Ep 208: When Kids Always Sound Stuffy: Chronic Congestion, Snoring, and Mouth Breathing with Dr. Nina Shapiro (Part 2)

In this episode of Your Child Is Normal, Dr. Jessica Hochman welcomes back Dr. Nina Shapiro, pediatric ENT and author of Take a Deep Breath: Clear the Air for the Health of Your Child.

If your child always sounds congested, snores at night, or breathes through their mouth, this episode is for you. Dr. Shapiro explains the most common causes of chronic nasal stuffiness in kids — from back-to-back colds to allergies — and what parents can realistically do to help.

You’ll learn:

• Why constant congestion is so common in young kids
• How to safely use nasal saline, steroid sprays, and antihistamines
• When to think about allergies, adenoids, or sinus infections
• What “tired and wired” means, and how sleep and behavior connect
• Why mouth breathing happens — and when it’s okay vs. when to act

Dr. Shapiro also shares her favorite over-the-counter nasal spray for kids, her take on milk and mucus, and practical tricks for teaching kids to blow their noses.

🎧 If you missed Part 1, go back to hear Dr. Shapiro discuss baby breathing, safe sleep, and how to help infants breathe easier.

Your Child is Normal is the trusted podcast for parents, pediatricians, and child health experts who want smart, nuanced conversations about raising healthy, resilient kids. Hosted by Dr. Jessica Hochman — a board-certified practicing pediatrician — the show combines evidence-based medicine, expert interviews, and real-world parenting advice to help listeners navigate everything from sleep struggles to mental health, nutrition, screen time, and more.

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Transcript

Unknown: 0:06

Nina, welcome back to your child is normal. I'm your host, Dr Jessica Hochman, and today we're continuing my conversation with Dr Nina Shapiro, pediatric ENT and author of take a deep breath, clear the air for the health of your child. In part one last week, we talked about baby breathing, what's normal, what's not, and how to help little ones breathe easier. In part two, today, we're shifting our focus to older kids. Dr Shapiro breaks on the most common causes of chronic nasal stuffiness, when to consider allergies or sinus issues and how to help our kids get better sleep and breathe comfortably without overusing medications or antibiotics. You'll also hear a lot of great practical advice. For example, Dr Shapiro will teach you how to teach your kids to blow their noses, and she also explains how to know when congestion might be a sign of something more. If you haven't already, please take a moment to follow and leave a five star review for your child as normal. It really helps other people discover this podcast and supports our growing community. Now let's jump into part two of my conversation with Dr Nina Shapiro. So now I would love to transition to talking about older breathing concern. Of the most common concerns I hear concerns I hear from about their kids, about their kids and without a kid, about a kid always seeming stuff. Can you talk about? Talk about the common reasons why products have just chronic congestion, chronic, chronic stuffiness, Stuffy, nothing. That is something really common and really common in kids. Parents are very aware, very aware kids. Certainly kids don't care. Don't care. Sometimes there's sometimes there's fluctuation, fluctuation, always a little, always a little stuff. You're really stuck, really stuff. When they're not real, when they're not really stuff, they're a little there all the time. And so my job, and my job is to figure out what it figure out what it is there something, there's something is that, quote, unquote fix, quote, unquote fix, or something to address that we take care of this. Because, again, it's because they're not. Kids are not obligated. All breathers, they feel breathers of the vine of a nose. Function of the nose is to breathe so it filters, just airs the air, modifies, solidifies that we air that so ideally should be nasal breathing. Why do kids, why do kids have stuffy nose? It could be, it just be low grade, a little bit of ingestion, because they're getting these virus getting these viruses, fluctuation that says something, that says something out of to grow out of, back to nasal. Nasal, the greatest stuff, too. And kids started probably a lot better, a lot better. That. Minimize. I agree. I think I agree. I think the number one reason, number one reason why kids honestly congested is congested, is because of all of because of all these, especially in the average, especially during, especially during the fall and winter months. So that's right. So that's cold a month siblings that have siblings that have siblings that may be exposed, maybe exposed to more. So it can seem like they're always seem like they're always congested and they are and sometimes another one that's just some comfortable worry about, worry about frustrating, and it's frustrating and it's so hard, but I try to minimize, I try to minimize for that tolerable, tolerable medicine, or even or allergy medicine, allergy medicine, if it's not allergy, but another, Another possible could be indoor allergies, indoor allergy. Outdoor allergies. Less common, less common allergies. Allergies start having, they're having a certain food. Allergies don't. Allergies don't cause that, cause that congestion, congestion, but I think, but as a child, it is a child who's not saying they're stuffy, all their stuffy, all the time. Other signs, other signs, you're running, no, you're running a nose, water, running water. We also have eyes. Then it's very then it's very reasonable to whether there's another there's more allergies. So to ask you a little bit more about this environmental, environmental allergy is a possibility, possibility. Typically don't we see that we don't we see that. We don't see the first couple of years, first couple years of life. It takes some time. It takes on Time Aware of to be aware of the times we have to either win treated with histamine, histamine allergies, allergies, of allergens, have allergies, and it's not expected, not expected in the first couple years. Right? Right? If you do any out, you do any allergy, food, allergy, clear, food, clear, sensitivity, sensitivity. Testing accurate, very accurate. Under age, under age four or five. Are you opposed? Are you to give their kidney to see, to see if it's helpful? No, I think it's, I think it's reasonable to try. I like to, I like to. Know what their treat, if an anti histamine, histamine, sure. Again, allergies, allergies, twice a day, day, every day. I don't know. I don't know. I feel like, why give a medication? Why give a medication unless it's necessary? I agree. I'm not. I agree. I'm not fantastic. It's not so be aware, so that we don't with the medication, with the medication, necessarily the other thing, with the other things, allergies are related. That's a sign to be aware. And they get a line in the middle of nose, called the nose, called the allergen. That's also so that's also sometimes an allergic side, another, another child congested, really congested all the time. And it seems potentially Terriers and barriers nasal steroids to use a topical top spray, spray just two years and up, and one spray once, one spray once a day, absorbed into the blood way, even way he does, the child does allergy. Allergies, it's just because it's just inventory, inflammatory, not specific, not specific words, allergies. Allergy can help. It can help a lot. And those kids are and those kids are a lot more comfortable. I agree. I do. I agree. I do see symptom improvements certain brands lead to more lead to side effects because alcohol and alcoholness and so much just the really mild, really little bit, stings a little lot of a lot of don't like she has, don't funny smells. It's got a lot about and one of the and one of the side effects that we side a lot is nosy, a lot is nosebleed, sensimist sentiment, older teenagers. Better tolerated, better tolerated smells, no smell no doesn't stand, doesn't cause very safe terms, long term, that's so that's usually what I recommend. I remember once. I remember once after hearing loss. Yeah, great recommendation. Great recommendations of things helpful. So thank you. Okay, now I love it. Now. I love how you brought up allergies. Allergies are not a common cause of China