Acute sinusitis in children

Sinusitis (pokenga pakohu ihu) is an infection or inflammation of your sinuses. There are some differences in symptoms and treatment of acute sinusitis in children compared to adults.

On this page, you can find the following information:

This page is about acute sinusitis in children. Read about acute sinusitis in adults

Key points 

  1. There are some differences in the symptoms and treatment of acute sinusitis in children than in adults.
  2. In most cases, children with acute sinusitis will get better without medication or, if needed, will be successfully treated with antibiotics.
  3. However, children are more prone to complications than adult are. If you see any swelling or redness of an eyelid or cheek in a child with sinusitis, see your doctor urgently.
  4. There are things you can do at home to help your child’s symptoms while they are sick.
  5. You can help prevent acute sinusitis in your child by keeping then away from cigarette smoke and managing any allergies well. 

What causes acute sinusitis in children? 

Acute sinusitis is usually caused by a viral infection, such as a cold. If your child has symptoms longer than the usual week to 10 days that a cold lasts, then they may have an acute sinus infection. Young children are more prone to infections in their sinuses, especially in their first few years. These infections may be made worse if your child has any allergies.

What are the symptoms of acute sinusitis in children?

In children, symptoms may include:

  • irritability and fever
  • ear discomfort
  • snoring
  • mouth breathing
  • feeding difficulty
  • nasal speech
  • bad breath
  • cough.

What complications might children with acute sinusitis experience?

The most common complication is chronic sinusitis. Chronic sinusitis causes similar symptoms to acute sinusitis but lasts longer.

Other complications are rare but can be serious. This can include infections spreading from the sinuses to around an eye or into bones, blood or brain. Children are more prone than adults are to such complications. See your doctor urgently if you child with sinusitis has swelling or redness of an eyelid or cheek.

How is acute sinusitis in children diagnosed?

Your doctor will examine your child’s ears, nose and throat. The doctor may look for things that make your child more likely to get a sinus infection, such as the structure of their airways, any allergies or conditions that affect their immune system.

In some cases, the doctor may also get a CT scan may to work out how fully your child's sinuses are developed, where any blockage has occurred and to confirm the diagnosis of sinusitis.

How can I care for my child with acute sinusitis?

To help relieve the pain and discomfort caused by sinusitis, try the following home treatments for your child:

  • Make sure they rest to help their body to heal faster.
  • Keep them hydrated by encouraging them to drink lots of fluids – this helps to thin the mucus.
  • Hold a hot compress or warm face pack over the painful area.
  • Consider using saline nasal spray or drops, or a sinus rinse of home-made saline solution to relieve congestion and blockage in their nose.
Home-made saline solution
Home-made saline solution is made using 1/4 teaspoon non-iodised salt, 1/4 teaspoon baking soda dissolved in 250 mL (1 cup) of warm (previously boiled) water. You can buy a sinus rinse bottle or pot from your pharmacy. Read more about saline nasal sprays, drops and rinses.

Steam inhalation is a traditional remedy but is not recommended. This is because there is little evidence that it helps. Also, there is a risk your child might burn themselves. However, some people say that their nose feels clearer for a short while after a hot shower. 

Medicines for sinusitis

Pain relief medicines: you can give your child paracetamol to reduce pain and discomfort. Read more about giving paracetamol safely to children

Decongestants nasal sprays (eg, Otrivin) should not be used in children younger than 2 years old. Antihistamines and oral decongestants are not generally effective for viral upper respiratory infections in children and should not be given to children younger than 6 years old.

Does my child need antibiotics for sinusitis? 

Antibiotics are seldom needed to treat sinusitis because sinusitis is mostly caused by viruses (a viral infection). Antibiotics only work against bacteria (a bacterial infection) but not viruses. 

