Decongestant nasal sprays

Is your child experiencing persistent nasal congestion? It could be worthwhile reassessing their current treatment methods. Using decongestant nasal sprays as a regular part of any medication routine can actually exacerbate the congestion if continued use takes place for more than three days in a row.

Nasal sprays to relieve sinus congestion and pressure should not be given to children under 6 years of age. Children aged 6 to 12 years of age should use nasal sprays under adult supervision. If your child is under 6 years old, a nasal aspirator, steam or humidifier will help. Saline drops are for use for children over 2 years old.

What is congestion?

Nasal congestion is a condition that arises when an illness, allergies, or other factors trigger inflammation and swelling of the blood vessels in the nasal passageways. This reaction causes the sensation of a congested nose, blocked nose or “stuffy” nose.

Generally, the go-to treatment for congestion is nose sprays that work by reducing the swelling of blood vessels in the lining of the nose enabling your child to breathe easier. This is because decongestant nasal sprays work quickly to alleviate nasal congestion because they deliver the decongestant directly to the affected area.

This side effect of nasal decongestant sprays is called rebound congestion. It is often mentioned on the label, and in the patient information leaflet, but not given enough emphasis. In fact, rebound congestion can actually feel worse than the original congestion that caused you to start using the spray on your child in the first place!

What is rebound congestion?

Rebound congestion, also known as rhinitis medicamentosa, is a condition where the nasal passages become congested or blocked due to the overuse of nasal decongestant sprays. It occurs when the blood vessels in the nasal passageways become accustomed to the active ingredients and develop a dependence on it, leading to a rebound effect when the medication wears off.

This causes a cycle of congestion when the blood vessels in your nose become dependent on these sprays, leading some people to continue using decongestant nasal sprays, which exacerbates the condition. Rebound congestion can be frustrating and uncomfortable, so it’s important to not use nasal decongestant sprays for more than three days to avoid it.

How long does rebound congestion last?

If your child is experiencing rebound congestion, it’s crucial to understand that the condition will persist as long as they continue to use the nasal decongestant spray. Once they stop using the spray, it may take a week or more for the congestion to subside. There is no quick fix – you just need to stop the spray, and help them start the recovery process.

Depending on how long they have been using the spray, they may suffer from severe congestion and headaches. If they have been using a spray for months or years, you may need to contact their healthcare professional to form a plan. This may involve using the spray only at night and in just one nostril for a few days. They may recommend a nasal steroid spray along with a saline spray to help keep the nose moist.

Should you avoid nasal sprays altogether?

Nasal sprays that contain oxymetazoline or phenylephrine are known to cause rebound congestion and should be used with caution. It’s essential to follow the instructions on the label and limit use to three days or less. There are both well-known brands, and also generic options available, so it is crucial to check the active ingredients of any nasal spray you use on your child.

It’s not necessary to completely avoid decongestant sprays containing oxymetazoline or phenylephrine, especially if your child is experiencing severe congestion due to a cold. However, it’s essential to view these sprays as a short-term solution rather than a long-term one. To avoid rebound congestion, it is important to be aware of the potential risks and limit use.

Dealing with chronic congestion

If you were using decongestant sprays on your child to manage congestion resulting from a cold or upper respiratory infection, the condition will likely improve on its own. But once you have stopped the spray, and symptoms persist, the next question becomes: What caused the symptoms to make you give it to them in the first place?

If their congestion is of a chronic nature, you will need to consult their healthcare professional about the root cause and the best way to manage it. The underlying cause of congestion could include allergies, chronic sinusitis, or a deviated nasal septum.

We recommend that you see an expert if your child is suffering from chronic nasal congestion, and to get them help dealing with rebound congestion if they have been using decongestant nasal sprays for a prolonged period. There will be reasons the underlying issues are happening. At Children’s Allergy Doctors we can identify these and provide an approach to dealing with it effectively.

If you have any questions about decongestant nasal sprays or if you wish to further seek advice, please contact our practice team on 0203 146 7721 or email


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