UMEM Educational Pearls

Title: Pediatric Sinusitis- A Primer

Keywords: pediatrics, sinusitis, infectious diseases (PubMed Search)

Posted: 10/10/2025 by Kathleen Stephanos, MD (Updated: 12/5/2025)
Click here to contact Kathleen Stephanos, MD

As we enter cold and flu season, sinus issues become commonplace in the ED. What do we need to know about pediatric sinusitis?

First, it is important to know when pneumatization of the sinuses occur (so we don't look for symptoms where they can't be present). Completion of their development does not occur until around age 21 years.

Ethmoid and Maxillary sinus- present at birth continue to develop over time
Frontal sinus- does not develop until around age 7 years
Sphenoid sinus- not present until the teen years

Sinusitis should be a clinical diagnosis and does not require imaging unless there is concern for abscess development, cellulitis or other complications, or in cases where symptoms are not improving despite treatment.

In most otherwise healthy children, acute sinusitis is typically viral in nature, regardless of the color of nasal discharge, and can be managed with symptomatic care, including saline sprays, humidifiers, warm compresses and monitoring.

There are strict criteria for otherwise healthy children regarding when to initiate antibiotics including:

patients with persistent symptoms of pain over the sinuses and nasal drainage for at least 10 days
patients with URI symptoms AND purulent discharge AND high fever for 3 days
patients with biphasic worsening of symptoms

The antibiotic of choice is high-dose amoxicillin with or without clavulanic acid (cefpodoxime or cefdinir can be considered in penicillin allergic patients)

Antibiotic stewardship is critical in these patients, as unnecessary antibiotics can result in resistance or undesired side effects. There should be a clear conversation about return precautions with parents including education about the importance of symptomatic management over antibiotics in the first 10 days.

References

Ramadan HH, Chaiban R, Makary C. Pediatric Rhinosinusitis. Pediatr Clin North Am. 2022 Apr;69(2):275-286. doi: 10.1016/j.pcl.2022.01.002. PMID: 35337539.

Leung AK, Hon KL, Chu WC. Acute bacterial sinusitis in children: an updated review. Drugs Context. 2020 Nov 23;9:2020-9-3. doi: 10.7573/dic.2020-9-3. PMID: 33281908; PMCID: PMC7685231.