Sinus Infections in Children
Content reviewed against published AAP, CDC, NIH guidelines
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Sinusitis is an infection or inflammation of the sinuses — the air-filled spaces in the bones around the nose. In children, it typically develops as a complication of a viral upper respiratory infection when bacteria invade the swollen, fluid-filled sinus cavities. About 6-9% of colds in children are complicated by bacterial sinusitis. The maxillary and ethmoid sinuses are present at birth, making sinusitis possible even in infants.
Key takeaways
- Sinusitis is an infection or inflammation of the sinuses — the air-filled spaces in the bones around the nose.
- Duration: With appropriate antibiotics, improvement is expected within 72 hours. Full course of treatment is 10-14 days. Without treatment, may persist or develop complications.
- Go to ER if: Swelling or redness around the eyes (possible orbital cellulitis)
- A vaccine or immunization is available
Symptoms
How It Presents by Age
0-12 months
Persistent nasal congestion and discharge beyond 10 days. May have cough and irritability. Ethmoid sinusitis can cause periorbital swelling. Cannot report facial pain.
Risk level: Low to moderate
1-3 years
Persistent runny nose and cough, foul-smelling breath, and nighttime cough from post-nasal drip. Cannot localize facial pressure. Often misdiagnosed as prolonged cold.
Risk level: Low to moderate
3-7 years
May describe facial pain or headache. Classic presentation with nasal symptoms persisting beyond 10 days or "double-sickening" pattern where cold improves then worsens again.
Risk level: Low
7-12 years
Can describe symptoms clearly — facial pressure, headache, congestion. Frontal sinuses develop around age 7-8, so frontal headache becomes possible.
Risk level: Low
Treatment
Antibiotics
Amoxicillin or amoxicillin-clavulanate is first-line. High-dose amoxicillin (90 mg/kg/day) for 10-14 days. Amoxicillin-clavulanate if no improvement in 72 hours or for severe presentation.
Watchful waiting
For children 2+ years with persistent but non-severe symptoms, 3 additional days of observation may be appropriate per AAP 2013 guidelines.
Nasal saline irrigation
Helps thin mucus and improve sinus drainage. Safe and effective as adjunctive therapy.
Pain management
Acetaminophen or ibuprofen for facial pain and headache.
Home Care
- Use saline nasal spray or drops several times daily
- Run a cool-mist humidifier in the bedroom
- Elevate the head of the bed slightly
- Encourage extra fluids to thin secretions
- Apply warm compresses to the face for pain (older children)
- Use a bulb syringe to suction mucus in infants
- Steam from a hot shower can help loosen congestion
When to Worry
Go to the ER if:
- Swelling or redness around the eyes (possible orbital cellulitis)
- Vision changes or eye pain
- Severe headache with high fever, vomiting, or stiff neck
- Altered mental status or extreme lethargy
- Swelling of the forehead (Pott puffy tumor — rare)
Call your doctor if:
- Cold symptoms lasting more than 10 days without improvement
- Cold that improves then suddenly worsens (double-sickening)
- High fever (102°F+) with thick nasal discharge for 3+ days
- Facial pain or severe headache in older children
- Recurrent sinusitis episodes
- Symptoms not improving after 72 hours of antibiotics
Keep an eye on:
- Symptoms not improving after 72 hours of antibiotics
- Fever developing or increasing during antibiotic treatment
- Swelling or redness around the eyes
- Severe headache, especially with vomiting
- Visual changes or eye pain
Prevention
- Treat nasal congestion from colds promptly with saline
- Annual influenza vaccine
- Pneumococcal vaccine (PCV)
- Frequent handwashing
- Avoid exposure to secondhand smoke
- Manage allergies with appropriate treatment
- Use a humidifier to keep nasal passages moist
Contagion & Incubation
Incubation
Typically develops 7-10 days after the start of a cold when symptoms fail to improve or worsen
Contagious for
The bacterial sinus infection itself is not contagious. The preceding viral infection may be contagious for 7-10 days.
Duration
With appropriate antibiotics, improvement is expected within 72 hours. Full course of treatment is 10-14 days. Without treatment, may persist or develop complications.
Frequently asked questions
How long does sinus infections in children last?
How does acute bacterial sinusitis spread?
When should I take my baby to the ER?
Can acute bacterial sinusitis be prevented?
When can my child return to daycare?
Sources
All content follows our editorial policy and is reviewed against published clinical guidelines.
2,705 evidence-based guides6 authoritative medical sources
Related Illnesses
Bottom line
Sinus Infections in Children is treatable with appropriate medical care. Seek emergency care if swelling or redness around the eyes (possible orbital cellulitis).
Trust your instincts. If something feels wrong, reach out to your pediatrician. Worrying about your baby means you care — that is a good thing.