Otolaryngology

Otolaryngology

Adult & Pediatric Ear, Nose, Throat & Sinus
Facial Plastic Surgery

Facial Plastic Surgery

Eyelid Surgery, Facial Surgery, Facial Liposuction & Rhinoplasty
Head and Neck Surgery

Head and Neck Surgery

Thyroid, Parathyroid & Salivary Gland Disorders
Skin Rejuvenation

Skin Rejuvenation

Injectables, Peels, Skin Care & Microdermabrasion

Ear, Nose and Throat

Head & Neck Surgery

HotButton HeadNeck

Facial Plastic Surgery

HotButton FacialPlasticSurgery

Request More Info

Your child’s sinuses are not fully developed until late in the teen years. Although small, the maxillary (behind the cheek) and ethmoid (between the eyes) sinuses are present at birth. Unlike in adults, pediatric sinusitis is difficult to diagnose because symptoms of sinusitis can be caused by other problems, such as viral illness and allergy.

How do I know when my child has sinusitis?

The following symptoms may indicate a sinus infection in your child:

  • a cold lasting more than 10 to 14 days, sometimes with a low-grade fever
  • thick yellow-green nasal drainage
  • post-nasal drip, sometimes leading to or exhibited as sore throat, cough, bad breath, nausea and/or vomiting
  • headache, usually in children age six or older
  • irritability or fatigue
  • swelling around the eyes

Young children are more prone to infections of the nose, sinus and ears, especially in the first several years of life. These are most frequently caused by viral infections (colds), and they may be aggravated by allergies. However, if your child remains ill beyond the usual week to ten days, a sinus infection may be the cause.
 
You can reduce the risk of sinus infections for your child by reducing exposure to known environmental allergies and pollutants such as tobacco smoke, reducing his/her time at day care and treating stomach acid reflux disease.

How will the doctor treat sinusitis?

Acute sinusitis: Most children respond very well to antibiotic therapy. Nasal decongestant sprays or saline nasal sprays may also be prescribed for short-term relief of stuffiness. Nasal saline (saltwater) drops or gentle spray can be helpful in thinning secretions and improving mucous membrane function. Over-the-counter decongestants and antihistamines are not generally effective for viral upper respiratory infections in children, and the role of such medications for treatment of sinusitis is not well defined. Such medications should not be given to children younger than two years old.

If your child has acute sinusitis, symptoms should improve within the first few days of treatment. Even if your child improves dramatically within the first week of treatment, it is important that you complete the antibiotic therapy. Your doctor may decide to treat your child with additional medicines if he/she has allergies or other conditions that make the sinus infection worse.
 
Chronic sinusitis: If your child suffers from one or more symptoms of sinusitis for at least 12 weeks, he or she may have chronic sinusitis. Chronic sinusitis or recurrent episodes of acute sinusitis numbering more than four to six per year are indications that you should seek consultation with an otolaryngologist (an ear, nose and throat – ENT – specialist). The ENT may recommend medical or surgical treatment of the sinuses.

Diagnosis of sinusitis: If your child sees an ENT specialist, the doctor will examine his/her ears, nose and throat. A thorough history and examination usually leads to the correct diagnosis. Occasionally, special instruments will be used to look into the nose during the office visit. An x-ray called a CT scan may help to determine how completely your child's sinuses are developed, where any blockage has occurred and confirm the diagnosis of sinusitis. The doctor may look for factors that make your child more likely to get sinus infection, including structural changes, allergies, and problems with the immune system.

When Is Surgery Necessary for Sinusitis?

Surgery is considered for the small percentage of children with severe or persistent sinusitis symptoms despite medical therapy. Using an instrument called an endoscope, the ENT surgeon opens the natural drainage pathways of your child’s sinuses and makes the narrow passages wider. This also allows for culturing so that antibiotics can be directed specifically against your child’s sinus infection. Opening up the sinuses and allowing air to circulate usually results in a reduction in the number and severity of sinus infections.
 