Antibiotic resistance
Using antibiotics when they are not needed can lead to antibiotic resistance. This is when overuse of antibiotics encourages the growth of bacteria that can’t be controlled easily with medicines. That makes your child more at risk of antibiotic-resistant infections in the future and makes antibiotics less effective for everyone. 
  • Antibiotics are considered when symptoms last longer than 10 days, start to improve but then worsen again, or are very severe such as a fever over 39°C, extreme pain and tenderness over your sinuses, or signs of a skin infection, such as a hot, red rash that spreads quickly.
  • If your child is given antibiotics, it’s important that they finish the full course, even if they feel better after a few days. 

Does my child need surgery for sinusitis?

For a small percentage of children with severe or persistent sinusitis symptoms despite medication, surgery may be considered. This is done by an ENT (ear, nose and throat) surgeon. They use an instrument called an endoscope to open the natural drainage pathways of your child's sinuses and make the narrow passages wider. Opening up the sinuses and allowing air to circulate usually leads to fewer and less severe sinus infections. 

Adenoidectomy (removal of the adenoids) may also be considered at the time of surgery as this may also help reduce the symptoms of sinusitis.

How can I prevent acute sinusitis in my child?

You can reduce the risk of sinus infections for your child by managing their allergies, getting any acid reflux treated and making sure they are not exposed to tobacco smoke.

Learn more

The following links provide further information about acute sinusitis in children. Be aware that websites from other countries may have information that differs from New Zealand recommendations.   

Sinusitis in children Stanford Children’s Health, US, 2018


  1. Pediatric sinusitis American Academy of Otolaryngology, US, 2018
  2. Use of cough and cold medicines in children – updated advice Medsafe, NZ, 2013
  3. Acute sinusitis Patient Info, UK, 2018
  4. Acute bacterial rhinosinusitis in children – clinical features and diagnosis UpToDate, 2018
  5. AAP releases guideline on diagnosis and management of acute bacterial sinusitis in children one to 18 years of age Am Fam Physician. 2014 Apr 15;89(8):676-681. 

Information for healthcare providers

Acute bacterial sinusitis should be diagnosed in a child who has an acute upper respiratory tract infection with persistent illness (ie, nasal discharge or daytime cough or both) lasting more than 10 days; worsening cough, worsening or new nasal discharge, or daytime cough or fever after initial improvement; or severe onset of fever and purulent nasal discharge for at least 3 consecutive days. The clinician should prescribe antibiotics for acute bacterial sinusitis in children with severe onset or worsening course. Children with persistent illness should be either prescribed antibiotic therapy or offered additional observation for 3 days. DeMuri G, Wald ER. Acute bacterial sinusitis in children Pediatrics in Review.2013 Oct 01;34(10): 429-437.

Complications are rare (of the order of 1 in 10,000 cases of sinusitis) but they occur more commonly in children. They include orbital cellulitis, meningitis, brain abscess, osteomyelitis (known as Pott's puffy tumour when the frontal bone is affected) and cavernous sinus thrombosis. Very occasionally, there is formation of a cutaneous fistula. Acute sinusitis can become chronic. Sinusitis PatientInfo Professional, UK, 2014

Pediatric sinusitis American Academy of Otolaryngology, US, 2018
AAP releases guideline on diagnosis and management of acute bacterial sinusitis in children one to 18 years of age Am Fam Physician. 2014 Apr 15;89(8):676-681.
Wald ER, Applegate KE, Bordley C. Clinical practice guideline for the diagnosis and management of acute bacterial sinusitis in children aged 1 to 18 years Pediatrics. 2013 July;132
Acute bacterial rhinosinusitis in children – clinical features and diagnosis UpToDate, 2018

Reviewed by

Dr Andrew Cho works in private practice at Robot Head and Neck Surgery and as an otolaryngologist, and head and neck surgeon at Counties Manukau DHB, Auckland. He has previously worked at Starship Hospital in Auckland and undertook a prestigious American Head and Neck Society Fellowship at the University of California in head and neck oncological surgery and microvascular reconstruction. His area of expertise includes general ENT, paediatric ENT, sinusitis, and head and neck surgery.
Credits: Health Navigator Editorial Team. Reviewed By: Dr Andrew Cho, specialist head and neck surgeon and otolaryngologist Last reviewed: 25 Jul 2019