Sinusitis in Children: Symptoms, Treatment and When to Worry
Why it looks different in children, what helps at home, and the signs that need urgent attention.
Part of our Sinusitis condition guide.
Access Doctor treats adults aged 18 and over only. We can't assess or prescribe for children. If you think your child has sinusitis, contact your GP, an NHS walk-in centre or NHS 111. This page is information for parents, not a route to treatment.
If your child is 12 or over, try a pharmacy first. Acute sinusitis is one of the seven NHS Pharmacy First pathways in England, covering anyone aged 12 and up. A pharmacist can assess your child and supply treatment without an appointment or a GP referral. It's free at the point of use, and for under-16s there's no prescription charge either. Ring ahead, as not every pharmacy participates. For children under 12, your GP or NHS 111 is the route.
The headline: The frontal sinuses behind the forehead aren't fully formed until adolescence. That's why children rarely describe the forehead pain adults do—and why sinusitis in children is more often mistaken for a cold that simply won't clear.
Why children are different
Adults and children don't have the same sinuses. They develop over years, and which ones exist changes what a child can feel.
| Sinus | When it develops | What that means |
|---|---|---|
| Ethmoid (between the eyes) | Present from birth | Can be infected at any age. Infection here sits closest to the eye socket, which is why eye swelling in a child is urgent. |
| Maxillary (cheeks) | Present from birth, enlarges through childhood | Cheek and upper tooth discomfort possible, though often not described clearly. |
| Sphenoid (deep behind the nose) | Begins around age 5 | Rarely involved alone in young children. |
| Frontal (forehead) | Begins around 7–8, mature in adolescence | Forehead pain is uncommon in young children because the sinus barely exists yet. |
Two other differences matter. Children's nasal passages and drainage channels are narrower, so they block more readily. And children get many more colds—the NHS average is around five to eight a year, and more once they're at nursery—so there are simply more opportunities for a cold to progress.
Symptoms by age
Under 5
- A cold that hasn't cleared after 10 days
- Thick, often discoloured nasal discharge lasting more than 10 days
- A persistent cough, present in the day but noticeably worse at night
- Irritability, poor sleep, reduced appetite
- Mild fever, or fever that returns after settling
- Bad breath
- Rubbing at the nose or face without being able to explain why
5 to 12
- All of the above, plus a growing ability to describe symptoms
- Cheek pain or a heavy feeling behind the nose
- Reduced sense of smell—often noticed as food tasting bland
- Headache, more often described than localised precisely
- Tiredness and difficulty concentrating at school
Teenagers
Symptoms increasingly resemble adults: clear facial pressure over the cheeks or forehead, worse bending forward, blocked nose and reduced smell. Our sinusitis condition guide describes the adult picture in full.
The most useful sign in a young child is duration, not severity. A miserable child on day three of a cold is usually just having a cold. A moderately unwell child on day twelve with no sign of improvement is the one worth getting looked at.
Is it a cold or sinusitis?
| Ordinary cold | Suggests sinusitis | |
|---|---|---|
| Duration | Improving by day 7–10 | No improvement past day 10 |
| Course | Worst days 2–3, then steadily better | Improved, then clearly worse again |
| Nasal discharge | Clear, then thicker, then clearing | Thick and persistent beyond 10 days |
| Cough | Settles as the cold does | Persists, worse lying down |
| Fever | Mild, early, short | May return after settling |
| Mood | Back to themselves within a week | Still not themselves after two weeks |
Green mucus doesn't mean bacteria and doesn't mean antibiotics. The colour comes from immune cells doing their job and appears in ordinary viral colds too. It's one of the most common reasons antibiotics get asked for unnecessarily.
The three patterns to recognise
1
Persistent
Nasal symptoms and cough that continue past 10 days with no real improvement. The most common presentation in children, and the one most often mistaken for a cold that's simply dragging.
2
Worsening
A child who was improving and then clearly deteriorates—returning fever, worsening discharge, new facial pain. Sometimes called double sickening. It raises the likelihood of bacterial infection.
3
Severe from the start
High fever with thick discharge from the outset, in a child who looks unwell. Less common, and warrants prompt assessment rather than waiting for day 10.
Home care that helps
- Fluids. Regular small drinks. Thinner mucus drains more easily, and children dehydrate faster than adults when feverish.
- Pain and fever relief. Paracetamol or ibuprofen at the dose for their age and weight. Follow the packaging or ask your pharmacist. Never give aspirin to a child under 16.
- Saline drops or spray. Safe from infancy. Useful before feeds and before sleep to clear the nose enough to breathe.
- Raise the head of the bed slightly. Put something under the mattress rather than adding pillows for younger children.
- Moist air. A humidifier, or sitting in a steamy bathroom with the door shut—not over a bowl of hot water.