Also, your doctor may advise removing adenoid tissue from behind the nose as part of the treatment for sinusitis. Although the adenoid tissue does not directly block the sinuses, infection of the adenoid tissue, called adenoiditis (obstruction of the back of the nose), can cause many symptoms that are similar to sinusitis, namely, runny nose, stuffy nose, post-nasal drip, bad breath, cough and headache.

Summary

Sinusitis in children is different than sinusitis in adults. Children more often demonstrate a cough, bad breath, crankiness, low energy and swelling around the eyes, along with a thick yellow-green nasal or post-nasal drip. Once the diagnosis of sinusitis has been made, children are successfully treated with antibiotic therapy in most cases. In the rare child where medical therapy fails, surgical therapy can be used as a safe and effective method of treating sinus disease in children.

Who is in day care?

The 2000 census reported that of among the nation's 19.6 million preschoolers, grandparents took care of 21 percent, 17 percent were were cared for by their father (while their mother was employed or in school); 12 percent were in day care centers; nine percent were cared for by other relatives; seven percent were cared for by a family day care provider in their home; and six percent received care in nursery schools or preschools. More than one-third of preschoolers (7.2 million) had no regular child-care arrangement and presumably were under maternal care.

Day care establishments are defined as those primarily engaged in care of infants or children, or in providing pre-kindergarten education, where medical care and/or behavioral correction are not a primary function or major element. Some may or may not have substantial educational programs, and some may care for older children when they are not in school.

What are your child's risks of being exposed to a contagious illness at a day care center?

Medline, a service of the National Library of Medicine and the National Institutes of Health, reports that day care centers do pose some degree of an increased health risk for children, because of the exposure to other children who may be sick.

When your child is in a day care center, the risk is greatest for viral upper respiratory infection (affecting the nose, throat, mouth, voice box) and the common cold, ear infections and diarrhea. Some studies have tried to link asthma to day care. Other studies suggest that being exposed to all the germs in day care actually IMPROVES your child's immune system.

Studies suggest that the average child will get eight to ten colds per year, lasting ten - 14 days each, and occurring primarily in the winter months. This means that if a child gets two colds from March to September, and eight colds from September to March, each lasting two weeks, the child will be sick more than over half of the winter.

At the same time, children in a day care environment, exposed to the exchange of upper respiratory tract viruses every day, are expected to have three to ten episodes of otitis media annually. This is four times the incidence of children staying at home.

When should your child remain at home instead of day care or school?

Simply put, children become sick after being exposed to other sick children. Some guidelines to follow are:

  • When your child has a temperature higher than 100 degrees, keep him/her at home. A fever is a sign of potentially contagious infection, even if the child feels fine. Schools often advise keeping the child at home until a fever-free period has existed for 24 hours.
  • When other children in the day care facility have a known contagious infection, such as chicken pox, strep throat or conjunctivitis, keep your child at home.
  • Children taking antibiotics should be kept at home until they have taken the medicine for one or two days.
  • If your child is vomiting or has diarrhea, the young patient should not be around other children. Other signs of illness are an inability to take fluids, weakness or lethargy, sunken eyes, a depressed soft spot on top of infant’s head, crying without tears and dry mouth.

Can you prevent your child from becoming sick at a day care center?

The short answer is no. Exposure to other sick children will increase the likelihood that your child may catch the same illness, particularly with the common cold. The primary rule is to keep your own children at home if they are sick. However, you can:

  • Teach your child to wash his or her hands before eating and after using the toilet. Infection is spread the most by children putting dirty toys and hands in their mouths, so check your day care’s hygiene cleaning practices.
  • Have your child examined by a physician before enrollment in a day care center or school. During the examination, the physician will:
    • Look for otitis (inflammation) in the ear. This is an indicator of future ear infections.
    • Review with you any allergies your child may have. This will assist in determining if the diet offered at the day care center may be harmful to your child.
    • Examine the child’s tonsils for infection and size. Enlarged tonsils could indicate that your child may not be getting a healthy sleep at night, resulting in a tired condition during the day.
    • Alert the day care center manager when your child is ill, and include the nature of the illness.

