It was once a truth universally acknowledged that children should not be stuffing things up their little noses.
And while that view still holds true generally, shooting large quantities of a saline solution into a child's nose can work wonders in helping to clear colds and sinus infections.
It's called high volume nasal saline irrigation, and it's sold in squeeze bottles at drugstores or big box stores. A patient or a parent holds the rinse bottle up to one nostril and gently squeezes the saline liquid, which will fill that nostril, go around the septum and come out the other side of the nose -- flushing out mucus and bacteria along the way.
"I think they're fantastic," said Farrel Buchinsky, a pediatric otolaryngologist at Allegheny General Hospital and a professor at Drexel University College of Medicine. "While they might sound gross, from the perspective of getting rid of secretions, bacteria and thick mucus, nothing could be better."
In his practice, Dr. Buchinsky sees children with chronic rinosinusitis ("They've basically been a snot factory for months on end."), which can go hand in hand with persistent sinus infections.
Traditionally, those sinus infections are treated with antibiotics and even endoscopic sinus surgery. But Dr. Buchinsky believes that a sinus rinse can be just as effective.
"I would advocate for using high volume nasal irrigation in lieu of antibiotics," he said. "It sometimes works as well as endoscopic sinus surgery."
High-volume nasal irrigation -- as much as 200 milliliters in each nostril -- works by first thinning the secretions with saline and then physically flushing them out. Sometimes bacteria can get stuck in the nasal passages, where they "settle down and form a colony of slime," said Dr. Buchinsky.
The bottles come with saline packets, which are mixed with lukewarm water before each use. Nasal rinsing "won't necessarily remove every last bacteria but certainly can move the bulk of it out."
Studies from the University of Wisconsin have found nasal rinsing to be effective in decreasing symptoms from colds and sinus problems.
In the form of a neti pot, nasal rinsing has been around for centuries as part of the Hindu practice of Jala Neti -- the cleansing of the breathing passages in the head. Neti pots in the U.S. got a big boost in 2007 after they were demonstrated on "Oprah" in a segment with Dr. Mehmet Oz.
The sinus rinse bottles were developed more recently. One of the leading companies, NeilMed, started selling its Sinus Rinse product in the mid-2000s.
More recently, companies have developed products specifically for children, such as the NeilMed pediatric sinus rinse, which uses a smaller bottle. While manufacturers recommend that children start doing the nasal rinse at age 5 or 7, Dr. Buchinsky said that they are appropriate in children younger than that.
Babies and young toddlers should not use the product, he said. "You cannot do this on a 1-year-old child -- You'll drown them," he said. "But a child who can pick up a glass and drink should be able to do this," he said, even as young as 3- or 4-year-olds.
Parents who want to try nasal rinses with their children should just be very tentative, he said, starting with a small amount of fluid and squeezing gently.
Clare Sarknas, a pediatrician with Children's Community Pediatrics-Bass Wolfson in Cranberry, said that while nasal rinsing may be effective in children, their willingness to participate could be an issue. "Toddlers are challenging for compliance, and teenagers are not thrilled about putting something in their nose," she said.
Anecdotally, she said, she has heard of more patients using neti pots and other sinus rinses in the last couple of years. She also recommends using nasal saline sprays like Little Noses in infants and young toddlers to get some of the benefits of saline irrigation.
She also cautioned that children and adults using neti pots or sinus rinses should use distilled, sterilized, filtered or boiled water. The Centers for Disease Control and Prevention issued guidelines earlier this year on the importance of using water treated in one of those fashions after two people died from brain infections that they believe were contracted from using tap water in a neti pot.
Although nasal rinsing is very effective, said Dr. Buchinsky, it is not 100 percent effective. If a patient has been doing it regularly for two to three weeks and symptoms still persist, it's probably time to move on to another treatment, he said.
Although manufacturers might recommend doing the sinus rinse every day, regardless of whether a person is sick, he said that he recommends it only during periods of illness.
Sinus rinses and neti pots usually cost between $10 and $15 and have become popular enough that they are now available at most drug stores and even grocery stores. The low cost of the devices might be one reason why they're not as well known as other cold remedies, said Dr. Buchinsky.
"It's not high-tech. It's not imbued with the latest and greatest organic chemistry," he said. "I can only speculate that because it's so cheap, nobody has a financial incentive to spend millions on advertising and promotions."