- Rest. Keep them off nursery or school while feverish or clearly unwell.
What to avoid
Don't use steam inhalation over a bowl with a child. Scalds from tipped bowls of hot water are a recognised cause of serious paediatric burns. A steamy bathroom achieves the same effect safely.
- Decongestant sprays and drops—not suitable for young children, and in older children only briefly and on advice.
- Adult medicines at a smaller dose—children's dosing isn't simply a fraction of an adult's.
- Leftover antibiotics from a previous illness, or another child's prescription.
- Aspirin under 16—risk of Reye's syndrome.
- Doxycycline under 12—it can affect developing teeth and bone. It's not a paediatric option for sinusitis.
- Cough and cold remedies under 6—not recommended by the MHRA.
Do children need antibiotics?
Usually not. Most sinusitis in children, as in adults, is viral, and NICE NG79 doesn't recommend routine antibiotics for acute sinusitis of under 10 days' duration at any age.
They're considered when symptoms persist beyond 10 days without improvement, when a child is systemically unwell, when there is double sickening, or when a child is at higher risk of complications.
That assessment belongs to a clinician who can examine the child. Paediatric antibiotic dosing is weight-based, formulations differ (liquids rather than tablets), and choice depends on age and allergy history in ways adult prescribing doesn't.
For context, not application: in adults, phenoxymethylpenicillin is a common first-line choice for bacterial sinusitis, with doxycycline as an alternative where penicillin can't be used. Neither dose nor choice transfers to children—and doxycycline isn't used under 12 at all. Our guides on antibiotics for sinus infection and penicillin for a sinus infection cover adult treatment.
Steroid nasal sprays in children
Some steroid nasal sprays are licensed for children, but the age limits, doses and licensed indications differ from adults, and there are considerations that don't apply to grown-ups.
- Growth is monitored where a child uses a steroid nasal spray long term
- Total steroid load matters if the child also uses an inhaler for asthma or eczema creams
- Technique is harder to get right, and poor technique causes nosebleeds
- Licensed minimum ages vary between products
Don't give a child an adult's nasal spray, including one prescribed to you for sinusitis or hay fever. Access Doctor supplies steroid nasal sprays for adults only, and they shouldn't be shared.
Red flags—when to act immediately
Call 999 or go to A&E if your child has: swelling, redness or puffiness around an eye; an eye that appears pushed forward; double vision or difficulty moving the eye; a severe headache; a stiff neck or dislike of bright light; a rash that doesn't fade when pressed with a glass; unusual drowsiness, confusion or difficulty waking; a fit; difficulty breathing; or a bulging soft spot in a baby.
Swelling around the eye deserves particular emphasis. The ethmoid sinuses sit directly against the eye socket, separated by paper-thin bone, and they're present from birth. Orbital cellulitis is uncommon but is a genuine emergency, and children are more affected than adults. Any puffiness or redness around a child's eye during a sinus or nasal illness needs same-day assessment.
When to see the GP
Arrange a routine appointment if:
- Symptoms have persisted 10 days or more without improvement
- Your child improved and then clearly got worse
- Sinus symptoms keep coming back over months
- Sleep is disturbed most nights, or school is being affected
- Your child has asthma and it's become harder to control
- You're simply not happy with how they are—a good enough reason on its own
Contact NHS 111 or your GP the same day for a high fever you can't bring down, a child who is much more drowsy or floppy than usual, poor fluid intake with reduced wet nappies, or rapid deterioration.
Recurrent and chronic sinusitis
Sinus symptoms lasting beyond 12 weeks are classed as chronic rhinosinusitis, and it occurs in children as well as adults. Contributing factors that are more common in childhood include:
- Enlarged adenoids, which obstruct drainage and can harbour bacteria—a frequent factor in preschool children
- Allergic rhinitis, where ongoing nasal inflammation keeps the sinus openings narrowed
- Frequent nursery infections, which can look like one continuous illness
- Reflux in younger children
- Rarely, underlying conditions affecting mucus clearance or immunity, which is why persistently recurrent sinusitis warrants proper review
A GP can assess these and refer to a paediatric ENT service where appropriate. Our guide on acute vs chronic sinusitis explains the distinction in more detail.
If you're the one who's unwell
Parents often catch what their children bring home, and adult sinusitis after a run of family colds is a common pattern. Access Doctor can help with that.
Sinusitis Treatment for Adults
For adults aged 18 and over. Complete a short online consultation reviewed by a GPhC-registered pharmacist independent prescriber, who will decide whether treatment is appropriate. We don't treat children.
View Sinusitis Treatments →Frequently Asked Questions
Can Access Doctor treat sinusitis in children?
