Springdale Mason Pediatrics

Sinus Infection - Bacterial


  • A bacterial infection of one or more of the sinuses

Call or Return If

  • Fever lasts more than 2 days after starting antibiotics
  • Sinus pain lasts more than 3 days after starting antibiotics
  • Sinus and nose congestion lasts more than 2 weeks
  • You think your child needs to be seen
  • Your child becomes worse

About This Topic


  • Main symptoms are increased sinus pain and return of fever.
  • Pain or pressure on the face over a sinus.
  • Sinus pain occurs above the eyebrow, behind the eye, and under the cheekbone
  • The skin around the eyelids or cheeks may become red or swollen.
  • Other common symptoms are a stuffy or blocked nose.
  • Thick yellow nasal discharge is common.
  • Bad breath and mouth-breathing can also occur.


  • A doctor can diagnose bacterial sinusitis by reviewing the details of your symptoms.
  • Tests or X-rays are not needed.


  • Starts as a viral sinus infection. The sinuses normally drain into the nose. If a sinus opening becomes completely blocked, it can become infected with bacteria. This occurs in about 2% of colds.

Nasal Discharge with Bacterial Sinusitis

  • The nasal discharge changes color during different stages of a cold. This is normal.
  • It starts as a clear discharge and later becomes cloudy.
  • Sometimes it becomes yellow or green colored for a few days. This is still normal for a cold.
  • Thick, colored discharge points to bacterial sinusitis ONLY if it occurs with other symptoms. These are:
  • Sinus pain (not just sinus congestion) OR
  • Swelling or redness over any sinus OR
  • Return of a fever after it has been gone for over 24 hours OR
  • Thick nasal discharge and post-nasal drip lasts over 14 days without improvement.

After Care Advice

  • Bacterial sinus infections occur in about 2% of colds.
  • On an antibiotic, most children get better slowly over 2 to 3 days.
  • Here is some care advice that should help.
Antibiotic by Mouth:
  • Bacterial sinus infections need a prescription for an antibiotic.
  • The antibiotic will kill the bacteria that are causing the sinus infection.
  • Give the drug as directed.
  • Try not to forget any of the doses.
  • Give the drug until it is gone. Reason: To stop the sinus infection from flaring up again.
Pain Medicine:
  • To help with the pain, give acetaminophen (such as Tylenol) or ibuprofen. Use as needed.
Cold Pack:
  • For pain or swelling, use a cold pack. You can also use ice wrapped in a wet cloth.
  • Put it over the sinus for 20 minutes. Caution: Avoid frostbite.
  • For fevers above 102° F (39° C), give acetaminophen (such as Tylenol) or ibuprofen. Note: Lower fevers are important for fighting infections.
  • For ALL fevers: Keep your child well hydrated. Give lots of cold fluids.
Nasal Saline to Open a Blocked Nose:
  • Use saline (salt water) nose drops or spray to loosen up the dried mucus. If you don't have saline, you can use a few drops of bottled water or clean tap water. Teens can just splash a little tap water in the nose and then blow.
  • STEP 1: Put 3 drops in each nostril.
  • STEP 2: Blow each nostril out while closing off the other nostril.
  • STEP 3: Repeat nose drops and blowing until the discharge is clear.
  • How often: Do nasal saline when your child can't breathe through the nose.
  • Saline nose drops or spray can be bought in any drugstore. No prescription is needed.
  • Saline nose drops can also be made at home. Use 1/2 teaspoon (2 ml) of table salt. Stir the salt into 1 cup (8 ounces or 240 ml) of water. You must use bottled or boiled water for this purpose.
  • Reason for nose drops: Blowing alone can't remove dried or sticky mucus.
  • Other option. Use a warm shower to loosen mucus. Breathe in moist air, then blow each nostril.
  • Try to get your child to drink lots of fluids.
  • Goal: Keep your child well hydrated.
  • It will thin out the mucus discharge from the nose. Also, it loosens up any phlegm in the lungs.
  • If the air in your home is dry, use a humidifier. Reason: Dry air makes nasal mucus thicker.
Decongestant Nose Spray (No prescription needed) for Teens:
  • Use this only if the sinus still seems blocked up after nasal washes. Also, only use for age 12 years or older. Use the long-acting type such as Afrin.
  • Dose: 1 spray on each side. Do this 2 times per day.
  • Always clean out the nose before using.
  • Use for 1 day. After that, use only for symptoms.
  • Don't use for more than 3 days. (Reason: Can cause rebound congestion).
  • Oral decongestants (such as Sudafed) are not advised in children.
What to Expect:
  • Once on antibiotics, your child will get better in 2 or 3 days.
  • The fever should be gone by 2 days (48 hours).
  • The sinus pain should be better by 2 days. It should be gone by 3 days (72 hours).
Return to School:
  • Your child can return to school after the fever is gone.
  • Your child should feel well enough to join in normal activities.
  • Sinus infections cannot be spread to others.

Author: Barton Schmitt MD, FAAP
Copyright 2000-2021 Schmitt Pediatric Guidelines LLC
Disclaimer: This health information is for educational purposes only. You the reader assume full responsibility for how you choose to use it.
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