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Secondary Bacterial Infections – Sinus Infections

While ear infections are the most common complication of colds and can occur in up to 30% of children, bacterial sinus infections are only seen in up to 7% of children with colds.

Children with sinus infections will have a persistent runny nose after 10-14 days or worsening of their runny nose. The major symptom to monitor for is a lack of improvement in their runny nose. Older children may complain of headaches or facial pain, often in the forehead or under the eyes. There may also be painless eye swelling in the mornings or new foul-smelling breath.

Some bacterial sinus infections can present earlier than 10-14 days with fevers over 101.5 degrees, a sicker overall appearance of the child, and facial pain for more than 3 days. You may also see headaches or tooth pain. When a bacterial sinus infection is suspected, antibiotics are often prescribed and should result in improving symptoms within 1 week. It is important to remember that if your child is prescribed antibiotics, they should complete the entire course even if they have started feeling better before the antibiotics are done.

Symptomatic management is also quite helpful in treatment. This includes using acetaminophen or ibuprofen to treat headaches and fevers, 1 tablespoon of honey for cough in children older than 12 months of age, and nasal saline irrigation as needed throughout the day.

Often, parents are concerned about the color of their child’s nasal mucus. While it was once thought that the transition from clear to yellow or green meant a bacterial infection, this is no longer considered true. With a viral infection, the natural progression of color is from clear and watery to green-yellow and thicker, then it will either dry out or become clear and watery again before resolving. In fact, the change in color is actually a signal that your child’s immune system is fighting off the (likely) viral infection! The color change may just represent the presence of white blood cells from your child’s immune system, as long as there aren’t any other signs such as fever, worsening runny nose, and headache.

Remember, however, that if your child appears sicker than they usually do with a typical illness, they should be seen by their pediatrician for evaluation. Proper management of a bacterial sinus infection can help prevent rare but serious complications.

Important points to remember about sinus infections:

  • Sinus infections are less common than ear infections as complications of colds
  • Persistent or worsening nasal congestion and runny nose after 10 days may mean a bacterial sinus infection
  • If your child’s illness starts with high fevers (over 101.5) and a sicker overall appearance, this is likely a bacterial sinus infection
  • Older children may complain of headaches or facial pain
  • If your child is prescribed antibiotics, they should complete the entire course
Haley Pledger, PA
Women’s Care
Matthew Walton, DO
Austin Bills, DO
Family Medicine
Aaron Fausett, PA
Family Medicine
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