No. Access Doctor provides online consultations for adults aged 18 and over only. Children with suspected sinusitis should be assessed by their GP, an NHS walk-in centre or NHS 111. This is a deliberate clinical boundary rather than an administrative one. Assessing a child safely usually needs an in-person examination, weight-based dosing and an understanding of how symptoms present differently at different ages.
How is sinusitis different in children compared to adults?
The frontal sinuses behind the forehead are not fully developed until adolescence, so young children rarely get the classic forehead pain adults describe. Instead, sinusitis in children usually shows as a cold that does not clear, with prolonged thick nasal discharge, a persistent daytime cough that worsens at night, irritability and disturbed sleep. Younger children also often cannot describe facial pressure even when they have it.
How long should a child's cold last before I worry?
Children get colds far more often than adults. The NHS puts the average at around five to eight a year, and more is common once a child is at nursery. A single cold usually improves within seven to ten days. The pattern that suggests sinusitis is nasal symptoms and cough persisting beyond ten days without any improvement, or a child who was getting better and then clearly deteriorated with a returning fever. Back-to-back colds are common and can look like one long illness.
Do children with sinusitis need antibiotics?
Usually not. Most sinusitis in children is viral and settles without antibiotics. NICE advises that antibiotics are not routinely needed for acute sinusitis lasting under ten days. They are considered when symptoms have persisted beyond ten days without improvement, when a child is systemically unwell, or when there are signs of a serious complication. That decision needs a clinician who has examined the child.
What can I do at home to help my child?
Keep fluids up, use paracetamol or ibuprofen at the correct dose for their age and weight for pain and fever, and raise the head of the bed slightly to help drainage overnight. Saline nasal drops or spray are safe from infancy and can loosen mucus before feeds or sleep. Steam inhalation is not recommended for children because of the scalding risk. Decongestant sprays and drops are not suitable for young children.
Can children use steroid nasal sprays for sinusitis?
Some steroid nasal sprays are licensed for children, but at different ages, different doses and often for different conditions than in adults. This is a decision for the child's own doctor, who can weigh growth monitoring and total steroid exposure if the child also uses an inhaler. Do not use an adult's nasal spray for a child, and do not use a spray prescribed for one child for another.
When should I take my child to A and E?
Go to A and E or call 999 if your child has swelling, redness or puffiness around an eye, an eye that looks pushed forward, double vision or difficulty moving the eye, a severe headache, a stiff neck, a rash that does not fade under a glass, unusual drowsiness or confusion, a fit, or difficulty breathing. Swelling around the eye in particular needs the same day assessment, because infection can spread from the sinuses into the eye socket.
Can sinusitis in children become chronic?
Yes. Symptoms lasting beyond twelve weeks are classed as chronic rhinosinusitis, and it does occur in children. Enlarged adenoids, allergy and, less commonly, underlying conditions affecting mucus clearance can all contribute. A child with persistent or repeatedly returning sinus symptoms should be reviewed by their GP, who may refer to a paediatric ear, nose and throat service.
Completing the treatment
For children, the route is your GP, an NHS walk-in centre or NHS 111—not an online pharmacy. For adults in the household, Access Doctor supplies mometasone nasal spray for sinusitis, beclometasone nasal spray for sinusitis and, where a bacterial infection is genuinely likely, phenoxymethylpenicillin or doxycycline, following an online consultation reviewed by a pharmacist independent prescriber. These are for the adult they are prescribed to and must never be given to a child.
Adults 18+ · Rx
Mometasone Nasal Spray for Sinusitis
For adult sinus symptoms persisting past day 10.
View product →Adults 18+ · Rx
Beclometasone Nasal Spray for Sinusitis
Alternative steroid nasal spray for adults.
View product →Adults 18+ · Rx
Phenoxymethylpenicillin for Sinusitis
Where a bacterial sinus infection is likely in an adult.
View product →Adults 18+ · Rx
Doxycycline Capsules for Sinusitis
Adult alternative where penicillin can't be used. Not for under 12s.
View product →References
- National Institute for Health and Care Excellence. Sinusitis (acute): antimicrobial prescribing (NG79). nice.org.uk
- NICE Clinical Knowledge Summaries. Sinusitis. cks.nice.org.uk
- NHS. Sinusitis (sinus infection). nhs.uk
- NHS. Coughs, colds and ear infections in children. nhs.uk
- NHS. Orbital cellulitis. nhs.uk
- Medicines and Healthcare products Regulatory Agency. Over-the-counter cough and cold medicines for children. gov.uk
- NHS. Reye's syndrome. nhs.uk
Medical disclaimer: This article is for informational purposes only and does not constitute medical advice. Access Doctor does not provide consultations or treatment for anyone under 18. Always consult a qualified healthcare professional for diagnosis and treatment of a child. In a medical emergency, call 999.