Appendix 15. Clearing of the nasopharynx (nasal irrigation)

Nasal irrigation is indicated in children with breathing difficulties due to upper airway obstruction from secretions. It should be performed one hour before or after a feed or a meal if possible. There are two methods: the instillation method and the volumetric method.

15.1 Instillation technique (done by parents, at home)

– Wash hands.
– Lay the child on his back.
– Instil 2 to 4 drops of normal saline in each nostril when the child inhales.
– Raise the child (to a semi-seated position) and collect the secretions from the nose and mouth with a tissue.
– Wash hands.

15.2 Volumetric technique (done by care provider at an outpatient visit or in the hospital)

– Wash hands.
– Lay the child on his back, head slightly elevated.
– Placing one hand under his neck, turn his head to the right to treat the left nostril.
– Insert the dropper tip of the normal saline vial at the opening of the left nostril.
– Squeeze the vial when the child inhales.
– If the child coughs, stop the instillation and let him settle down for a few minutes.
– Check that the saline and secretions have drained via the right nostril.
– Raise the child’s head slightly so that the fluid can drain more easily.
– Collect the secretions.
– Repeat the procedure on the other side.
– Monitor the child for a few minutes after the procedure.
– Wash hands.