Snot a Problem


"Isn’t it boring seeing all those snotty-nosed kids?"

This isn’t the first time I’ve heard this question from one of my colleagues who wouldn’t think of laying his stethoscope on anyone under the age of 25. My usual response is, "How can you tolerate a whole day of listening to whining adults?" I guess after awhile one just accepts the potholes in the path one has chosen.

Dr. William G. Wilkoff

But for me, snotty noses aren’t just slimy annoyances that I have learned to tolerate. I have actually come to appreciate and even embrace the reality of snot in all its multicolored drippiness. The fact that snot was probably not a word you encountered in medical school is a bit odd, because snot is the very substance that lubricates the wheels of general pediatrics. Without snot, your office accounts receivable would grind to a bankrupting halt.

If noses didn’t run, a parent might not know his child’s cold had lasted for 3 weeks. How many of the children with allergic rhinitis would sit in your office saluting each other across the waiting room if their noses were dry?

I have been immersed in snot since the day I chose to practice pediatrics. It’s the reason why between patients sometimes I must scrub up to my elbows like a surgeon. Snot is what I polish off my glasses at the end of a busy morning.

But not everyone seems to understand and appreciate the variety of liquids that can run out of a youngster’s nose. For example, too few people appreciate the counterintuitive fact that for the most part the color of snot is not one of Mother Nature’s warning signs of severe illness. I try to appear to be listening patiently as parents struggle to choose just the right shade and consistency to describe their child’s runny nose. I always end up blurting out, "You know, color doesn’t really tell me much; let me hear some more about his other symptoms." I have struggled mightily to get day care providers to expunge the words "colored nasal mucus" from their lists of exclusionary conditions. But, sometimes I feel as if I am swimming up stream, so to speak.

I continue to be surprised and disappointed at the number of physicians who diagnose and treat "sinusitis" in situations in which the child’s only sign or symptom seems to have been off-color mucus. Once a child has been labeled as sinusitis prone, I have a devil of a time convincing his parents that an antibiotic isn’t the best choice every time he has a yucky-looking runny nose.

I have even more trouble convincing parents to stop wiping their child’s nose every time they see it dripping. By the end of the day, the poor little tyke’s nostrils and upper lip look like raw hamburger. It seems to be a blow against motherhood to suggest that they should just let the snot cake up and then gently soak it off before naps and bedtimes. I know it’s not a pretty picture, but it’s the right thing to do.

While it may not qualify as snot, the foul-smelling unilateral runny nose that usually accompanies a retained foreign body has provided me with numerous rewarding diagnostic and therapeutic successes. Extracting a rank piece of foam rubber from the nose of 2-year-old is on a par with deftly removing a cerumen plug the size of a pencil eraser with a single swipe of an ear curette.

If I still haven’t convinced you to view snot in the same positive light that I do, how about this: In a recent issue of the New York Times, there was a report suggesting that a runny nose is a sign of a strong and functioning immune system. It turns out the rhinovirus and its cousins create little or no damage to nasal mucosa. Snot is simply a drippy sign that our defenses are revved up and working. Snotty noses are going to be around as long as there are little children. Learn to embrace them.

This column, "Letters From Maine," regularly appears in Pediatric News, an Elsevier publication. Dr. Wilkoff practices general pediatrics in a multispecialty group practice in Brunswick, Maine. E-mail him.