Springdale Mason Pediatrics

Sinus Pain or Congestion - Symptom


  • Fullness, pressure or pain on the face over a sinus
  • Sinus pain occurs above the eyebrow, behind the eye, and under the cheekbone
  • Other common symptoms are a stuffy or blocked nose or nasal discharge. Your child may also have a nasal drip down the back of the throat. This is called a postnasal drip.
  • Also, may have a sore throat and throat clearing from postnasal drip

Call or Return If

  • Sinus pain lasts more than 24 hours after starting treatment
  • Fever lasts more than 3 days
  • Sinus and nasal congestion lasts more than 2 weeks
  • You think your child needs to be seen
  • Your child becomes worse

About This Topic

Causes of Sinus Congestion

  • Viral Sinus Infection. Part of the common cold. A cold infects the lining of the nose. It also infects the lining of all the sinuses. Nasal and sinus congestion occur together.
  • Bacterial Sinus Infection. A problem when a sinus becomes blocked and infected with bacteria. This occurs in 2% of colds. It starts as a viral sinus infection. Main symptoms are increased sinus pain or return of fever. Thick nasal secretions that last over 14 days may point to a sinus infection.
  • Allergic Sinus Reaction. Sinus congestion often occurs with nasal allergies (such as from pollen). Sneezing, itchy nose and clear nasal discharge point to this cause.

Treatment of Sinus Congestion

  • Viral Sinus Infection. Nasal washes with saline. Antibiotics are not helpful.
  • Bacterial Sinus Infection. Antibiotics by mouth are needed.
  • Allergic Sinus Reaction. Treatment with allergy medicines helps the nose and sinus symptoms.

Color of Nasal Discharge with Colds

  • 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 lasts over 14 days without improvement.

After Care Advice

  • Sinus congestion is a normal part of a cold. It usually clears up on its own.
  • Usually, nasal washes can prevent a bacterial sinus infection.
  • Antibiotics are not helpful for the sinus congestion that occurs with colds.
  • Here is some care advice that should help.
  • 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.
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 clean 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.
  • If the air in your home is dry, use a humidifier. Reason: Dry air makes nasal mucus thicker.
Decongestant Nose Spray (No prescription needed):
  • 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 for children.
  • 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.
Pain Medicine:
  • To help with the pain, give acetaminophen (such as Tylenol) or ibuprofen. Use as needed.
Allergy Medicine:
  • If the child also has nasal allergies, give an allergy medicine.
  • Long-acting allergy medicines are a good first choice. Examples are Zyrtec, Allegra or Claritin. Reason: These meds do not cause your child to act sleepy. To save money, purchase the store brand.
  • Benadryl can be used if these products do not control symptoms.
What to Expect:
  • With this advice, viral sinus congestion goes away in 7 to 14 days.
  • The main risk is a sinus infection from bacteria. This can occur if bacteria multiply within a blocked sinus. This leads to a fever and increased pain. A bacterial sinus infection will need antibiotics.
Return to School:
  • Sinus infections cannot be spread to others.
  • Your child can return to school after the fever is gone.
  • Your child should feel well enough to join in normal activities.

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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