He was one of the first pediatricians to make his knowledge available to everyone on the Internet. Its teleconsultation platform in pediatrics, pediatre-online, is a reference for many parents who are confused by the plethora of – often contradictory – advice they are given regarding the health and growth of their children. With his experience and an ability to communicate things clearly and simply (especially on the set of La Maison des Maternelles), Arnault Pfersdorff reassures and comforts. But he also pushes sometimes! Thus he does not hesitate to question the lightness with which nose washing is often treated, as if it were ordinary care to be applied without moderation. This technique, which consists of projecting the contents of a pipette of physiological serum into the nostril of a baby, is, he recalls on the contrary, to be used sparingly.
The Point: Nose washing is often presented as THE solution to treating young children. Their noses should be washed daily, even when they have not yet had a cold, to prevent them from getting sick…
Dr. Arnault Pfersdorff: Because we have to fight against bronchiolitis, we have fallen into excess. A baby who is well, it is not useful to systematically wash his nose with saline solution. It is useless, it is even counter-productive, because it will attack the child and attack his nasal mucous membranes which are fragile. Besides, we know that too many nose washes have the opposite effect: there is an attack on the nasal mucosa which causes inflammation. We are going to cause what we call, in our jargon, iatrogenic rhinitis, that is to say that it is caused by an excess of treatment. The little one will then have a stuffy or runny nose, even bleeding, because of these untimely nose washes. So, you have to be careful and only do it when necessary.
But how do you know if it’s necessary?
At this point ?
We must not forget that the nostrils are an orifice. And all orifices, even in a newborn, must be respected. A nose wash is very aggressive, very intrusive. If we do it anyhow, it can create a trauma. In fact, it shows: when I bend down to examine an infant, if he has very frequent nose washes, he will turn his head and scream. Just getting close to his face will put him on alert. You have to put yourself in his place, after all it’s not nothing to send ten milliliters at once into the nostril of a baby who does not understand what is happening to him, who has the impression that drowns him. In addition, often the parent is stressed himself from having to wash his nose and transmits his stress to the child. And because of these nose washes that have been done too aggressively, a fear settles, perhaps for a lifetime, in his subconscious.
What parent will still dare wash their child’s nose with everything you say!
Again, I’m not saying don’t, nose washing can be life-saving and luckily it exists! Simply, when you do it, you have to do it well. Some parents have been taught that you have to swaddle the baby to block it, it’s more practical and it allows the adult to get there more quickly. But imagine yourself in his place: how can you stay calm when all your movements are blocked and you don’t know why?
So how should it be done? Is it better to lay the child down or sit him down?
The best is to put him sitting against you. He is reassured to be against his dad, his mom or the nanny. There is no need to put the head back since the anatomy makes it fall straight down. We explain what we are going to do, that it will bother him a little. “You see the pipette, I put it on the entrance to your nostril. And then we’re going to put in a drop or two and say, “See, there’s a little bit of liquid.” And then we apply more pressure. We are quick in our actions. The helping hand is taken quite quickly. It is better for the baby to be trapped by a parent’s arm blocking his shoulder and head than by a towel.
Despite all these precautions, some babies can’t stand having their noses washed. Should I give up or insist?
It’s true, some children react very violently, especially those who have had a medical birth, a suction cup, a forceps or an emergency cesarean, for example. These little ones have an orofacile hypersensitivity and as soon as we approach the face, they are afraid. You have to weigh the pros and cons. When it’s necessary, so much the worse for the trauma. But if he does not have a constant cough, if he eats well, we can simply clean his nose with a tissue. In general, I think that we should focus on everything that can help, before we avoid getting there.
We check that the atmosphere of the chamber is not too dry – often there is nasal obstruction because the hydrometry rate in the chamber is 30% and it is too low, suddenly it dries out the natal mucous membranes . So we start by hydrating the room. We also eliminate a possible allergy: a child whose nose is repeatedly taken, it may be because an allergy to dust mites is setting in. There are also all the viruses reported by older brothers or sisters. So we regularly wash our hands and change our clothes to avoid the transmission of germs. Let’s start by modifying the environment before resorting to nose washing. And then, of course, as soon as possible, the child is taught to blow his nose.
From what age can he learn to blow his nose?
It can happen very quickly. At 18 months, you can already start teaching him to blow out a candle with his nostrils. It’s a method that I use a lot, because a candle amuses children. He is asked to blow out the candle with his mouth first. Once he understands how it works, he is asked to do the same with his nose by putting his hand over his mouth. At first, he can’t do it but, little by little, he will visualize the exhalation and understand for himself. It is a challenging game. Once he masters extinguishing the flame with the breath of the nostrils, the third step is to do the same with one nostril. You put your hand over your mouth, you press one of his nostrils and he continues. And there, it is won. And we explain to him that if he blows his nose, there will no longer be a need for nose washing. They usually understand very well!
Baby first instruction manual, by Arnault Pfersdorff, Hachette editions. Your child – 0 to 16 years old, New Parents’ Guide, by Arnault Pfersdorff, Hatier editions.
