When Your Child Has Sinusitis
Sinuses are hollow spaces in the bones of the face. Healthy sinuses constantly make and drain mucus. This helps keep the nasal passages clean. But an underlying problem can keep sinuses from draining properly. This can lead to sinus inflammation and infection (sinusitis). Sinusitis can be acute or chronic. Acute sinusitis comes on suddenly, often after a cold or flu. When your child has acute sinusitis at least 3 times in a year, it is called recurrent acute sinusitis. When acute sinusitis lasts longer than 12 weeks, it’s called chronic. Chronic sinusitis is usually caused by allergies or a physical blockage in the nose.
What causes sinusitis?
These problems can lead to sinusitis:
Upper respiratory infections. A cold or flu can cause the sinuses and nasal linings to swell. This blocks the sinus openings, allowing mucus to back up. The pooled mucus can then become infected with germs (bacteria or viruses).
Allergic reactions. Sensitivity to substances in the environment such as pollen, dust, or mold causes swelling inside the sinuses. The swelling prevents mucus from draining.
Obstructions in the nose. A polyp or deviated septum can cause sinusitis that doesn’t go away. A polyp is a sac of swollen tissue, often the result of infection. It can block the tiny opening where most of the sinuses drain. It can even grow large enough to block the nasal passage. The septum is the wall of tough connective tissue (cartilage) that divides the nasal cavity in half. When this wall is crooked (deviated), it can prevent the sinuses from draining normally.
Obstructions in the throat. The adenoids and tonsils are masses of tissue in the throat. As part of the immune system, they help trap bacteria and other germs. But the tonsils and adenoids themselves can become inflamed or infected. They can then swell, blocking the normal drainage of mucus.
What are the symptoms of sinusitis?
Thick discolored drainage from the nose
Pain and pressure around the eyes, nose, cheeks, or forehead
Thick mucus draining down the back of the throat (postnasal drainage)
Loss of smell
How is sinusitis diagnosed?
Your child’s doctor will ask about your child’s health history and do a physical exam. During the exam, the doctor checks your child’s ears, nose, and throat and looks for signs of tenderness near the sinuses. That is all that is usually done with acute sinusitis.
With recurrent acute sinusitis or chronic sinusitis, your child may need tests. These may be to check for bacteria, allergies, or polyps. Your child may also need X-rays or CT scans. In some cases, your child may be referred to an ear, nose, and throat (ENT) specialist. If so, the doctor may use a long, thin instrument (endoscope) to look into the sinus openings.
How is acute sinusitis treated?
Acute sinusitis may get better on its own. When it doesn’t, your child’s doctor may prescribe:
Antibiotics. If your child’s sinuses are infected with bacteria, antibiotics are given to kill the bacteria. If after 3 to 5 days, your child's symptoms haven't improved, the healthcare provider may try a different antibiotic.
Allergy medicines. For sinusitis caused by allergies, antihistamines and other allergy medicines can reduce swelling.
Note: Don't use over-the-counter decongestant nasal sprays to treat sinusitis. They may make the problem worse.
How is recurrent acute sinusitis treated?
Recurrent acute sinusitis is also treated with antibiotic and allergy medicines. Your child's healthcare provider may refer you to an otolaryngologist (ENT) for testing and treatment.
How is chronic sinusitis treated?
Your child’s doctor may try:
Referral. Your child's doctor may want you to see a specialist in ear, nose, and throat conditions.
Antibiotics. Your child our child may need to take antibiotic medicine for a longer time. If bacteria aren't the cause, antibiotics won't help.
Inhaled corticosteroid medicines. Nasal sprays or drops with steroids are often prescribed.
Other medicines. Nasal sprays with antihistamines and decongestants, saltwater (saline) sprays or drops, or mucolytics or expectorants (to loosen and clear mucus) may be prescribed.
Allergy shots (immunotherapy). If your child has nasal allergies, shots may help reduce your child’s reaction to allergens such as pollen, dust mites, or mold.
Surgery. Surgery for chronic sinusitis is an option, although it is not done very often in children.
If antibiotics are prescribed
Sinus infections caused by bacteria may be treated with antibiotics. To use them safely:
It may take 3 to 5 days for your child’s symptoms to start to improve. If your child doesn’t get better after this time, call your child’s doctor.
Be sure your child takes all the medicine, even if he or she feels better. Otherwise the infection may come back.
Be sure that your child takes the medicine as directed. For example, some antibiotics should be taken with food.
Ask your child’s doctor or pharmacist what side effects the medicine may cause and what to do about them.
Caring for your child
Many children with sinusitis get better with rest and the following care:
Fluids. A glass of water or juice every hour or two is a good rule. Fluids help thin mucus, allowing it to drain more easily. Fluids also help prevent dehydration.
Saline wash. This helps keep the sinuses and nose moist. Ask your child's healthcare provider or nurse for instructions.
Warm compresses. Apply a warm, moist towel to your child’s nose, cheeks, and eyes to help relieve facial pain.
Colds, flu, and allergies can lead to sinusitis. To help prevent these problems:
Teach your child to wash his or her hands correctly and often. It’s the best way to prevent most infections.
Make sure your child eats nutritious meals and drinks plenty of fluids.
Keep your child away from people who are sick, especially during cold and flu season.
Ask your child’s doctor about allergy testing for your child. Take steps to help your child avoid allergens to which he or she is sensitive. Your child’s doctor can tell you more.
Don’t let anyone smoke around your child.
Tips for proper handwashing
Use warm water and soap. Work up a good lather.
Clean the whole hand, under the nails, between fingers, and up the wrists.
Wash for at least 10-15 seconds (as long as it takes to say the ABCs or sing “Happy Birthday”). Don’t just wipe—scrub well.
Rinse well. Let the water run down the fingers, not up the wrists.
In a public restroom, use a paper towel to turn off the faucet and open the door.
What are long-term concerns?
It’s important to find and treat the underlying cause of sinusitis in children. In rare cases, the infection from sinusitis can spread to the eyes or brain. If your child has allergies or asthma, talk with your doctor about treatment options. Tell your child’s doctor if your child gets more colds or flu than normal.
Call your child's healthcare provider if:
Your child’s symptoms get worse or new symptoms develop
Your child has trouble breathing
Symptoms don’t get better within 3-5 days after starting antibiotics
A skin rash, hives, or wheezing develops: these could signal an allergic reaction
April 03, 2018
Clinical Practice Guideline for the Diagnosis and Management of Acute Bacterial Sinusitis in Children Aged 1 to 18 Years. Wald ER. Pediatrics. 2013;132(1):e262-80.
Bass, Pat F III, MD, MPH,Image reviewed by StayWell medical illustration team.,Kacker, Ashutosh, MD