis. It is advisable to visit a pediatrician or an otolaryngologist for diagnosis and treatment. If her nasal condition is treated but she still experiences headaches,...

Understanding Persistent Nasal Congestion in Children: Causes and Solutions

Hello Dr. Jian: My 5-year-old child has been experiencing nasal congestion since last month. When blowing his nose, the mucus is thick, sticky, and white. He often has a cough accompanying the nasal symptoms. We have seen an ENT specialist who diagnosed it as allergies and prescr...

Dr. Jian Huangqi reply Otolaryngology
Hello, Xiao Ou: Your child may have acute rhinitis accompanied by post-nasal drip causing coughing symptoms. You can bring him to my clinic for a consultation. Thank you!

Managing Sleep Breathing Issues in Allergic Children: Effective Solutions

Hello Doctor: My child is currently 4 years old and has a history of allergic conditions. He/she has loud and noisy breathing during sleep and often wakes up crying at night due to nasal congestion. He/she also has a habit of sneezing, having a runny nose, and rubbing his/her eye...

Dr. Lin Sixie reply Rare Disease
Your child may be suffering from allergic rhinitis. Allergic rhinitis can be broadly classified into two types: seasonal allergic rhinitis, which occurs during the flowering season of plants, and perennial allergic rhinitis, which is associated with year-round allergens such as d...

Understanding Allergies vs. Tic Disorders in Children: A Parent's Guide

Hello Dr. Hsiao: For the past month, my son has been constantly sniffing. One doctor said it is allergies, while another suggested it might be a tic disorder. We took him to see a pediatric psychiatrist, and the doctor said we need to observe him further. I would like to know if ...

Dr. Xiao Kaiwen reply Pediatrics
Nasal itching, nasal congestion, sneezing, and persistent runny nose are most likely due to nasal allergies in Taiwan. If there is a family history of allergies (such as allergic rhinitis, asthma, or skin allergies), the likelihood increases. Blood tests can be conducted to measu...