congestion. This comes up all the time, all the time, very cut out male child's congestion. Congestion got better. So I don't want to say that. I don't want to say that actually happened, actually chronic congestion. I don't think so. I hear that. I think a Lawrence parents were saying that are saying that are milling to mill child, or certainly when it's right, baby, right before bed, and even, like a bottle in, like a bottle, and then certainly including their 10, their and their so I think, out great, too high, almost a problem. So, so a lot of it, just take a lot of it, just with time. And we don't drink, we don't drink down and lie down and go to certainly, a child doing that, doing that, and it's going to cause including they have no if they have too close to line, too close to I think that's really, I think that's really the main issue. Yeah, I think a lot, I think a lot of people believe that milk creases, creases the amount of mucus that you produce, and so and so. I like what you wrote. I like a little more stick, yes, and frankly, and frankly this question, I get this question a lot dairy Sure. Actually, they've been studying that ice cream and ice reduces constantly, pain, so more, though, more than popsicle. And I think I love that, and I think the back of the throat a little that never hurt it, that never heard it made you say it's not going to give you more, because, in and of itself, in and of itself, there may be a little bit of film back there, and actually there and way in about 10 minutes, and that's fine. And that's fine. It's not going to make them, not going to make them just stick or congested. Adjusted or congested, or just don't do it just like down or we shouldn't. So neither should babies. That's a good point. Just keep them up right. Just put them up right for 510, minutes long. And their stomach, and their stomach is, is there's not a large distance, and make it into the always startle, always start again. Milk out of the No. It gets to their ears, to their ears, to that too. Now the other question, I have a question I have the parents get fresh. Parents get frustrated through kids blow their nose. You happen to have any church kids to encourage kids to blow their nose? Yes. So blowing your nose, blowing your nose, especially when you're traveling, when your child, and you're learning, you're stuffing and you're very scared. It's very scary. Feels like, feels like, it feels like it's gonna hurt your brain. Your brain don't really, don't really understand going on and going on in my head. So I recommend, I recommend those small, those small as well, and they don't have a stuff, don't have a stuffy nose, and there's no congestion, no congestion, no that's the time. That's the time when there's nothing, when there's nothing there, because then they don't, because then they don't fear of so you can make a game, have them close one nostril and nostril, it'll blow across the table, a tissue, a tissue back and move it back and forth. I recommend, I recommend teaching them nose blow and clear their nose. Clear their nose when they're when their nose is clean, then they'll be less if they'll be less afraid. That's my doing. I like that. I like the tissue. And again, it's best again when they're well, that makes sense to catch them when they're not happy. Yeah. Okay. Now the big question I get a lot from parents is, antibiotic, antibiotic, do you find that the antibiotic, antibiotics are beneficial to a kid having, we having some weeks of, is it worth giving? Is it worth what are the signs and symptoms when you will actually, may well actually prove it, and there's improvement in their sense. So specifically for nasal antibiotic, antibiotic, very little, very little benefit. Frankly, it really has to be, really has to prolong, prolong, meaning a week or two, week or two of chronic, chronic dark nasal discharge, discharge, fever, fever, cough, headache, and that is, that's a sinus infection, everything else, everything else is of infection and infection, pretty much, pretty a lot of parents. A lot of parents fever and trill and really, I need really high fevers. We all know that. We all know that. And I think a lot of it has a lot of it has to do. A lot of parents. A lot of parents talk about the color runny nose. The runny nose, clear, yellow, green, brown, brown. All nasal, dark. Morning, because morning feels congeal, condensed and condensed. It's more dark color, dark color, other sorts of, other sorts of symptom, facial gain, facial pain, fatigue, cough, typically, we typically buy the books. Buy the books for two weeks, for two of that. Oftentimes it's a long time starting of a yellow REM. Cause, yeah, it's true. And I think indicating for antibiotics, antibiotics, the way I explain it to parents is if he'll a banana, peel a banana, over time, it starts to brown and brown and black and oxidize and oxidize. Or if you cut an apple, cut an apple at first crisp and clean, and then clean and then time, and give it some time, and it ready looking overnight. You wake up, it's different color, a different color, a different color that's normal, and that's I love that I love to use doctors. I love that. I love that I love your being. I love to do with how a child doesn't matter the color, matter the color on snot, as long as they're eating, okay, eating, okay. Sleep, good energy, good energy. They're happier, up to their normal mischief, as long as they're as long as they're as long as they're acting like their normal brings our worry, raise our worry way down. Yes, for sure. Now I'd love to ask. Now I love to ask you about normal sleep, what to expect, what to expect a child when there's a child when they're sleeping. And first I'd like to ask, first I'd like to ask you about some doctors never, normally, never snore. And then, as you point out, 85% 5% of kids snore a little bit or a little bit normal and expected. So talk to me about, look at snoring as normal. So I think, I think a little bit what's snoring? What's snoring? Air turbulence. So there's some sort of, some sort of tissue blocking. That's blocking there, and that could be some simple just positioning a little bit of muscle, a little bit of muscle tone, so a little bit so, a little bit of small ages, all ages, including abortions, is nothing to worry, nothing to worry. Things to look for. Have a child, you have a snores? Is the regularity? Do they seem like they're breathing, irregular case? Or do they see more? Do they seem like gasps, little gasps, arching, arching, discomfort, discomfiture, but a little bit of a little bit of snoring night? All night, waking up, waking up. I don't think there's to worry about. To worry about, when should parents think about? Parents think about sleep apnea. So sleep