Sinusitis – acute in children

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!

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(Fauquier ENT, US, 2021)

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:

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.