Sinusitis – acute in children

Key points about acute sinusitis in children

  • Sinusitis (pokenga pakohu ihu) is an infection or inflammation of your sinuses – air-filled spaces in the skull behind your forehead, eyes, nose and cheeks.
  • There are some differences in symptoms and treatment of acute sinusitis in children compared to adults.
  • In most cases, children with acute sinusitis will get better without medication or, if needed, will be successfully treated with antibiotics.
  • However, children are more prone to complications than adults are. If you see any swelling or redness of an eyelid or cheek in a child with sinusitis, see your healthcare provider urgently.
  • There are things you can do at home to help your child’s symptoms while they're sick.
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Note: This page is about acute sinusitis in children. Read about acute sinusitis in adults

Acute sinusitis is usually caused by a viral infection, such as a cold. If your child has symptoms longer than the usual week to 10 days that a cold lasts, then they may have an acute sinus infection. Young children are more prone to infections in their sinuses, especially in their first few years. These infections may be made worse if your child has any allergies.

In children, symptoms may include:

  • fussiness and fever
  • ear pain or pressure
  • snoring
  • mouth breathing
  • feeding problems
  • nasal speech
  • bad breath
  • cough.

The most common complication is chronic sinusitis. Chronic sinusitis causes similar symptoms to acute sinusitis but lasts longer.

Other complications are rare but can be serious. This can include infections spreading from the sinuses to around an eye or into bones, blood or brain. Children are more prone than adults are to such complications.

See your healthcare provider urgently if your child with sinusitis has swelling or redness of an eyelid or cheek.

Your healthcare provider will examine your child’s ears, nose and throat. They may look for things that make your child more likely to get a sinus infection, eg, the structure of their airways, and any allergies or conditions that affect their immune system.

In some cases, your healthcare provider may also get a CT scan to work out how fully your child's sinuses are developed, where any blockage has occurred and to confirm the diagnosis of sinusitis. Regular X-rays are not usually helpful for diagnosing sinusitis. 

To help relieve the pain and discomfort caused by sinusitis, you can try the following home treatments for your child:

  • Make sure they rest to help their body heal faster.
  • Keep them hydrated by encouraging them to drink lots of fluids – this helps to thin the mucus.
  • Hold a hot (but not too hot) compress or warm face pack over the painful area.
  • Consider using saline nasal spray or drops, or a sinus rinse of saline solution to relieve congestion and blockage in their nose. You can make your own saline solution or buy one from your pharmacy.

Home-made saline solution

Home-made saline solution is made using 1/4 teaspoon non-iodised salt and 1/4 teaspoon baking soda dissolved in 250 mL (1 cup) of warm (previously boiled) water. You can buy a sinus rinse bottle or pot from your pharmacy. Read more about saline nasal sprays, drops and rinses.

The video below demonstrates how a sinus or nasal rinse is performed using saltwater in young kids.

Video: Pediatric Nasal Rinse - How a Sinus Rinse is Performed in Kids!

This video may take a few moments to load.

(Fauquier ENT, US, 2021)

Important note

Steam inhalation is a traditional remedy but is not recommended. This is because there is little evidence that it helps. Also, there is a risk your child might burn themselves. However, some people say that their nose feels clearer for a short while after a hot shower. 

Medicines for sinusitis

Pain relief medicines: You can give your child paracetamol to reduce pain and discomfort. Read more about giving paracetamol safely to children.

Decongestants nasal sprays (eg, Otrivin): These should not be used in children younger than 2 years of age.

There's no evidence that antihistamines and oral decongestants work for sinusitis in children and they should be avoided.

When should I seek help?

You should see a healthcare provider if your child:

  • has cold symptoms that last longer than 7-10 days
  • has fever for more than 2 or 3 days
  • has swelling or redness around their eyes or cheeks
  • has bad tenderness around their forehead, eyes, or cheeks
  • isn't eating or drinking well, or is much less active than usual.

Does my child need antibiotics for sinusitis? 

Antibiotics are seldom needed to treat sinusitis because sinusitis is mostly caused by viruses (a viral infection). Antibiotics only work against bacteria (a bacterial infection) but not viruses. 

Antibiotic resistance

Using antibiotics when they're not needed can lead to antibiotic resistance. This is when overuse of antibiotics encourages the growth of bacteria that can’t be controlled easily with medicines. That can make it harder to treat your child's infections in the future and make antibiotics less effective for everyone.

