Sinusitis is the inflammation of the tissue lining the air-filled cavities known as the sinuses. This inflammation often follows a common cold or an allergic reaction, causing the lining to swell and produce excess mucus. When the drainage pathways become blocked, fluid gets trapped, creating an environment where bacteria can grow, leading to a bacterial sinus infection. While babies can experience severe congestion, true bacterial sinusitis is uncommon in infancy due to the underdeveloped anatomy of the sinuses. The potential for infection increases significantly as a child’s facial structure and immune system mature, with infections becoming more frequent around age two. Understanding the development of the sinuses and recognizing key symptoms helps parents distinguish a lingering cold from an infection requiring medical attention.
Understanding Sinus Development in Children
The age at which a child can develop a sinus infection is directly related to sinus development. Infants are born with the ethmoid sinuses, located between the eyes, and the maxillary sinuses, found in the cheekbones, already present but in a small form. The ethmoid sinuses grow rapidly during the first two years of life, which aligns with the age where true sinus infections begin to become more common.
The other two pairs, the frontal and sphenoid sinuses, develop much later in childhood. The sphenoid sinuses, situated deep behind the nose, begin to develop around age three to five years. The frontal sinuses, located in the forehead, are often the last to appear, typically starting to develop around ages six to eight and not reaching their full size until adolescence.
A true sinus infection requires a cavity large enough to become blocked and fill with fluid, which is why infants with small, undeveloped sinuses typically experience only severe nasal congestion. The developing anatomy explains why ethmoid sinusitis is more common in young children, while frontal sinusitis is rarely seen before the school-age years.
Recognizing Symptoms of Sinusitis in Young Children
Distinguishing pediatric sinusitis from a simple cold can be challenging because the initial symptoms are often identical. Sinusitis is often characterized by cold symptoms—nasal discharge and/or a daytime cough—that persist for more than ten days without showing any signs of improvement.
The duration of symptoms is one of the most important indicators. A lingering cold that seems to be getting worse after seven days, or one that lasts past the ten-day mark, raises suspicion for a possible bacterial sinus infection. The nasal discharge associated with sinusitis is often thick and persistent, sometimes appearing yellow or green, although the color alone is not a definitive sign of a bacterial infection.
A persistent cough that frequently worsens at night is another common sign, often caused by post-nasal drip where mucus drains down the back of the throat. In older children, a headache or facial pain, which may feel like pressure around the eyes or cheeks, can be reported. Other symptoms can include persistent bad breath, increased irritability, or low-grade fever that lasts for several days.
Medical Intervention and Home Care
The majority of acute sinusitis cases in children are viral and will resolve naturally without antibiotics. For a child with mild symptoms that persist for more than ten days, a doctor may recommend a period of watchful waiting before prescribing medication. This approach monitors the child to see if the body can clear the infection naturally.
Home care focuses on managing symptoms and encouraging drainage. Using saline nasal rinses or drops helps to keep the nose and sinuses moist, thinning the mucus and facilitating its flow. A cool-mist humidifier in the child’s room can also help to ease congestion. Over-the-counter pain relievers, such as acetaminophen, can be used to manage discomfort or fever.
Antibiotics are typically reserved for children whose symptoms worsen after an initial period of improvement or those whose symptoms are severe from the start. Severe symptoms include a high fever combined with thick nasal discharge that lasts for three or four days, or a sudden, severe onset of symptoms. Seek immediate medical attention if the child develops signs that can indicate a rare but serious complication:
- Swelling or redness around the eyes.
- A severe headache.
- Sensitivity to light.
- Increasing irritability.