Sinus Infections in Children: Signs and Symptoms

Rhinosinusitis refers to the inflammation of the mucosa of the nose and sinuses. The diagnosis can be challenging as the symptoms resemble that of allergic rhinitis or adenoid hypertrophy, but the management differs.

Table of Contents

1. What are acute and chronic rhinosinusitis?
2. What are the symptoms of sinusitis in children?
3. How can I tell if my child has rhinosinusitis?
4. What causes sinusitis in children?
5. How does a doctor diagnose sinusitis?
6. How long will it take my child to get better?
7. What happens if my child keeps getting sinus infections?
8. Can sinus infections be prevented?
9. Where can I find additional information about sinus infections in children?

What are acute and chronic rhinosinusitis?

The following criteria identify acute bacterial rhinosinusitis in children:

• Cold and cough lasting more than 10 days
• Recurrence of symptoms after initial improvement i.e. worsening fever and cough
• Severe onset of fever with pus-like nasal discharge, associated with a headache for 3 consecutive days.

Viral rhinosinusitis has similar features but is caused by viral pathogens instead of bacteria. Symptoms lasting more than 3 months fall under the diagnosis of chronic rhinosinusitis.

What are the symptoms of sinusitis in children?

5-10% of viral coughs and colds in children progress to rhinosinusitis. The child would complain of a blocked nose with yellowish-green discharge from the nose, headache and pain over the cheeks and the inner corners of the eyes. This is also accompanied by fever. They might not feed well as they lose their sense of taste and smell. As the infection progresses, they can develop swelling around the eyes as well.

How can I tell if my child has rhinosinusitis?

The criteria of symptoms mentioned earlier in this article can point to a possible sinus infection. Your doctor would take a swab from the nose to identify whether the infection is bacterial or viral.

What causes sinusitis in children?

Sinuses are air-filled cavities in the bone of the head and face which provide humidification to the air we breathe through the nose and give resonance to our voice. There are 4 pairs of sinuses – the maxillary – situated in the bone under the cheek, the ethmoid sinuses – deep in the nose, the sphenoid sinus – at the base of the head, and the frontal sinus – under the bone of the forehead. Children are not born with developed sinuses, they develop as the child grows – the last to develop is the frontal sinus. They secrete a layer of mucus and each sinus has an outflow tract. When this outflow gets obstructed due to any inflammation in the nose – such as a cold, large adenoid gland or a deviated septum – the mucus does not drain and becomes a reservoir of infection.

Furthermore, the mucosa of the nose and sinus are the same, thus any infections of the nose can lead to an infection of the sinuses.

How does a doctor diagnose sinusitis?

Your paediatric ENT doctor will ask you about any recent viral infections your child may have had. They will then ask about fever, headache, pain over the face and the colour and consistency of the nasal discharge.

Your doctor will then examine the child for mucopus in the nose – and take a swab to identify the organism causing the infection, as well as to identify the antibiotic that might help it. A culture sensitivity report usually takes 72 hours, so they will prescribe a broad-spectrum antibiotic to cover the infection. An x-ray of the nose may sometimes be required as well – which can also rule out enlarged adenoids, nasal polyps, or a deviated septum. EPOS and NICE guidelines dictate the management of paediatric sinusitis.

How long will it take my child to get better?

Antibiotics will help to cover the infection but the mucus needs to be drained out for relief of symptoms.

Saline nasal drops are highly recommended as they help to thin out the secretions so that they can be drained easily. Your doctor may also prescribe a short course of oral or topical decongestants that aid in reducing the congestion in the nose.

What happens if my child keeps getting sinus infections?

It is unusual for children to get repeated sinus infections. In this case, you should talk to your doctor about the possibility of a deficient immune system or genetic diseases that impair ciliary movement in the mucosa of the nose and sinuses. Vaccination against common infections may prevent future infections.

Children with allergies and asthma are predisposed to these infections as well. Treatment of the underlying cause is thus a necessity.

Can sinus infections be prevented?

Once any underlying genetic or environmental cause has been ruled out, you can inculcate the practice of nasal irrigation using saline drops in your child – this keeps the mucosal lining healthy and any thick nasal discharge can be washed off.

Where can I find additional information about sinus infections in children?

https://indianpediatrics.net/may1996/424.pdf

Conclusion

Sinus infections in children are uncommon, but severe. Management is usually with oral and topical (nasal) medications but severe cases may necessitate urgent drainage of the sinuses. If your child has a cough and cold with phlegm lasting more than 10 days – it is vital to visit your paediatric ENT doctor.