Decongestants are “reliever” drugs that treat symptoms of nasal congestion by constricting blood vessels in the nose. This decreases tissue swelling in the nose and opens the airways.  

Decongestants can be effective in clearing up a child’s allergy-related congestion, but only as a short-term solution. It is critical to limit a child’s use of decongestants to no more than three consecutive days. Long-term decongestant use results in “rebound effect,” which will actually make congestion worse (rhinitis medicamentosa).

While antihistamines often make children drowsy, decongestants are a stimulant and are likely to have the exact opposite effect. Decongestants can sometimes make children jittery because the drug is closely related to adrenaline. In particular, small children and infants are susceptible to this effect.

Since decongestants are chemically related to adrenaline, they can also raise blood pressure. This is not a major concern for children who have healthy hearts. However, the stimulant effects of this medication may cause sleeplessness or irritability in many children.

Pseudoephedrine is found in many decongestants advertised as “non-drowsy.” It is more likely to cause side effects in infants than in older children and adults. Newborns and infants born prematurely are especially at risk. Although regular, short-acting decongestants that contain this chemical can be given to infants and small children (with the dosage approved by a physician), long-acting decongestants are not recommended for children under 12. Most physicians agree that children under the age of six months should avoid taking decongestants.

Phenylpropanolamine is an ingredient previously found in decongestants that is no longer used. The drug is associated with a low risk of hemorrhagic stroke (bleeding into the brain or into tissue surrounding the brain) in women. However, some older medications may contain this drug, and it should not be taken without consulting a physician beforehand.

Decongestants are available in topical forms and oral preparations. Topical decongestants (eye drops and nasal sprays) are likely to provide a child with a better combination of relief and fewer side effects than oral decongestants. Because these medications are delivered in a concentrated form to the specific area they are targeted to treat, the amount of decongestants passed into the rest of the child’s body is reduced. This helps limit side effects. However, children using nasal sprays or eye drops need to be carefully supervised. Children may be tempted to overuse these medications, leading to rebound congestion.

Examples of over-the-counter (OTC) and prescription decongestants given to children include:

Antihistamine/decongestant prescription and OTC medications combine the effects of these two drugs. Popular choices include: