Sinusitis is inflammation (redness and swelling) of the sinuses, the small air-filled spaces in the bones of the face near the nose. Special tissue lining the sinuses makes mucus, which is a sticky liquid that traps germs, dust and other particles as they are breathed into the nose. This mucus normally drains out of the sinuses through small openings into the nose. When the lining of the sinuses becomes so irritated and swollen, as with a cold or allergies, that the opening is blocked, mucus cannot drain easily. As mucus builds up in the sinuses, a person may feel pressure, congestion or discomfort. Sometimes bacteria grow in the trapped mucus, causing a sinus infection.
Since a sinus infection often starts with a cold, the two illnesses can look similar, with runny nose, cough and fever, but they really are different. Colds, which are caused by viruses, can last one to two weeks, but symptoms almost always have begun to improve by then. On the other hand, sinus infections are caused by bacteria and symptoms last longer or are more severe than the common cold. When a runny nose and cough do not seem to be getting any better after 10 to 14 days, or are getting worse, it is possible that a sinus infection has developed.
Sinus infections can occur at any age and at any time of year, but most commonly are seen in school-aged children during the winter months. Between 5 percent and 10 percent of children with colds may go on to develop bacterial sinusitis.
- Check your child's temperature, since sinus infections often cause fever.
- Look at your child's:
- Nose for clear or yellow-green discharge, and for redness and swelling of the inside lining.
- Throat for mucus (called postnasal drip) or redness in the back of it.
- Check for soreness over the sinuses by gently pressing or tapping on the cheeks and forehead.
- Consider further testing. X-rays generally are not necessary to diagnose sinusitis at any age, but especially not in young children. CT scans sometimes are needed for complicated cases.
If your child does have sinusitis, the doctor will:
- Prescribe an antibiotic. Bacterial sinus infections usually are treated with antibiotics to speed recovery and prevent spread of the infection toward the eyes or brain. The length of treatment is typically 10 days, but longer courses sometimes are necessary.
- Discuss whether any other medicines are necessary. If your child has allergies (allergic rhinitis), nasal steroids and antihistamines may help to reduce nasal swelling and inflammation, so things drain better.
- Recommend ways to ease the pain.
- Discuss the things you should watch for at home.
- Tell you whether your child should be seen again. Usually no follow-up visit is required if your child is feeling better.
What can we do at home?
Some over-the-counter medications may be helpful:
- For mild pain and fever, try acetaminophen (Tylenol) or ibuprofen (Advil, Motrin).
- Saline (salt water) nose drops or nose sprays do not contain any medicine, so they can be used safely to rinse out any mucus from the nose and help keep the nasal passages open and moist.
- Decongestants (for example, pseudoephedrine or Sudafed) taken by mouth may help to treat nasal stuffiness by decreasing swelling of the lining in the nose. Decongestants should always be used carefully because they can make some children "hyper" or fussy. They are not recommended for children under 4 years of age.
These over-the-counter medicines usually are not helpful:
- Expectorants, also called mucolytics (for example, guaifenesin), are supposed to loosen up mucus so that it could drain out of the sinuses easier. Unfortunately, they have not been shown to help children who have sinusitis.
- Antihistamines (for example, diphenhydramine or Benadryl) have not been shown to be helpful in children who do not have allergies. Antihistamines often make things worse, as it may thicken the mucus so drainage is more difficult.
Certain over-the-counter medications should not be used (unless directed by your doctor):
- Decongestant nose sprays (for example, oxymetazoline or Afrin) may initially help to treat nasal stuffiness by decreasing swelling of the lining in the nose, but should never be used for more than two or three days. If used longer, the nasal congestion will actually get worse instead of better.
- Ephedra (mahuang) has been used as a decongestant, but is not recommended for children due to its possible serious side effects.
- Any product that combines more than one medicine to treat cold symptoms must be used very carefully. They can be hard to dose correctly and may contain too much medication for your child, leading to unwanted side effects.
- Never give your child aspirin or any products containing aspirin because it has been associated with Reye’s syndrome, a serious illness that affects the liver and brain.
Other things you and your child can do that may help your child feel better:
- Blow mucus out of the nose gently.
- Use a cool mist vaporizer (humidifier) in your child's room to help keep nasal passages moist and reduce inflammation. Be sure to clean it every few days according to the manufacturer’s instructions.
- Give your child lots of liquids — warm (broth, apple juice, lemonade or tea) or cool (milk shakes, gelatin desserts, flavored ices) — to soothe the throat and keep well hydrated.
- Take a warm bath or shower to help loosen nasal congestion.
- Hold warm (not hot) compresses over the nose and eyes.
- Do not smoke around your child because it will make symptoms worse.
Call the doctor if your child:
- Is getting worse instead of better.
- Is having trouble breathing.
- Is not drinking and has not made any urine in six to eight hours.
- Seems too sleepy or tired (lethargic) at those times when he would normally be awake and active.
- Continues to have fever or pain two to three days after having seen a doctor.
- Gets redness or swelling on the cheek, eyelid or forehead.
- Starts vomiting or gets bad headaches.
Prevent other episodes of sinusitis by:
- Teaching your child to always wash his hands regularly and well.
- Teaching your child to cover his mouth and nose when he coughs or sneezes.
- Using disposable tissues to wipe or blow noses (use once and then throw them away).
- Using a humidifier in the winter months when the air in most homes is very dry. Dry air irritates the sinuses, increasing the risk of infection.
- Making sure that if your child has any condition that makes sinus infections more likely (for example, allergic rhinitis), you closely follow the doctor’s advice in treating that condition.
When can my child return to school or day care?
Check with your school or day care regarding specific policies about returning after illness. Although sinusitis is not contagious (spread from person to person), the cold that often comes before the sinus infection is contagious. However, children with colds or sinusitis usually can go back to school or day care as soon as they have no fever for 24 hours and feel well enough to be there.
If your child needs to take a dose of medicine during the school day, it can be helpful to ask your pharmacist to put the medicine into two different labeled containers. That way you can send one to school or daycare and leave the other at home. Also be sure to fill out any necessary forms, including a note from your doctor, with specific instructions for giving the medicine.