However, antibiotics are considered when symptoms:

  • last longer than 10 days
  • start to improve but then worsen again
  • are very severe (eg, a fever over 39°C)
  • include extreme pain and tenderness over their sinuses
  • include signs of a skin infection (eg, a hot, red rash that spreads quickly).
  • If your child is given antibiotics, it’s important that they finish the full course, even if they feel better after a few days. 

If your child is given antibiotics, it's important that they finish the full course, even if they feel better after a few days. 

Does my child need surgery for sinusitis?

For a small percentage of children with severe or persistent sinusitis symptoms despite medication, surgery may be considered. This is done by an ENT (ear, nose and throat) surgeon. They use an instrument called an endoscope to open the natural drainage pathways of your child's sinuses and make the narrow passages wider. Opening up the sinuses and allowing air to circulate usually leads to fewer and milder sinus infections. 

Adenoidectomy may also be considered at the time of surgery as this may also help reduce the symptoms of sinusitis. Adenoidectomy involves the removal of the adenoids – a patch of tissue at the very back of the nose.

You can reduce the risk of sinus infections for your child by managing their allergies, getting any acid reflux (heartburn) treated and making sure they're not exposed to tobacco smoke.

The following links provide further information about acute sinusitis in children. Be aware that websites from other countries may have information that differs from New Zealand recommendations.   

Sinusitis in children(external link) Stanford Children’s Health, US


Treating sinus infections – don’t rush to antibiotics(external link) Consumer Reports. Adapted by Choosing Wisely Canada
Your family and antibiotics – What you need to know(external link) PHARMAC, NZ
Virus action plan (child over 6 months)(external link) He Ako Hiringa, NZ


  1. Pediatric sinusitis(external link) American Academy of Otolaryngology, US, 2018
  2. Use of cough and cold medicines in children(external link) – updated advice Medsafe, NZ, 2013
  3. Acute sinusitis(external link) Patient Info, UK, 2023
  4. Acute bacterial rhinosinusitis in children – clinical features and diagnosis(external link) UpToDate, 2022
  5. AAP releases guideline on diagnosis and management of acute bacterial sinusitis in children one to 18 years of age(external link) Am Fam Physician. 2014 Apr 15;89(8):676-681. 

Acute bacterial sinusitis should be diagnosed in a child who has an acute upper respiratory tract infection with persistent illness (eg, nasal discharge or daytime cough or both) lasting more than 10 days; worsening cough, worsening or new nasal discharge, or daytime cough or fever after initial improvement; or severe onset of fever and purulent nasal discharge for at least 3 consecutive days. The clinician should prescribe antibiotics for acute bacterial sinusitis in children with severe onset or worsening course. Children with persistent illness should be either prescribed antibiotic therapy or offered additional observation for 3 days.
DeMuri G, Wald ER. Acute bacterial sinusitis in children(external link) Pediatrics in Review.2013 Oct 01;34(10): 429-437.

These are rare (around 2.5 to 4.3 per million people per year). They occur more commonly in children. They include orbital cellulitis(external link)meningitis(external link), brain abscess, osteomyelitis(external link) (known as Pott's puffy tumour when the frontal bone is affected) and cavernous sinus thrombosis. Very occasionally, there is formation of a cutaneous fistula. Acute sinusitis can become chronic.
Sinusitis(external link) PatientInfo Professional, UK, 2019

Pediatric sinusitis(external link) American Academy of Otolaryngology, US, 2018
AAP releases guideline on diagnosis and management of acute bacterial sinusitis in children one to 18 years of age(external link) Am Fam Physician. 2014 Apr 15;89(8):676-681.
Wald ER, Applegate KE, Bordley C. Clinical practice guideline for the diagnosis and management of acute bacterial sinusitis in children aged 1 to 18 years(external link) Pediatrics. 2013 July;132
Acute bacterial rhinosinusitis in children – clinical features and diagnosis(external link) UpToDate, 2022 (requires login).


treating sinusitis choosing wisely canada

Treating sinus infections: Don’t rush to antibiotics

Consumer Reports. Adapted by Choosing Wisely Canada, 2016

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Credits: Healthify editorial team. Healthify is brought to you by Health Navigator Charitable Trust.

Reviewed by: Dr Art Nahill, Consultant General Physician and Clinical Educator.

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