apnea is sort of on the spectrum obstructive, mild scenario, kids who have somewhere in the somewhere in that range. So apnea, so apnea, destructive, obstructive, relative to snoring, to snoring, that means that he's trying to, trying to move air, because air, because structure, structure, more than two, more than child six seconds where they're not there, they're not air, and that's air, and that's a lot of kids. Had a lot of kids, middle parents, when the parents, but if they're having those, having those on regular time periods, waking up, waking up fully, without fully weight, that's a sign, that's a sign of the child obstructive sleep, which needs to be deceived, physical, physical physical cause logic, neurologic, neurologic cause obstructive, constructive, that definitely needs that definitely I always ask, if I always ask you, think about, how do they act? How do they act? Always time, always tired. Do they have really? Do they have really good? My goal is my goal. I think, I think your pediatrician talk to any right. And for kids, unlike adults, doctors, parents, what it's, what it's like to be sleep, different. And if you lose a knife, you lose a night, frankly, we can get, frankly, next day if it happens, if it happens that can't learn to play violin in school, can school? We can't sit here. Kids have not necessarily, not necessarily, we can't sleep. We can't have a conversation, a conversation. Oftentimes get tired and wired, and some of some of the HD diagnosis, diagnosis can be, really can be related, but certainly detail, sleep deprivation, deprivation, that threshold. Some of the kids, some of the kids are going to fall asleep. Some of the kids are but some of the kids are going to be running around the class, not sitting, not sitting, because they're sleeping, because they're sleep deprived. So any sort of, any sort of behavioral issue. Need to ask about, need to ask about their sleep. Yeah, it's worth it to get evaluated, because sometimes I get there so tired, tired and wired expression. It's true now. Now last thing I want to ask, I want to ask the topic of, is the topic everything? Now, there's a lot of parents, a lot of parents about concerned about now that mouth, maybe they're sleeping and they're mouthing and they mouth breathe or or never have their mouth, never have their mouth breathed when they're breathing. That here's something that parents would be concerned about. So I think so. Question is, question is for mouth? Is it habitual, meaning that they can read through their mouth? Their mouth is, those are often, those are often had mouth, had mouth breathing, physical, physical reason. Physical grass was drastic. Developed this muscle and this muscle memory. So they used to pursue mouth, their mouth, whether it's while they're while they're awake, their mouth, just their mouth opens, as opposed to, as opposed to the really, just can't, really, just can't open through their nose. So for the kids, really, important to address why and why and what we do to that again, sometimes, and sometimes it's a palette of the palette, the roof is the mouth, is the mouth, or is the nose, or of the nose. So if you open up, open it was a little bit, was a little bit open up issue in the back of shoe, in the back of the mouth. I think that's one area. So, area so as well, nose as well. I think if there isn't, if there is a vision, why their mouth? I think that has to be addressed, depending on age and the age and the circumstance severe. But if it's habitual, habitual, that's actually, that's actually hard, mouth shut. Have a little fear about, fear about, I don't think obstructing an airway. Why is this child and the child their mouth is? Kind of process, process, even at home, even at home, remind them to remind but during their mouth, sometimes their mouth is open. They're breathing through their breathing, so it's functional. It's functional. That's okay. So that's my question for you. That question for you. That question for you, then would be sounds like, sounds like, some degree about a congestion, congestion have open, open normal for normal for kids, maybe just to impart a message, when is that okay and when should parents work? And mostly the emphasize, when is it okay that I something that I see all the time, all the time around. To grow out of it over time. So I think all the times, especially especially this career, which is September the year. So I think that's so as long as they're as long as they're crying, getting good energy and energy, well, eating, well, there's anything, there's anything really about, unless they seem to be uncomfortable. So if so sounded a lot, parents come because sounds like they sounds like they have adult when they don't, and they're not, and they're not just sound, they just sound. Then they're destined. Then there. I think that needs to I think that's certainly not just an emergence, but something that needs, something that needs data, and it may debt, and it may have everything they have physically, as physically as more. And that is just and then it's where we say nothing to nothing, to worry, nothing to worry about. Most I think we're allowed as long as, as long as to the point of being to the building or interfere develop with their development. True, there's so many conditions, so many conditions really, that cause really, agree, but there's a lot of things. There's a lot of things that we can advise to help get through and get through it. So I just want to say, I just want to say about, so excited about your there's a lot in the there's a lot and talk about your advice. I love your advice, how to help me or clean, how to think about how to think about toxic thinking about thinking about to do so what to do is really great. Is really a great facility, a great one to learn about, anything to do with, anything to do. I highly recommend. I'm really proud of you for doing it's a lot of fun. It's a lot of fun. When's it gonna come out? When's it gonna come out? It's actually available. Actually available. Land. Gonna land in some time, sometime or late fall, early. And then, if people want, and then, if you want to located, can they schedule a visit again? Culver City. And I love I love this. I love patients. Patients available, available, very have a very small access, small accessible to get in your child. Can see your child quite quickly. We'll take good and we'll take thank you for this podcast, for this podcast, and it was great. Thanks. It was great. Thank you for listening. And I hope you enjoyed this week's episode of your child is normal. Also, if you could take a moment and leave a five star review, wherever it is you listen to podcasts, I would greatly appreciate it. It really makes a difference to help this podcast.