Sinus Congestion in Children

What are the sinuses?

The sinuses are four sets of air-filled cavities located behind and around the nose and eyes. Many people (adults as well as children) only become aware of these spaces when they begin hurting, so they may not appreciate their value. Sinuses make a person's skull lighter (so that we can hold our head up) and filter out many irritating airborne particles in the air that's breathed in. They also serve as a humidifier, moisturizing dry air before it reaches the lungs.

Here's how they work: On the surface of the membranes lining the sinuses are tiny hairlike filaments (cilia) that engage in a constant sweeping motion to keep mucus moving through these passages. This is a good defense against infection. Mucus traps particles that enter the sinuses and the cilia sweep them toward the back of the nose, where they're swallowed and broken down in the stomach. Each sinus is connected to the nasal passage by a thin duct that allows mucus to drain and air to flow. These passages can easily become blocked, however, making drainage difficult.

What is sinus congestion?

This occurs when mucus fluid accumulates in your child's sinuses. When something -- say, secondhand cigarette smoke -- irritates his nasal passages, the linings become inflamed. The fluid can't drain easily into his nose, so it builds up in the sinuses.

Congestion isn't the same as an infection, but it does create a breeding ground for bacteria. If the sinuses stay congested for a while, the multiplying bacteria may result in a sinus infection.

What causes sinus problems in general?

Sinus congestion and infections frequently result when irritants inflame the nasal passages so that mucus can't drain properly. Leading culprits for sinus problems in kids include the common cold, secondhand cigarette smoke, air pollution, dry air, cold air, fumes (such as those from paint or cleaning solutions), allergies, and emotional stress. Common nose malformations such as polyps or a deviated septum can make sinus infections more likely. A child who swims or dives is especially susceptible since these activities sometimes push water into the sinuses, where it can become trapped and lead to an infection.

Also, if you have a small child, you should investigate the possibility that he may have pushed an object up his nose -- particularly if he has more nasal drainage from one side of his nose, or if he develops a nagging cough after playing with small objects such as peas.

How common is sinus congestion?

Very. Children catch a lot of colds, and a typical symptom is sinus congestion. This is generally nothing to worry about; the condition typically clears up by itself in 10 to 14 days. Symptoms may include a runny nose, with the color of the discharge progressing from clear to yellow to green and then back to yellow and clear again. A cough and slight fever (below 100 degrees F) are other common symptoms.

What can I do to relieve my child's sinus congestion?

Keeping your child's nasal passages moist can lessen the congestion. Using a humidifier, preferably one that produces warm vapor, is a common method. It may also be therapeutic to put your child in the bathroom with the shower running hot, so that he can breathe in the warm, moist air through his noise. You can also use saltwater or saline nasal sprays (available at drugstores) to loosen dried mucus and irrigate the nasal passages.

Decongestant spray or nose drops or oral antihistamines can alleviate the symptoms of sinus congestion, but you should consult your pediatrician before giving one of these products to your children. Both can have side effects: Decongestants frequently have a "rebound effect" if taken for many days in a row: The congestion comes back with a vengeance after the medicine wears off. Antihistamines, which dull the allergic response that often sets off sinus congestion, may induce sleepiness or hyperactivity.

When should I be concerned about sinus congestion?

If you think your child's congestion may be turning into a sinus infection, call your pediatrician. This infection, called sinusitis, occurs when a sinus is blocked and bacteria build up inside. The more sinus problems your child has had in the past, the greater the possibility that his congestion will lead an infection.

Make an appointment with your pediatrician if:

• Your child is under 4-months-old and has sinus congestion. (Sinus congestion may interfere with your baby's eating or sleeping: During the first few months of life your baby breathes mostly through his nose rather than his mouth, so congestion can cause more problems in him than in older children.)
• Your child has a stuffed-up nose accompanied by a high fever, a mild headache or facial discomfort, and bad breath.
• Your child has symptoms of a common cold with sinus congestion that last more than two weeks.

Can a sinus infection become dangerous?

In rare cases an untreated sinus infection spreads to other areas in the skull and becomes a serious problem. The passages around the eyes can become infected, and because only a thin membrane separates these sinuses and the brain, the bacteria can penetrate this membrane and bring about meningitis (inflammation of the membranes that envelop the brain).

For this reason, if your child has a sinus condition and complains of a severe headache or develops severe facial pain or swelling, get to an emergency room immediately.

What are my child's treatment options?

Antibiotics are the most common method of treating a sinus infection. Your pediatrician will probably first prescribe an antibiotic -- most likely amoxicillin -- that kills a broad range of bacteria. If that doesn't work, she'll try an antibiotic that targets specific bacteria. Even if your child's symptoms disappear in a few days, make sure he keeps taking the medicine until it's all gone, or the infection may not be eradicated.

If your child has a severe case or chronic sinusitis, your physician may refer you to a specialist, who may attempt to manually drain the sinus passages.

What can I do to prevent sinus problems?

Providing a clean environment, free of dust and smoke, is one of the simplest and best ways to help your child avoid sinus congestion and related problems. An allergist can also examine your child to learn which irritants make his immune system go into overdrive and advise you on how to limit his exposure to irritants.

References

Pantell, Robert H. M.D., James F. Fries M.D., and Donald M. Vickery M.D. Taking Care of Your Child: A Parent's Illustrated Guide to Complete Medical Care, Eighth Edition. Da Capo Lifelong Books.

American Academy of Pediatrics, Clinical Practice Guideline, Management of Sinusitis, Volume 108, Number 3, pp 798-808

Lucile Packard Childrens Hospital at Stanford. Sinus pain or congestion. http://www.lpch.org/HealthLibrary/ParentCareTopics/sinuspainandcongestion.html