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Should Your Child See a Doctor?

Sinus Pain or Congestion

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Definition

  • A sensation of fullness, pressure or pain on the face overlying a sinus cavity
  • The sinuses are located above the eyebrow, behind the eye, around the eye, and over the cheekbone 

Symptoms

  • The pain or pressure usually is just on one side of the face.
  • Puffiness or swelling around just one eye.
  • Commonly associated symptoms are a congested nose, blocked nose, nasal discharge, and/or postnasal sinus drip.
  • Less common symptoms are bad breath, mouth breathing, sore throat from postnasal drip and throat clearing.
  • Age limitation: sinus pain is not a reliable symptom before 5 years of age.

Causes of sinus congestion

  • Viral Sinusitis: part of the common cold. Viral inflammation of the lining of the nose also involves the lining of all the sinuses.
  • Bacterial Sinusitis: A complication where viral sinusitis becomes secondarily infected with bacteria. (occurs in 5% of colds). Main symptoms are increased sinus pain, the return of fever or the overlying skin (around the eyelids or cheeks) becomes red or swollen. In younger children, the main symptoms are thick nasal secretions that last longer than 14 days or return of fever.
  • Allergic Sinusitis: Sinus congestion commonly occurs with nasal allergies (e.g. from pollens). Associated sneezing, itchy nose and clear nasal discharge point to this cause.

Treatment of sinusitis

  • Viral Sinusitis: Nasal washes with saline. Antibiotics are not helpful.
  • Bacterial Sinusitis: Oral antibiotics
  • Allergic Sinusitis: Treatment of the nasal allergy with antihistamines also usually relieves the sinus symptoms.

Color of nasal discharge with colds

  • The nasal discharge normally changes color during different stages of a cold.
  • It starts as a clear discharge and later becomes cloudy.
  • Sometimes it becomes yellow or green colored for a few days; and this is still normal.
  • Intermittent yellow or green discharge is more common with sleep, antihistamines or low humidity. (Reason: All of these events reduce the production of normal nasal secretions.)
  • Yellow or green nasal secretions suggest the presence of a bacterial sinusitis ONLY if they occur in combination with [1] sinus pain OR [2] the return of a fever after it has been gone for over 24 hours OR [3] nasal discharge lasts over 14 days without improvement.
  • Nasal secretions need treatment with nasal washes when they block the nose and interfere with breathing through the nose. During a cold, if nasal breathing is noisy but you can't see blockage in the nose, it usually means the dried mucus is farther back. Nasal washes can remove it.

Return to school

  • Sinus infections are not contagious. If the sinus pain or congestion is associated with a cold or other infection, your child can return to school after the fever is gone and your child feels well enough to participate in normal activities.

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When to Call Your Doctor

Call 911 Now (Your Child May Need an Ambulance) If

  • Not moving or too weak to stand

Call your doctor now (night or day) if

  • Your child looks or acts very sick
  • Confused speech or behavior
  • Redness or swelling on the cheek, forehead or around the eye
  • Severe pain
  • Weak immune system (sickle cell disease, HIV, chemotherapy, organ transplant, chronic steroids, etc)
  • Fever over 104° F (40° C) and not improved 2 hours after fever medicine
  • You think your child needs to be seen urgently

Call your doctor within 24 hours (between 9 a.m. and 4 p.m.) if

  • You think your child needs to be seen, but not urgently
  • Frontal headache present over 48 hours
  • Fever present for more than 3 days
  • Fever returns after gone for over 24 hours
  • Earache occurs
  • Sinus pain with fever

Call your doctor during weekday office hours if

  • You have other questions or concerns
  • Sinus pain persists after using nasal washes and pain medicine for 24 hours
  • Sinus congestion and fullness lasts over 2 weeks
  • Nasal discharge lasts over 14 days

Parent care at home if

  • Sinus congestion as part of a cold and you don't think your child needs to be seen

Home Care Advice for Sinus Congestion

Reassurance

  • Sinus congestion is a normal part of a cold.
  • Usually, home treatment with nasal washes can prevent an actual bacterial sinus infection.
  • Antibiotics are not helpful for the sinus congestion that occurs with colds.

