Sinusitis in Children: Symptoms and Care

Sinusitis in children is swelling of the spaces around the nose, often after a cold. It can cause a blocked or runny nose, cough, thick mucus, bad breath, facial pressure, or fever. Many cases are caused by viruses and improve with time and simple care. A pediatrician should assess symptoms lasting more than 10 days without improvement, getting worse after improving, or accompanied by persistent high fever.

What causes sinusitis in children?

Sinusitis occurs when the lining of the sinuses, the air-filled spaces around the nose and eyes, becomes swollen. This swelling can interfere with normal mucus drainage. The condition often develops during or after a common cold. Viruses cause many sinus infections, although bacteria can cause some cases. Allergies may also contribute to nasal swelling and symptoms that resemble sinusitis. According to MedlinePlus, colds, allergies, and certain nasal or medical conditions can interfere with normal sinus drainage.

Most children with cold symptoms do not necessarily have a bacterial sinus infection. A cold may cause a runny or blocked nose, sneezing, and coughing before gradually improving. Sinus symptoms can overlap with those of a cold or allergies, so the length and pattern of the illness are important when deciding whether further assessment is needed.

Which symptoms of sinusitis may appear in children?

Children can experience several symptoms when their sinuses become inflamed. Some symptoms are similar to those of a routine cold, while others may become more noticeable when the illness persists or worsens. The American Academy of Pediatrics describes the symptom patterns that can help a clinician distinguish a cold from possible bacterial sinusitis.

• Blocked or runny nose: Nasal congestion or discharge may continue for longer than expected.
• Thick nasal mucus: Discharge may appear yellow or green, although its color alone does not establish a bacterial infection.
• Persistent cough: A cough may continue during the day or become more noticeable at night, sometimes because mucus drains down the back of the throat.
• Facial pressure or pain: Some children, particularly older children, may describe discomfort around the cheeks, forehead, or eyes.
• Headache or tiredness: Head discomfort, reduced energy, or a general feeling of being unwell may occur.
• Fever or bad breath: These can accompany sinusitis, although they may also occur with other illnesses.

Young children may find it difficult to describe facial pressure or a headache. Caregivers may notice changes in sleep, appetite, mood, or normal activity instead. Because several childhood illnesses cause similar symptoms, these signs should be considered alongside how long the child has been unwell and whether the symptoms are improving.

When might a cold suggest bacterial sinusitis?

For children aged 1–18 years, pediatric guidance identifies three important patterns that may suggest acute bacterial sinusitis. These patterns help healthcare professionals assess the illness; they are not a checklist for parents to use to diagnose a child.

• Symptoms that persist: A runny nose, nasal congestion, daytime cough, or a combination of these continues for more than 10 days without improvement.
• Symptoms that worsen: The child initially seems to recover from a cold, but the nasal symptoms or cough return or become worse.
• Severe symptoms at the start: A fever of 39°C (102.2°F) or higher occurs together with thick nasal discharge for at least three consecutive days.

A pediatrician considers these patterns along with the child's medical history, examination findings, and overall condition. A clinician may consider other causes, including viral infections and allergies, before deciding whether treatment for bacterial sinusitis is appropriate. These commonly used diagnostic patterns cover children aged 1–18 years; infants younger than 1 year need assessment appropriate to their age and symptoms.

How is sinusitis diagnosed in children?

Diagnosis usually begins with questions about when the symptoms started, whether they have improved or worsened, the presence and duration of fever, and how the illness affects the child's daily activities. The healthcare professional may examine the nose, throat, face, and eyes and assess the child's general condition. According to the Centers for Disease Control and Prevention (CDC), healthcare professionals assess possible sinus infections by reviewing symptoms and performing an examination.

Routine imaging is not usually necessary to assess an uncomplicated case. If symptoms suggest that an infection may have spread beyond the sinuses, or if the diagnosis remains uncertain, further tests or specialist assessment may be considered.

How can parents care for a child with sinusitis at home?

When symptoms are not severe and the child is otherwise doing well, simple supportive measures may help relieve discomfort while the illness improves. The main goals are to keep the child comfortable, maintain hydration, and ease nasal congestion.

