Common cold and sinusitis (acute rhinosinusitis) in children

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What is it about ?

When suffering from a common cold, the sinuses can also be inflamed. The sinuses are located in the forehead bone (frontal sinuses), above the back of the nasal bone (ethmoid sinuses), on either side of the nose, in the jaws (maxillary sinuses), and at the temples, in the center of the skull (the sinus sphenoidal). The child’s sinuses grow as he does. All the sinuses are connected to the nasopharynx by a small opening. Inflammation can therefore easily go up to the sinuses in the case of a cold.

The cause of a cold associated with sinusitis is most often a viral infection. A bacterial infection is much rarer. If so, it is often a superinfection on top of a viral infection.

What is its frequency?

The diagnosis is very rare in children between 0 and 4 years old. Indeed, the sinuses are not yet very developed at that age. In children between 5 and 17 years old, the frequency is about 8 in 1,000 patients per year.

How to recognize it?

Think about a acute maxillary sinusitis when your child has, (10 to 14 days) after a banal infection of the respiratory tract, a persistent purulent nasal discharge, headache and an cough. The sinusitis is likely, especially if symptoms worsen after initial improvement.

Children who develop sinusitis are at greater risk of complications than adults. In children, the infection can spread more easily to the eyelids or cheek. If the doctor notices this type of complication, it is a red flag. A middle ear infection (acute otitis media) is also common in young children.

How is the diagnosis made?

The doctor can make the diagnosis based on the symptoms and physical examination. Radiography is not recommended for the diagnosis of acute sinusitis, as mild to severe swelling of the lining is common, including in healthy children.

In addition, unnecessary imaging tests should be avoided in children, who are more sensitive to radiation.

What can you do ?

Acute rhinosinusitis, viral or bacterial, usually resolves on its own within 10 days. Most of the time, relieving the symptoms is enough.

  • Viruses are transmitted primarily through hand contact and through droplets of saliva produced in the air when coughing and sneezing. Good hand hygiene can prevent transmission.
  • Salt water rinses: Try to clear your child’s nose using saline drops or a spray to help clear the mucus. This mainly relieves nasal complaints, but it does not speed up healing.
  • The use of drugs to deflate the mucous membranes (decongestants) is not recommended (eg xylometazoline, Nesivine). If you do use them anyway, give them only overnight, and never for more than a week.

What can your pharmacist do?

Your pharmacist can advise you on saline solutions for the nose. Physiological serum, in nasal drops or in rinsing the nose, are to be preferred to drops or decongestant sprays, certainly in young children (under 7 years old). When using decongestants, it must be done according to very specific rules: follow the advice of your pharmacist and your doctor.

Pain relievers may be helpful in relieving headaches, muscles, or joints. Paracetamol is the drug of choice. It is necessary to respect 4 hours minimum between two catches. The pharmacist will tell you the correct dose.

What can your doctor do?

In most cases, symptomatic treatment is sufficient to alleviate symptoms, using painkillers such as paracetamol and saline drops or spray.

a antibiotic will only be implemented in the presence of a sinusitis in a child who is very ill or has weakened immunity. If this is the case, the first choice will be the administration of amoxicillin for 10 days. If the child’s condition does not improve and the pathogen is not known, a combination of amoxicillin and clavulanic acid may be prescribed. This antibiotic works against several types of bacteria, which increases the chances of success, but also the risk of side effects.

If the sinusitis are frequent, the doctor will refer you to a specialist, the ENT (otolaryngologist) or the “nose-throat-ears”. Any underlying predisposing factors, such as polyps swollen or a allergy, must be identified and treated.

The doctor will pay particular attention to complications in children, as the infection may spread behind the eyes, into the cheek or into the brain. In the presence of the slightest alarm signal, the doctor will refer your child directly to a specialist doctor for hospitalization.

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