Nasal washes to open a blocked nose

  • Use saline nose drops or spray to loosen up the dried mucus. If not available, can use warm tap water. Teens can just splash warm tap water in the nose and then blow.
  • STEP 1: Instill 3 drops per nostril.
  • STEP 2: Blow each nostril separately while closing off the other nostril. Then do other side.
  • STEP 3: Repeat nose drops and blowing until the discharge is clear.
  • Frequency: Do nasal washes whenever your child can't breathe through the nose.
  • Saline nasal sprays can be purchased without a prescription
  • Saline nose drops can also be made: add 1/2 tsp (2 ml) of table salt to 1 cup (8 ounces or 240 ml) of warm water.
  • Reason for nose drops: suction or nose blowing alone can't remove dried or sticky mucus.
  • Another option: use a warm shower to loosen mucus. Breathe in the moist air, then blow each nostril.

Fluids

  • Encourage your child to drink adequate fluids to prevent dehydration. This will also thin out the nasal secretions and loosen the phlegm in the airway.

Humidifier

  • If the air in your home is dry, run a humidifier.

Decongestant nose spray (no prescription needed)

  • Use this only if the sinus still seems blocked up after nasal washes AND age 12 years or older. Use the long-acting type (e.g., Afrin).
  • Dosage: 1 spray on each side 2 times/day.
  • Always clean out the nose before using.
  • Use routinely for 2 days, thereafter only for symptoms.
  • Don't use for more than 5 days (Reason: rebound congestion).

Pain medicine

  • Give acetaminophen (e.g., Tylenol) or ibuprofen for pain relief. The application of a cold pack or ice in a wet washcloth over the sinus for 20 minutes may also help.

Antihistamines

  • Give oral antihistamines (such as Benadryl) only if the child also has nasal allergies.(No prescription needed). See Dosage table.

Expected course

  • With treatment, the viral sinus congestion usually resolves in 7 to 14 days.
  • The main complication occurs if bacteria multiply within the blocked sinus (bacterial sinusitis). This leads to a fever and increased pain. It needs antibiotics.

Contagiousness

  • Sinus infections are not contagious. If the sinus pain or congestion is associated with a cold or other infection, your child can return to school after the fever is gone and your child feels well enough to participate in normal activities.

Call your doctor if

  • Sinus pain persists for over 1 day after starting treatment
  • Sinus congestion persists for over 2 weeks
  • Sinus pain present and fever occurs
  • Your child becomes worse

And remember, contact your doctor if your child develops any of the "Call Your Doctor" symptoms.

References

  1. 1. Abbasi S and Cunningham AS. Are we overtreating sinusitis? Contemp Pediatr. 1996;13(10):49-62.
  2. American Academy of Family Physicians. Patient information. Saline nasal irrigation for sinus problems. Am Fam Physician. 2009; 80(10): 1121
  3. American Academy of Pediatrics, Subcommittee on Management of Sinusitis and Committee on Quality Improvement Clinical practice guideline: management of sinusitis. Pediatrics. 2001;108:798-808
  4. Butler CC, Kinnersley P, Hood K, et al. Clinical course of acute infection of the upper respiratory tract in children: cohort study. BMJ. 2003:327;1088-1089.
  5. Isaacson G. Sinusitis in childhood. Pediatr Clin North Am .1996;43:1297-1318. 
  6. Nash D and Wald E. Sinusitis. Pediatr Rev. 2001;22:111-116.
  7. Wald ER, Nash D, Eickhoff J. Effectiveness of amoxicillin/clavulanate potassium in the treatment of acute bacterial sinusitis in children. Pediatrics. 2009;124:9-15.
  8. Wald ER. Sinusitis. Pediatr Ann 1998;27:811-818. 9. Wald ER. Sinusitis in children. N Engl J Med. 1992, 326:319-323.

Disclaimer

This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

Author and Senior Reviewer: Barton D. Schmitt, M.D. Clinical content review provided by Senior Reviewer and Healthpoint Medical Network.

Last Review Date: 6/1/2011

Last Revised: 8/1/2011 3:17:22 PM

Content Set: Pediatric HouseCalls Symptom Checker

Version Year: 2012

Copyright 1994-2012 Barton D. Schmitt, M.D. 

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