A child’s cold becomes acute bacterial sinusitis in one of three recognisable patterns: symptoms lasting more than 10 days without improvement, symptoms that improve and then worsen, or a severe start with high fever and thick discharge for three days in a row. The American Academy of Pediatrics uses these three patterns to diagnose the condition in children aged 1 to 18, and it advises against X-rays or scans for routine diagnosis. Between 5% and 10% of children’s viral colds are complicated by bacterial sinusitis, so most blocked noses in children never need an antibiotic.
For the wider picture, see the sinusitis hub, the shorter guides to symptoms of sinusitis in children and diagnosing sinusitis in children, and the emergency signs at the end of this page.
How Is Sinusitis Different in Children?
Sinusitis in children differs from adult sinusitis in three ways: the sinuses are still developing, cough replaces loss of smell as a key symptom, and complications around the eye occur mainly in young children. These differences change what parents should watch for and when a doctor needs to see the child.
Children’s sinuses are still developing
The maxillary and ethmoid sinuses are present at birth. The sphenoid sinus usually becomes visible between 3 and 7 years of age, and the frontal sinus between 6 and 8 years. The sinuses reach about half their adult size by age 10, and the frontal sinuses reach final volume only after puberty. A young child cannot have frontal sinusitis because the frontal sinus has not yet formed, which is why forehead pain is uncommon in preschool children.
Cough replaces loss of smell
The European Position Paper on Rhinosinusitis lists cough, rather than loss of smell, as a supporting symptom in children. Young children rarely report a change in smell, while a daytime cough caused by mucus draining down the throat is one of the most consistent signs of sinusitis in childhood.
Complications concentrate in young children
The most common orbital complications of acute bacterial sinusitis occur in children younger than 5 who have ethmoid sinusitis, according to the AAP guideline. The ethmoid sinuses sit between the eyes and are separated from the eye socket by a very thin bone, which is why a swollen eye in a child with a cold needs same-day assessment. The wider risks are covered in whether sinusitis can damage eyesight.
How Common Is Sinusitis in Children?
Acute sinusitis affects about 6% to 7% of children who see a doctor with respiratory symptoms, and between 5% and 10% of viral colds in children are complicated by bacterial sinusitis. Young children catch many colds a year, so even a small complication rate produces a large number of cases.
Why the numbers matter to parents
The 5% to 10% figure means that 9 out of 10 children with a cold recover without developing bacterial sinusitis. Thick, green or yellow nasal discharge is part of an ordinary cold and does not on its own indicate sinusitis. The deciding factor is the pattern of the illness over time, not the colour of the mucus.
What Are the Symptoms of Sinusitis in Children?
The main symptoms of sinusitis in children are persistent nasal discharge of any colour, daytime cough, nasal blockage, and in older children facial pain or headache. Fever is common in the severe pattern but absent in many persistent cases.
Symptoms in younger children
Younger children most often show nasal discharge, a daytime cough that may worsen when lying down, mouth breathing, snoring, irritability and poor feeding. Many do not complain of pain because they cannot locate or describe it.
Symptoms in older children
Older children add the symptoms seen in adults: facial pain or pressure over the cheeks or between the eyes, headache, nasal congestion, bad breath and, in teenagers, reduced sense of smell once the frontal and sphenoid sinuses have developed.
Symptoms that are not sinusitis
Itchy eyes, repeated sneezing, clear watery discharge and seasonal timing point toward allergic rhinitis rather than sinusitis. One-sided foul-smelling discharge in a young child can indicate a foreign object in the nose and needs a doctor’s examination.
How Do Doctors Diagnose Sinusitis in Children?
Doctors diagnose acute bacterial sinusitis in children from the pattern of illness alone, using three presentations defined by the American Academy of Pediatrics. Physical examination supports the diagnosis, and imaging is not used for routine cases.
Pattern 1 — Persistent illness
Persistent illness means nasal discharge of any quality, daytime cough, or both, lasting more than 10 days without improvement. This is the most common presentation and the one parents most often recognise as “a cold that will not go away”.
Pattern 2 — Worsening course
A worsening course means the child improves at first and then develops worsening or new nasal discharge, daytime cough or fever. This pattern is often called double worsening, and it does not require the 10-day wait.
Pattern 3 — Severe onset
Severe onset means a fever of at least 39°C (102.2°F) together with purulent nasal discharge for at least three consecutive days at the start of the illness. This pattern justifies earlier assessment than the other two.
Why X-rays and scans are not used
The AAP guideline states that plain X-rays, CT, MRI and ultrasound should not be performed to distinguish bacterial sinusitis from a viral cold, because the sinus lining looks abnormal on imaging during an ordinary cold as well. Contrast-enhanced CT or MRI is reserved for children suspected of having complications around the eye or inside the skull.
How Is Sinusitis Treated in Children?
Most children with sinusitis recover with supportive care, while antibiotics are reserved for the severe and worsening patterns and are optional for persistent illness. Every antibiotic decision belongs to the child’s doctor, who chooses the drug and dose for the child’s age and weight.
When doctors prescribe antibiotics
The AAP guideline recommends antibiotics for children with severe onset or a worsening course. For persistent illness, the doctor may either prescribe an antibiotic or offer three more days of observation, because some children recover during that period without treatment. If a child is not improving after 72 hours on treatment, or is getting worse, parents should contact the doctor again so the plan can be reviewed.
Which antibiotics doctors use
Amoxicillin, with or without clavulanate, is the first-line antibiotic in the AAP guideline. Other antibiotics are chosen for children with a penicillin allergy. Never give a child an antibiotic left over from a previous illness or prescribed for a sibling.
What the evidence says about extra treatments
The AAP guideline makes no firm recommendation on saline irrigation, intranasal steroids, decongestants or antihistamines for sinusitis in children. A Cochrane review cited in the guideline found no adequately designed studies establishing the effectiveness of decongestants, antihistamines or nasal irrigation for acute sinusitis in children. This means their benefit is unproven in children, not that they are harmful.
What Can Parents Do at Home?
Saline drops or spray, fluids, rest and a raised head position are the safest home measures for a child with a blocked nose, and several common remedies must be avoided in young children. Home care supports recovery; it does not replace assessment when one of the three sinusitis patterns appears.
Safe home measures
Five measures carry the lowest risk: saline nasal drops or spray to loosen mucus, a cool-mist humidifier in the bedroom, plenty of fluids, rest, and raising the head of the mattress slightly in older children. Teaching older children how to blow their nose properly, one nostril at a time, helps clear mucus without forcing it back toward the ears.
Remedies to avoid in young children
Two restrictions apply to all parents. Over-the-counter cough and cold medicines should not be given to children under 4 years old because of the risk of serious side effects, and products containing a decongestant or antihistamine must not be given to children under 2. Honey must not be given to babies under 12 months because it can cause infant botulism.
Pain and fever
Ask your pharmacist or doctor which pain or fever medicine suits your child’s age and weight, and follow the dose on the label for that weight. Never give aspirin to children or teenagers.
When Should You Take a Child With Sinus Symptoms to a Doctor?
Take the child to emergency care immediately for a swollen or red eye, a bulging eye, difficulty moving the eye, a severe headache, sensitivity to light, seizures, unusual drowsiness or confusion. These signs can indicate spread of infection to the eye socket or inside the skull, and they matter most in children under 5.
Emergency signs
The AAP guideline names these warning signs directly: a swollen eye, especially with bulging (proptosis) or impaired eye movement, points to an orbital complication; a severe headache, photophobia, seizures or other neurological signs point to an intracranial complication. Intracranial complications are rarer than orbital ones but more serious.
Signs that need a routine appointment
Book an appointment for nasal discharge or daytime cough lasting more than 10 days, for symptoms that improve and then worsen, for fever of 39°C (102.2°F) or higher with thick discharge for three days, and for a child who is not improving 72 hours after starting an antibiotic. Symptoms lasting 12 weeks or longer suggest chronic sinusitis, which needs specialist assessment. A symptom check for older teenagers is available in the sinusitis self-assessment test.
Can Children Use Nasodren®?
Nasodren® can be used in children aged 5 years and older according to its information leaflet, and it must not be used in children under 5 without specific medical advice. Talk to your child’s doctor before starting it, particularly if the child has allergies or takes other medicines.
Nasodren® is a CE 0051 Class IIA medical device, not a medicine, and it does not claim to cure sinusitis. Nasodren® is a 100% natural nasal spray made from Cyclamen europaeum extract, applied once daily into each nostril, which stimulates nerve endings in the nasal lining and increases drainage of retained mucus. It must not be used by anyone allergic to cyclamen, primula or other plants of the Primulaceae family. A brief burning sensation, sneezing or watery eyes after application is expected; contact with the eyes must be avoided, which requires particular care with children.
