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Pediatric Sinusitis


Rhinosinusitis, or sinusitis, is an inflammation of the nose and sinuses and is a very common condition affecting children. Pediatric sinusitis can be caused by:

  • Viruses
  • Bacteria
  • Environmental irritants
  • Other inflammatory factors

In children, a common cold or viral infection may lead to a sinus infection. When an infection begins, the lining of the nose and sinuses may become swollen, blocking the passage and resulting in a mucus build-up. When this mucous remains in the sinuses too long, it can become infected. It is common for children, especially those with allergies or those who are in daycare or school, to have 4 to 6 viral upper respiratory infections or more per year.

One of the challenges of diagnosing sinusitis in children is that many of the symptoms and signs of childhood bacterial sinusitis are the same as the common cold. When the symptoms last longer than 7 to 10 days, or when symptoms worsen after 5 to 7 days, it is time to consider the possibility of a bacterial sinus infection.

Common sinus infection symptoms include:

  • Nasal congestion
  • Increased nasal discharge (discolored drainage does not necessarily indicate bacterial infection)
  • Cough
  • Facial pain or pressure
  • Fever

Often, your doctor is able to diagnose sinusitis from your description of the problem and by examining your child. Your ear, nose and throat physician may need to perform a nasal endoscopy for further evaluation. In addition, your child may need a CT scan of the sinuses to identify the problem.

Treatment for your child’s sinusitis will depend on the cause. If your child is diagnosed with a viral infection, antibiotics will not help, and may cause side effects and antibiotic resistance. For these viral infections, the best treatments are supportive measures such as:

  • Adequate rest
  • Maintaining hydration
  • Over-the-counter medication such as acetaminophen/ibuprofen, etc.
  • Use of decongestants or mucolytics

Your child’s immune system clears the viral infection over 7 to 10 days.

Proper nasal hygiene is also important for children to learn at an early age, especially when they start school. Teach your kids to practice these behaviors to help prevent sinus infections.

  • Use tissues to keep their noses clean
  • Avoid picking their noses
  • Sneeze and cough into the pit of their elbows
  • Wash their hands thoroughly
  • Use saline nose spray regularly (with parental help if needed)

Using saline nose spray regularly has been shown to be very effective for improving nasal and sinus symptoms in children. This is a safe, effective habit that can be done in the morning and evening after brushing their teeth. This is very effective for keeping the nose moist and clean, and it also helps kids feel like they are doing something good for themselves.

If your child is diagnosed with bacterial sinusitis, antibiotics are the treatment of choice, in addition to the supportive measures described above. The length of antibiotic treatment may vary from a few days to a few weeks depending on the severity of the infection. Sometimes, nasal steroid sprays and/or oral steroids are prescribed to treat severe inflammation. The majority of the time, your child’s sinusitis will resolve with these medical treatments.

It is also important to consider other factors that may be contributing to your child’s sinusitis. These factors may include:

  • Allergies
  • Asthma
  • Acid reflux
  • Cystic fibrosis
  • Primary ciliary dyskinesia
  • Immune deficiency

Your physician will discuss these with you and may recommend further testing or treatment to improve your child’s condition. Your child may also need treatment for enlarged adenoids.

If your child is having frequent or recurrent sinus infections, or is having symptoms of chronic infection for more than 3 months despite medical treatments, your physician may suggest surgical treatment options with you and your child. These treatments may include: