Researchers leading the U.K.-based ELVIS-Kids trial found that children who were given hypertonic saline nose drops when they developed a cold had fewer sick days than those who did not use the drops. Of the 407 children ages 6 and under in the trial, 301 of them developed a cold. Of these, 150 participants received three drops of hypertonic saline per nostril at least four times daily. They experienced symptoms for an average of six days, compared to eight days for those who received standard cold care without saline drops. In addition, fewer households reported family members catching a cold, according to the study.

Saline drops and nasal rinses have long been recommended by physicians for cold symptom relief, usually in the form of isotonic saline, which has a salt concentration of 0.9%. This is similar to the natural salt content of the body. Hypertonic saline has a higher salt concentration of 2.6% or more. Both are safe and effective methods for reducing congestion by flushing and moisturizing nasal passages, according to Amy Stockhausen, M.D., a pediatrician at Cook Children’s Pediatrics Carrollton.

Trial investigators suggest the higher salt concentration of a hypertonic solution helps to increase the production of hypochlorous acid within the cells lining the nose. In turn, the hypochlorous acid helps to suppress viral replication, leading to fewer sick days and faster relief of symptoms. Dr. Stockhausen says this is a good theory for why it works, but other mechanisms could be at play. 

“I think that they are taking the body's natural physiologic mechanisms and assuming that that's what's going on, but it’s not clear to me from the article itself that we know that for certain, but it makes some sense,” Dr. Stockhausen said.

Even so, she says, the results are promising.

“This particular study gives us some interesting insight that what we've been recommending for symptomatic treatment may actually make you better faster,” she said. “That's pretty exciting if they can actually show that that's true.”

Both hypertonic and isotonic saline drops are safe, inexpensive and can be purchased over-the-counter. Dr. Stockhausen recommends isotonic saline drops to her patients for symptom relief with any upper respiratory virus that causes congestion and runny nose. With its higher salt concentration, hypertonic saline may sting or cause some discomfort to the lining of the nasal passages. Dr. Stockhausen recommends dropping down to isotonic saline if you experience discomfort with a hypertonic solution.

She also cautions parents about applying too much force when using a saline spray or mist.

“If you are forcibly pushing salt water into the nose, you can end up causing some pressure injury to the eustachian tubes or the back of the nose. So you have to be careful that it’s under low pressure,” she said.

Parents should also be careful about making their own saline solution at home. Using iodized salt from the baking shelf is not recommended as it can irritate the nose, and tap water should never be put into the nose. It contains chemicals and bacteria that can damage the inside of the mucous membranes and cause serious harm. Always use distilled water when mixing a saline nasal rinse.

In addition to saline drops, Dr. Stockhausen offers these tips for relieving cold symptoms:

• Moist air in the form of a steamy bathroom or a humidifier next to the bed helps keep mucus thin and wet, so it’s easier to expel. You can add Vicks to the steam or vaporizer if you choose. 
• Honey has natural mucus reducers and anti-inflammatories that help break up mucus in the throat and quiet coughs naturally without side effects. Give a spoonful of honey as often as needed to children over 12 months of age. It can also be given in warm liquids such as tea or apple juice. It should not be used in infants under 12 months.
• If your child is old enough to gargle, warm salt water gargles can help with throat symptoms.
• Use over-the-counter pain and fever medications like acetaminophen or ibuprofen as needed if your child's symptoms are causing discomfort or changes in their eating/drinking and sleeping patterns.
• Encourage fluids to stay hydrated, and get lots of rest to allow the immune system as much energy as possible for fighting off the illness.
• Over-the-counter cough and cold multi-symptom remedies for children are generally not recommended. They are often ineffective, can cause multiple side effects like elevated blood pressure and irritability, and can excessively dry up mucus making it difficult to expel. Additionally, data is limited on their safety, especially in young children.

In the meantime, here are some things you can do to help.

Suction, suction, suction. Your old friend the bulb suction (aka nasal aspirator or booger-sucker) is the best thing you have against congestion. Many times people tell me they don’t get anything out when they use it but that is usually because they aren’t doing it right. Depress the bulb, push the tip in the nose until you have a seal on the nostril and then release. Repeat for each side. There are other devices that you can use to accomplish the same goal. I’ve seen a mom place her mouth directly over the nose and suck (yeah, wow) and there’s also the battery operated device. The other one that I have a handful of families using is the Nose Frida. This device allows you to suck mucous out of baby’s nose with a tube that has a filter in it. Seems kinda weird to me but my families who use it swear by it.

My two main recommendations about suction are that you should stop whenever you are no longer getting anything and that you shouldn’t suction thousands of times a day. If you continue to suction without production, you are only causing swelling in the nasal passage and making the problem worse. If the child is happy and noisy, there is no reason to suction them. Reserve your suction times to before meals and at bedtime. If they are just noisy, it is bothering you more than it is bothering them.

Nasal saline drops-putting some nasal saline drops in the nose can be very helpful with that hard to reach congestion in the back of the nose and when the congestion seems to be thickening such that it cannot be extracted with suction. Just place a few drops to each side of the nose and then pull with suction to get a little more snot out.

Humidity-keeping the nose nice and moist actually helps to smooth the air flow as it goes from the nose to the trachea and into the lungs. This helps the babies breathing stay comfortable. I get asked all the time about whether it should be warm or cool mist and I frankly don’t care. If you have child have bad congestion/coughing, getting the bathroom with the shower going can be helpful as well.

So, these are my helpful tips for congestion.

Any one else have anything that they have used out there? Any one used the Nose Frida?