The published clinical studies on Cyclamen europaeum include trials in children and adolescents, and EPOS 2012 gave the extract a Level A recommendation. A 2018 Cochrane review of the extract for acute sinusitis, based on 2 trials in 147 adults, concluded that its effectiveness is unknown because neither trial reported the review’s main outcomes, and recorded mild adverse events such as nasal irritation in 50% of the treatment group against 24% on placebo. Parents who want a clinician’s view can book the free e-Health consultation at nasodren.com.
What Do Parents Ask About Sinusitis in Children?
How do I know if my child’s cold has turned into sinusitis?
Watch the pattern over time. A cold that has not improved after 10 days, a cold that improves and then gets worse, or a fever of 39°C (102.2°F) with thick discharge for three days in a row are the three patterns doctors use to diagnose bacterial sinusitis in children.
Does green mucus mean my child needs antibiotics?
Green or yellow mucus is part of an ordinary cold and does not on its own indicate bacterial sinusitis. Doctors decide on antibiotics from how long the illness has lasted and whether it is worsening or severe, not from mucus colour.
Can babies and toddlers get sinusitis?
Babies and toddlers can develop sinusitis because the maxillary and ethmoid sinuses are present from birth. The AAP guideline covers children from age 1, and orbital complications are most common in children under 5, so a swollen eye in a young child needs same-day assessment.
Does my child need an X-ray or scan?
Routine X-rays, CT, MRI and ultrasound are not recommended for diagnosing sinusitis in children because the sinus lining also looks abnormal during a normal cold. Scans are used only when doctors suspect a complication around the eye or inside the skull.
What can I give my child for a blocked nose?
Saline drops or spray, fluids, rest and a cool-mist humidifier are the safest options. Do not give over-the-counter cough and cold medicines to children under 4, and never give honey to babies under 12 months.
At what age can a child use Nasodren®?
Nasodren® can be used in children aged 5 and older according to the product leaflet. It is not used under 5 without specific medical advice, and parents should check with the child’s doctor before starting it.
Key Takeaways: What Should Parents Remember About Sinusitis in Children?
Most children’s colds never become sinusitis, and the ones that do are recognised by their pattern over time rather than by mucus colour. Six points summarise the article.
- Three patterns define bacterial sinusitis in children: more than 10 days without improvement, improvement followed by worsening, or fever of 39°C (102.2°F) with thick discharge for three consecutive days.
- Only 5% to 10% of children’s colds are complicated by bacterial sinusitis.
- X-rays and scans are not used for routine diagnosis; they are reserved for suspected complications.
- Antibiotics are recommended for severe and worsening cases, and observation for three more days is an accepted option for persistent illness.
- No cough and cold medicines under age 4, and no honey under 12 months.
- A swollen, red or bulging eye, severe headache or unusual drowsinessneeds emergency care, especially in children under 5.
This article is for informational purposes only and does not constitute medical advice. It does not recommend any medicine or dose for children. Medication choices and doses for children must be set by a doctor or pharmacist according to the child’s age and weight. Seek emergency care immediately for a swollen or bulging eye, severe headache, seizures, confusion or unusual drowsiness. Brand information for Nasodren® is included for commercial purposes; the medical content is sourced from published guidelines and peer-reviewed literature.
Which Medical Sources Support This Article?
- Wald ER, et al. Clinical Practice Guideline for the Diagnosis and Management of Acute Bacterial Sinusitis in Children Aged 1 to 18 Years. Pediatrics. 2013;132(1):e262.
- Hauk L. AAP Releases Guideline on Diagnosis and Management of Acute Bacterial Sinusitis in Children One to 18 Years of Age. American Family Physician. 2014;89(8):676-681.
- DeMuri G, Wald ER. Acute Bacterial Sinusitis in Children. Pediatrics in Review. 2013;34(10):429-437.
- US Food and Drug Administration. Should You Give Kids Medicine for Coughs and Colds? Consumer Update.
- Fokkens WJ, Lund VJ, Hopkins C, et al. European Position Paper on Rhinosinusitis and Nasal Polyps 2020. Rhinology. 2020;58(Suppl S29):1-464.
- Zalmanovici Trestioreanu A, Barua A, Pertzov B. Cyclamen europaeum extract for acute sinusitis. Cochrane Database of Systematic Reviews. 2018;5:CD011341.