Rhinosinusitis in children

The most common causes of rhinosinusitis in children, particularly in those under the age of 7, are a large adenoid and recurrent colds (upper respiratory tract infections).

Children between the ages of 2 to 5 years old have an average of 8 colds (upper respiratory tract infections) a year. Symptoms include a blocked-up and runny nose, which then becomes mucky before getting better without treatment in approximately 10 days. For children between the ages of 1 to 3 years, symptoms may continue for over 15 days.

If the sinuses become blocked with discharge, bacteria may start to grow, which can lead to rhinosinusitis.

Rhinosinusitis in children is also a common complication of allergic rhinitis, one of the most common chronic conditions in children (approximately 20% of children are affected). It can be classified as either intermittent (due to hayfever, for example) or persistent (all year round) and the chances of a child having allergic rhinitis increase when one or both parents suffer from it.

Milk allergy is also often outlined as a cause of rhinosinusitis in the media or on some websites, as it's thought that milk causes excess mucus. However, there's no proven relationship between drinking milk and excess mucus. If your child has a milk allergy, they won't have nasal symptoms in isolation and will also show other symptoms such as colic, diarrhoea, lack of weight gain, vomiting, rashes, bronchitis or wheezing, cough, irritability, and acute middle ear infection.

In children, it can be difficult to diagnose the condition responsible for the above symptoms as they often overlap and occur simultaneously. Children may also not be bothered by their symptoms.

However, at Welbeck, our experienced ENT specialists use a range of tests to make a fast and accurate diagnosis. They'll first ask you for your child’s medical and family medical history before performing a physical examination.

Additional tests, including culture swabs, X-rays and CT scans, may also be required to determine the cause of the rhinosinusitis, which will help your consultant deliver the most effective treatment possible to your child.

Allergic rhinitis is likely to be diagnosed if sneezing, itchy eyes, and a family history all occur. A large adenoid causes similar symptoms to allergic rhinitis without the sneezing or itchy eyes. Long-term health issues with rhinosinusitis could be diagnosed as chronic rhinosinusitis.

While some cases of rhinosinusitis in children can't be prevented entirely (for example, due to frequent colds or enlarged adenoids), there are practical steps you can take to reduce the risk or severity of episodes:

• encourage good hand hygiene – regular hand-washing, especially after nursery, school, or playgroups, helps reduce the spread of colds and other upper respiratory infections

• minimise exposure to second-hand smoke – second-hand smoke is associated with worse nasal and sinus symptoms in children

• ensure good nasal hygiene – using age-appropriate saline nasal sprays or drops can help keep the nasal passages clear of mucus and reduce blockage of sinus openings

• manage allergies effectively – if your child has allergic rhinitis (hay fever, house-dust mite allergy, pet dander), controlling the allergy may reduce the risk of sinus involvement

• keep your child up to date with routine vaccinations – while not specific to rhinosinusitis, vaccinations reduce the burden of viral infections, which can lead to the condition

• for children who mouth-breathe or have suspected enlarged adenoids/tonsils, see a specialist – persistent mouth-breathing or noisy breathing may suggest an enlarged adenoid, which is a known contributor to rhinosinusitis in children

Even with these measures, children may still develop rhinosinusitis. If symptoms persist, worsen, or if concerning features appear (high fever, facial swelling, visual changes), make an appointment with a specialist.

If left untreated or if symptoms persist over many weeks, rhinosinusitis in children can potentially lead to complications, including:

• chronic rhinosinusitis: when symptoms last for 12 weeks or more, the condition may become chronic and require long-term management

• spread of infection: in rare cases, the infection may spread beyond the sinuses, risking complications such as orbital (eye-socket) cellulitis or intracranial (brain) involvement. Seek urgent medical help if your child has facial swelling, eye symptoms, or neurological signs 

• impact on quality of life: persistent blockage, discharge, poor sleep (due to mouth-breathing or snoring), may affect school attendance, concentration, and general wellbeing

• middle ear problems: especially in younger children, persistent nasal/sinus problems may contribute to ear infections or glue ear by interfering with normal ear-tube drainage

• reduced sense of smell: in older children, or in severe cases, chronic nasal/sinus inflammation may reduce their sense of smell and taste, which can affect appetite or enjoyment of food

While complications are possible, they are relatively rare. Most children recover well with appropriate assessment and management. Always consult an ENT specialist if your child’s symptoms persist beyond expected timelines or there are worrying features.

Treatment of rhinosinusitis in children depends on several factors, including the severity of your child’s condition and their age.

Your consultant will recommend the best possible treatment for your child, which may include:

• antibiotics

• nasal or oral decongestants and anti-inflammatories

• painkillers

• surgery to remove their adenoids

• endoscopic sinus surgery (ESS)

When are antibiotics prescribed for rhinosinusitis?

Most cases of rhinosinusitis are caused by viral infections, which cannot be treated with antibiotics.

However, if your child’s rhinosinusitis is caused by a bacterial infection, your consultant will likely prescribe a course of antibiotics.

Does my child need rhinosinusitis surgery?

The best treatment for rhinosinusitis depends on the severity of your child’s symptoms and how long they’ve had them. Your consultant will guide you and recommend the best treatment.

What is the most common cause of rhinosinusitis?

The most common causes of rhinosinusitis in children are a large adenoid and recurrent upper respiratory tract infections.

How can I tell if my child’s snoring and nasal congestion are due to rhinosinusitis rather than a simple cold?

While a common cold typically improves within 7 to 10 days, if your child’s nasal congestion, snoring, or breathing through the mouth persists beyond this period, worsens, or repeatedly recurs, it may suggest underlying rhinosinusitis. Additional signs include facial pain, greenish nasal discharge, disturbed sleep, or reduced energy levels. We recommend booking an appointment with a specialist to evaluate the cause and discuss appropriate treatment.