Day care has become a necessity for millions of families. Monitoring the health of your own child is key to preventing unneccessary sickness. If a serious illness occurs, do not hesitate to have your child examined by a physician.

High risk foods and food characteristics:

  • Hard candy
  • Peanuts/nuts
  • Seeds
  • Whole grapes
  • Raw carrots
  • Apples
  • Popcorn
  • Hot dogs
  • Chunks of peanut butter
  • Marshmallows
  • Chewing gum
  • Sausages
  • Foods that are round and could conform to a child’s airway

Since 60% of non-fatal choking incidents result from food, let’s examine some ways to reduce the risk of choking while children are eating.

Reducing Food Choking Risks

  1. Children should be seated when eating – Caregivers/Teachers should ensure that children do not eat when standing, walking, running, playing, lying down or riding in vehicles.
  2. Children should not be allowed to continue to feed themselves or continue to be assisted with feeding themselves if they begin to fall asleep.
  3. Active supervision is a must! Watch children for “squirreling” of several pieces of food in their mouth. This increases the risk of choking. Remember a choking child may not make any noise, so adults must keep their eyes on children who are eating.
  4. Children at this age require increased supervision when eating because they are easily distracted and may not pay full attention to the task of eating.
  5. Food should not be used for children’s games that involve catching the food item in the mouth or stuffing large numbers or amounts of food in the mouth.
  6. Cut foods such as grapes and other fruits, meat, cheese and raw vegetables into small pieces and shapes that will not block the airways. Cut hot dogs lengthwise as well as widthwise.
  7. Cook vegetables so they become softer and easier to swallow.
  8. Give only small amounts of peanut butter or other similar foods to prevent them for blocking the child’s airway.
  9. Offer plenty of liquids to children when eating, but make sure liquids and solids are not swallowed at the same time.
  10. Remember, foods do not contain warning labels about possible choking hazards.

Reprinted with the permission of AAP News (January, 2011)

 

Choking is a very common cause of unintentional injury or death in children under age one, and the danger remains significant until the age of five. Objects such as safety pins, small parts from toys, and coins cause choking, but food is responsible for most incidents. You must be particularly watchful when children around the age of one are sampling new foods. Here are some additional suggestions for preventing choking:

  • Don’t give young children hard, smooth foods (i.e., peanuts, raw vegetables) that must be chewed with a grinding motion. Children don’t master that kind of chewing until age four, so they may attempt to swallow the food whole. Do not give peanuts to children until age seven or older.
  • Don’t give your child round, firm foods (like hot dogs and carrot sticks) unless they are chopped completely. Cut or break food into bite-size pieces (no larger than ½ inch [1.27 cm]) and encourage your child to chew thoroughly.
  • Supervise mealtime for your infant or young child. Don’t let her eat while playing or running. Teach her to chew and swallow her food before talking or laughing. Chewing gum is inappropriate for young children.

Because young children put everything into their mouths, small non-food objects are also responsible for many choking incidents. Look for age guidelines in selecting toys, but use your own judgment concerning your child. Also be aware that certain objects have been associated with choking, including uninflated or broken balloons, baby powder, items from the trash (e.g., eggshells, pop-tops from beverage cans), safety pins, coins, marbles, small balls, pen or marker caps, small, button-type batteries, hard, gooey, or sticky candy or vitamins, grapes and popcorn. If you’re unsure whether an object or food item could be harmful, you can purchase a standard small-parts cylinder at juvenile products stores or test toys using a toilet paper roll, which has a diameter of approximately 1¾ inches.

Source: American Academy of Pediatrics; Caring for Your Baby and Young Child: Birth to Age 5 (Copyright © 2009 American Academy of Pediatrics).