When sinus problems in children are more than just allergies

For many kids, sniffles, congestion and post-nasal drip are simply part of allergy season. But when their symptoms linger, worsen or start interfering with breathing or daily life, parents often wonder if something more is going on.

Understanding the difference between allergies, sinus infections and other sinonasal conditions can help parents know when symptoms can be managed at home — and when it may be time to look deeper.

“Persistent, severe or unusual symptoms can point to other underlying problems,” says Sei Yeon Chung, M.D., Otolaryngologist (ENT) - Rhinologist and Skull Base Surgeon at Children’s Health℠ and Assistant Professor at UT Southwestern.

The difference between allergies and a sinus infection

Allergies and sinus infections often have similar symptoms, but what’s happening in the body is different.

• Allergies are when you breathe in a substance you’re sensitive to – and it creates inflammation and swelling in the middle central compartment of your nose.

• Sinus infections occur when a virus or bacteria affects the deeper spaces in your face and head (the sinuses), creating inflammation and swelling in the lining of those spaces.

When kids have nasal symptoms, they can try over-the-counter allergy medicines first to see if they get any relief. If they get significant improvement or resolution from those, then they probably don’t have deeper sinus problems.

Symptoms of nasal allergies

Symptoms of nasal allergies include:

• Runny nose

• Stuffy nose

• Sneezing

• Itching

• Post-nasal drip (mucus draining down the back of the throat)

• Thick nasal mucus (clear or discolored)

Some kids also have other nasal-related symptoms that might signal other health problems, including:

• Mouth breathing. Structures inside the nose that help filter, warm and humidify air (called turbinates) can become enlarged or inflamed and cause kids to need to breathe through their mouth instead of their nose. Mouth breathing can also occur when kids have obstructive sleep apnea.

• Snoring. Kids with enlarged adenoids or tonsils, or deviated septum may snore when they sleep.

Symptoms of sinus infections

Symptoms of sinus infections in kids include:

• Stuffy, runny or blocked nose

• Post-nasal drip

• Facial pain or pressure, especially around the cheeks, eyes or forehead

• Headache

• Cough, often worse at night

• Reduced sense of smell or taste

• Feeling irritable or tired

• Swelling around the eyes

• Thick nasal mucus (clear or discolored)

• Fever (sometimes)

Some kids occasionally get sick and have sinus infections, which is normal. Others have chronic, baseline inflammation of their sinuses even when they’re not sick. And when those kids get exposed to anything – whether a virus or any other inhaled trigger, their symptoms are more severe – and can last longer and be harder to treat.

Symptom relief for allergies and/or sinus infections

Parents can help a child with nasal or sinus symptoms feel better by using:

• Over-the-counter saline rinses or washes to clean and irrigate the nose

• Over-the-counter steroid sprays (for example, Flonase)

• Antihistamine nasal sprays (for example, Azalastine, a prescription medicine for kids 5 or older)

• Allergy medicines (for example, Zyrtec)

• Topical steroid nasal irrigations (for example, prescription Budesonide) to reduce inflammation in the nasal cavities and sinuses

• Aquaphor or AYR saline nasal gel in the nose, for kids who have frequent nosebleeds, dryness or irritation

All of these medicines can help reduce inflammation in the nasal cavities and sinuses. And when you can reduce inflammation, your child is going to feel better.

Parents often worry about giving their children multiple medications, which is a valid concern. But all of these sinus and allergy medications have been proven safe for use in kids.

“Some treatments – such as nasal saline – contain no active pharmaceutical ingredients and are very gentle,” says Dr. Chung. “Even medicated nasal therapies have minimal absorption into the bloodstream. Trying a few different combinations, under guidance from a doctor, can help identify what works best and provide a lot of relief.”

Chronic sinus inflammation (chronic sinusitis)

Some children have chronic sinusitis, an inflammatory condition that can make a child more likely to have recurrent sinus infections.

In rare cases, chronic sinus infections can indicate a more serious underlying problem, including cystic fibrosis or primary ciliary dyskinesia.

