Sinus Pain or Congestion

Pediatric HouseCalls Online

DEFINITION

• A sensation of fullness, pressure or pain on the face overlying a sinus cavity (above the eyebrow, behind the eye, around the eye, or 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 blocked nose, nasal discharge, and/or postnasal drip.
• Age limitation: not a reliable symptom before 5 years of age.

Cause

• Sinus opening is blocked by a cold or hay fever.

Color of Nasal Discharge

• 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 only become a problem 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.

See More Appropriate Topic (instead of this one) If

• Age less than 5 years old or doesn't sound like sinus congestion, see COLDS
• Also has active nasal allergies, see HAY FEVER (NASAL ALLERGIES)

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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
• Fever over 104° F (40° C) and not improved 2 hours after fever medicine
• Redness or swelling on the cheek, forehead or around the eye
• Severe pain

Call Your Doctor Within 24 Hours (between 9am and 4pm) If

• You think your child needs to be seen
• Fever present for more than 3 days
• 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

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HOME CARE ADVICE FOR SINUS CONGESTION

1. Reassurance: Sinus congestion is normally part of a cold. Usually home treatment can prevent a true sinus infection.
2. Nasal Washes:
   • Use warm water or saline nose drops followed by suction or nose blowing to wash dried mucus or pus out of the nose.
   • Place 2 - 3 drops in each nostril. Repeat this until the nose is open.
   • Do nasal washes at least 4 times per day or whenever your child can't breathe through the nose.
   • To make saline nose drops - add ½ teaspoon of table salt to 1 cup (8 oz.) of warm water.
3. Humidifier: If the air in your home is dry, run a humidifier.
4. Decongestant Nose Drops or Spray (no prescription needed):
   • Use this only if the sinus still seems blocked up after nasal washes AND age 6 years or older.  Use the long-acting type (e.g. Afrin).
   • Dosage: 1 drop or spray on each side 2 times/day.
   • Always clean out the nose before using.
   • Useroutinely for 3 days, thereafter only for symptoms.
   • Don't use for more than 5 days (Reason: rebound congestion).
5. 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.
6. Antihistamines: Give oral antihistamines only if the child also has nasal allergies.
7. 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.
8. 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 activites.
9. 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.

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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.

Last Reviewed: 1/19/2009

Last Revised: 6/24/2008

Content Set: Pediatric HouseCalls Online

Copyright 1994-2009 Barton D. Schmitt, M.D.

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