• Offer fluids regularly. Encourage the child to drink water and other suitable fluids throughout the day.
• Use saline nasal drops or spray. Plain saline may help loosen mucus and ease a blocked nose. For babies, a caregiver may use saline drops followed by gentle suction with an appropriate nasal bulb or aspirator.
• Try a warm compress. A comfortably warm, damp washcloth placed over the nose or forehead for a short time may ease facial pressure.
• Consider a clean, cool-mist humidifier. Added moisture may make nasal symptoms more comfortable. Clean the device according to its manufacturer's instructions.
• Encourage rest. Allow the child to rest and return to normal activities as their comfort and energy improve.

Avoid having a child inhale steam over a bowl of hot water because spills can cause serious burns. Saline products should be used according to their instructions, and nasal irrigation should be undertaken only with an age-appropriate method and safe water. The American Academy of Pediatrics' guidance on childhood sinusitis also describes saline, gentle suction for babies, a clean humidifier, and warm washcloths as ways to ease symptoms.

Which medicines are safe for children?

Medicine choices depend on the child's age, weight, symptoms, medical history, and other medicines they take. A pediatrician or pharmacist can help caregivers choose an appropriate product and dose. Follow the product instructions carefully, and do not give a child an adult formulation or use several products containing the same active ingredient.

For pain or fever, the CDC advises that children younger than 6 months should receive acetaminophen only when appropriate, while children aged 6 months and older may be given acetaminophen or ibuprofen when suitable. Never give aspirin to children because of the risk of Reye's syndrome, a rare but serious illness affecting the brain and liver. Over-the-counter cough and cold medicines should not be given to children younger than 4 years unless specifically directed by a healthcare professional. For children aged 4 years and older, check with a clinician about whether these products are suitable.

Medicated nasal decongestants and other cold remedies may have age restrictions and potential side effects. Do not start them for a young child without checking with a healthcare professional. The CDC's guidance on sinus infections and children's medicines provides additional information about age-related precautions and the importance of using medicines correctly.

Are antibiotics always needed for sinusitis in children?

No. Antibiotics treat bacterial infections, not viral infections, and many sinus infections improve without them. A clinician may prescribe an antibiotic when the child's symptoms and examination suggest bacterial sinusitis. The decision depends on the symptom pattern, the child's overall condition, and the likelihood of complications.

In some children with persistent but uncomplicated symptoms, a clinician may recommend a short period of observation with reliable follow-up instead of starting antibiotics immediately. The CDC explains that watchful waiting for selected sinus infections may involve monitoring symptoms for 2–3 days, with treatment reconsidered if improvement does not occur. Children with severe or worsening symptoms may need a different approach.

If an antibiotic is prescribed, give it exactly as directed. Do not use leftover antibiotics, share a prescription, change the dose, or stop treatment early without advice from the prescribing clinician. Contact the clinician if symptoms worsen or fail to improve within the timeframe they recommend.

When should a child receive urgent medical attention?

Complications of sinusitis are uncommon, but an infection can sometimes spread to tissues around the eyes or other nearby structures. Seek urgent medical assessment if a child develops any of the following symptoms:

• Redness or swelling around an eye, especially if it persists or increases.
• Eye pain, double vision, or any new change in vision.
• A severe or unusual headache, particularly with neck stiffness.
• Repeated or persistent vomiting or sensitivity to light along with other concerning symptoms.
• Confusion, unusual difficulty waking, or a marked change in alertness.
• A child who appears very unwell or whose symptoms are rapidly worsening.

These warning signs require prompt assessment rather than continued home care. The Mayo Clinic's guidance on acute sinusitis identifies eye-area redness or swelling, vision changes, confusion, high fever, and neck stiffness as reasons for immediate medical attention. If a child has breathing difficulties, is difficult to wake, or appears critically ill, seek emergency care.

How can families reduce the risk of future infections?

Not every episode of sinusitis can be prevented, but everyday measures can reduce exposure to respiratory infections and irritants. Encourage regular handwashing, keep recommended childhood vaccinations up to date, and avoid tobacco smoke and secondhand smoke around children. If nasal symptoms repeatedly occur alongside suspected allergies, discuss them with the child's healthcare professional. Recurrent episodes or symptoms that continue for a long time may warrant further assessment to identify contributing factors and decide whether additional treatment is needed.