“When a child has a pattern of severe or recurrent sinus infections – especially if they’ve been hospitalized for pneumonia or other serious respiratory illnesses – we typically do more evaluation,” says Dr. Chung.

More evaluation may include blood tests to look for deficiencies in the immune system, genetic testing, and other tests to identify any underlying conditions that could be contributing to severe chronic or recurrent infections.

Developing a daily nasal routine

Any child who has frequent nasal or sinus symptoms can benefit from a regular nasal routine to help clean out the nose and prevent ongoing inflammation.

Your child’s nasal routine may include:

• Saline rinses with a squeeze bottle. Start these slowly and gently, so your child has a chance to get used to the feeling of irrigating their nose.

• Saline nasal mist spray. When a younger child can’t do a nasal rinse, aluminum can saline sprays that simply mist the nose are a gentler alternative.

• Topical steroid rinses inside the nose.

• Antihistamine nasal spray.

“Having a nasal routine helps wash out mucus and allergens that deposit inside the nose, decrease the overall level of inflammation, help kids breathe better through their nose – and not have congestion all the time or get sick as often or as severely,” says Dr. Chung.

“I do nightly nasal sprays with my kids after we brush our teeth. It took a while for them to get the hang of it, but now they love it because they know it helps them breathe better,” says Dr. Chung.

When to see a pediatric specialist for sinus problems

If your child suffers from nasal symptoms that may be related to allergies, seeing an allergist can be a good first step. A subsequent evaluation from an Ear, Nose and Throat doctor (ENT) may also be a good idea if your child has:

• 3-4 sinus infections a year

• A lot of pain or pressure in their sinuses or face

• Heavy, frequent nosebleeds (more than a Tablespoon of blood or lasting longer than 10 minutes)

• Inability to smell or taste foods normally

• A chronic cough

• Thick drainage down their throat

• Swelling or redness on their face or eyes

• One-sided pain or pressure in the nose or face or one-sided nosebleeds

• Inability to breathe through their nose especially if one-sided

“When a child has something that only occurs on only one side of their face or nose, it could be a sign that they may have some kind of obstructive growth and should be seen,” says Dr. Chung.

Getting an ENT evaluation

Pediatric ENTs evaluate kids of all ages who have sinus problems using a physical exam, a complete medical history and a tool called an endoscopy.

An endoscopy uses a small flexible or rigid camera to look inside a child’s nose and sinuses. It’s a simple, quick and safe procedure – with no side effects or risks.

A nasal endoscopy helps diagnose:

• Deviated septum. Kids may be born with a crooked (deviated) septum, or it can happen in a sports injury or accident.

• Inferior turbinate hypertrophy. Turbinates in kids can become enlarged or inflamed and cause nasal obstruction.

• Tumors. Tumors in the nose are rare but they can cause severe symptoms.

• Polyps. When a child has chronic inflammation of their sinus spaces, it can sometimes cause growths called polyps.

• Sinus infection. Infected drainage can be seen in the sinus drainage pathways. This drainage can also be collected and cultured (grown in the lab) to see what bacteria grows.

• Enlarged tonsils and/or adenoids.

Sinus surgeries and procedures

There are a few surgeries and procedures used to treat sinus problems or chronic sinusitis:

• Surgery to remove nasal polyps

• Surgery to enlarge sinus openings

• Cauterization of blood vessels to treat frequent nosebleeds

• Surgery to remove adenoids

When a child’s quality of life is greatly impacted by sinus problems, despite trying medicine and a nasal routine, surgery may be an option.

“A child’s sinuses are not all fully grown until around age 19, so they may outgrow their problems as their sinuses get bigger,” says Dr. Chung. “But if it’s necessary, having surgery younger will not harm a child or affect their sinus or facial growth long-term. And it can be life-changing for some kids.”

Learn more

Most sinus symptoms in children are mild and manageable. But if your child’s symptoms are lingering, worsening or affecting daily life, it may be time to look deeper. At Children's Health, we provide expert Primary Care and specialty care through our comprehensive Ear, Nose and Throat (ENT) program and Allergy and Sinusitis Clinic. Learn more and find a doctor.