Sinus Infections (Sinusitis) in Children

What sinusitis is (and why children get it)

The sinuses are air-filled spaces behind the cheeks and forehead and around the nose. When the lining of these spaces becomes swollen and mucus cannot drain normally, the result is sinusitis. In children this most often begins with an ordinary viral cold, or a flare of nasal allergies, that causes swelling and blocks the tiny drainage channels. Young children catch several colds a year, so it is normal for the nose and sinuses to be irritated fairly often, and most of these episodes clear up without any special treatment.

A child's sinuses are still developing: the ethmoid and maxillary sinuses are present at birth, while the frontal and sphenoid sinuses form later and keep growing into adolescence. Because their nasal passages are small and colds are frequent, congestion is common. Frequent congestion by itself does not mean a child has a sinus infection.

Acute vs. chronic sinusitis

Clinicians describe sinusitis partly by how long it lasts:

• Acute sinusitis usually follows a cold and lasts up to about four weeks, then resolves.
• Subacute sinusitis lasts for about four to twelve weeks.
• Chronic sinusitis is inflammation that persists for 12 weeks or longer, or keeps coming back.

Chronic or recurring sinusitis is more likely to be driven by ongoing triggers such as allergies. A child with frequent or long-lasting symptoms may benefit from an allergy evaluation or a visit to an ear, nose, and throat specialist.

Viral vs. bacterial: when it's more than a cold

Most sinus congestion is viral and improves steadily over about a week to ten days. The color of nasal mucus is not a reliable clue: green or yellow discharge is a normal part of a healthy immune response and does not by itself mean a bacterial infection or a need for antibiotics. Pediatric guidelines instead look at the pattern and timing of symptoms. A bacterial sinus infection is more likely when a child shows one of these patterns:

• Persistent symptoms: nasal discharge or daytime cough that lasts more than 10 days without starting to improve.
• Worsening course, sometimes called 'double-sickening': a cold that seemed to be getting better, then suddenly turns worse again with new fever or heavier congestion.
• Severe onset: a high fever together with thick, colored nasal discharge for at least three days in a row, with the child appearing unwell.

For a straightforward case, clinicians usually diagnose sinusitis from this history and an exam. Routine X-rays and CT scans are not recommended and are reserved for children who may be developing a complication.

When antibiotics may be considered

Because most sinusitis is viral, antibiotics are not always the answer. When a child fits the pattern of a likely bacterial infection, guidelines give clinicians two reasonable options: start an antibiotic, or, for milder but persistent cases, watch closely for a few days to see whether the child improves on their own before prescribing. For a clearly worsening or severe illness, antibiotics are more likely to be recommended promptly. If your child does need medication, your clinician or pharmacist will choose the right medicine and determine the exact dose based on your child's weight and age.

Never give leftover antibiotics or someone else's prescription, and do not start a sinus antibiotic without your clinician's guidance. If antibiotics are prescribed, finish the full course as directed, even after your child feels better. For fever or discomfort, use only medicines and amounts appropriate for your child's age and weight, and check with your pharmacist before combining products.

Home comfort measures

Whether an infection is viral or bacterial, the same simple measures help most children feel better while the sinuses heal:

• Saline (saltwater) nose drops, sprays, or gentle rinses to thin mucus and clear the nose; for babies, follow with a bulb or nasal aspirator. If you use a nasal rinse, prepare it only with distilled, sterile, or previously boiled and cooled water — never straight tap water.
• Plenty of fluids to stay hydrated and keep mucus loose.
• A cool-mist humidifier in the bedroom, cleaned regularly, or a few minutes in a steamy bathroom.
• Extra rest and sleep; for older children, slightly elevating the head can ease congestion that worsens when lying flat.
• Keeping your child away from tobacco smoke and other airway irritants.

Over-the-counter decongestants and antihistamines have not been shown to help acute sinusitis in children and are not recommended for it, and cough-and-cold combination products should not be used in young children. Use only age-appropriate fever or pain relief, exactly as directed, and ask your pharmacist if you are unsure.

Red flags: when to seek urgent care

Serious complications of sinusitis are uncommon, but because the sinuses sit close to the eyes and brain, certain warning signs need same-day medical care. Call your clinician promptly, or seek emergency care, if your child has:

• Swelling, redness, or bulging around an eye or eyelid, or pain when moving the eyes.
• Changes in vision, such as double or blurred vision.
• A severe or worsening headache, especially with a stiff neck, confusion, or extreme sleepiness.
• Swelling of the forehead.
• A high fever that persists, or a child who looks very ill, is unusually drowsy, or is hard to wake.
• Symptoms that keep getting worse instead of better, or that do not improve after starting treatment.

Swelling or redness around the eye, vision changes, a stiff neck, a severe headache, or a child who is very hard to wake can signal a spreading infection and are medical emergencies. When in doubt, call your pediatrician or seek urgent care right away; it is always okay to have your child checked.

Preventing sinus infections

Most sinus infections start with an ordinary cold, so the best prevention is the everyday habits that reduce respiratory illness: frequent handwashing, keeping up with recommended vaccines including the annual flu vaccine, and avoiding secondhand smoke. If your child has nasal allergies, keeping them well controlled can reduce the swelling that sets the stage for sinusitis.