Inspect the nostrils. Is flaring of the nostrils present? Flaring occurs in any type of respiratory distress.

Inspect the tip of the nose. Is there a permanent transverse crease near the lower part of the nose directing the tip upward? This is commonly seen in allergy sufferers. This unmistakable sign is caused by the allergic salute: using a palm or an extended forefinger to rub the nose upward and outward.

Elevate the tip of the nose and inspect the nasal mucosa. Are secretions present? Purulent secretions from above and below the middle turbinate may be suggestive of sinusitis. Watery discharge may be indicative of allergy or viral upper respiratory infection. Epistaxis is usually caused by local trauma and is quite common in preschool- and school-aged children. In children with head trauma, the presence of a clear discharge from the nose is suggestive of cere-brospinal fluid leakage.

Check for nasal polyps. These may be associated with allergies or cystic fibrosis.

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