Can Toddlers Get Sinus Infections?
Yes, toddlers absolutely can develop sinus infections, and they are actually quite common in this age group—approximately 6-7% of children presenting with respiratory symptoms have acute sinusitis. 1
Why Toddlers Are Susceptible
Viral upper respiratory infections (URIs) are the primary trigger, with children averaging 6-8 URIs per year compared to 2-3 in adults, making bacterial sinusitis more frequent in the pediatric population. 2
Viral inflammation sets the stage for bacterial superinfection by causing mucosal inflammation of the nose and paranasal sinuses, with approximately 8% of viral infections complicated by acute viral sinusitis. 1
Other predisposing factors in children include allergic rhinitis, nasal airway obstruction, immunodeficiency, ciliary dysfunction, cystic fibrosis, and odontogenic infections. 1
How to Recognize Sinusitis in Toddlers
The American Academy of Pediatrics defines three distinct clinical patterns for diagnosis: 3
Persistent Pattern (Most Common)
- Nasal discharge of any quality OR daytime cough lasting >10 days without improvement 1, 3
- This distinguishes bacterial sinusitis from uncomplicated viral URIs, which typically resolve within 10 days 3
Worsening Pattern
- Initial improvement from a viral URI followed by new onset or worsening of nasal discharge, daytime cough, or fever (≥38°C/100.4°F) 3
- This suggests bacterial superinfection 3
Severe Pattern
- Concurrent high fever (≥39°C/102.2°F) and purulent nasal discharge for ≥3 consecutive days at illness onset 1, 3
Key Clinical Differences from Adults
Cough and purulent rhinorrhea are the predominant symptoms in children (80% and 75% respectively), unlike adults who more commonly report facial pain. 3
Toddlers typically cannot articulate headache or facial pain, making persistent cough and nasal discharge the most reliable indicators. 2
Critical Diagnostic Pitfall to Avoid
Do NOT order imaging (plain films, CT, MRI, or ultrasound) to differentiate bacterial sinusitis from viral URI. 1, 3
Imaging abnormalities are unreliable: 68% of symptomatic children with viral URIs and 42% of healthy children show sinus abnormalities on imaging. 1, 3
One study found 97% of infants who had a cold in the preceding 2 weeks showed sinus abnormalities on CT done for other reasons. 1
Imaging is only indicated when orbital or central nervous system complications are suspected (proptosis, impaired extraocular movements, severe headache, photophobia, seizures, or focal neurologic findings). 1
When to Suspect Complications (High Morbidity/Mortality)
Intracranial complications are less common but more serious than orbital complications, with higher morbidity and mortality rates. 1
Watch for these red flags: 1
- Swollen eye with proptosis or impaired extraocular muscle function
- Severe headache
- Photophobia
- Seizures
- Other focal neurologic findings
These complications include meningitis, encephalitis, subdural/epidural empyema, brain abscess, orbital abscess, and dural sinus thrombophlebitis. 1
Risk Factors for Recurrent Sinusitis in Toddlers
Children who develop sinusitis experience significantly more frequent URIs (median 3 per year) compared to children whose URIs remain uncomplicated (median 1 per year). 4
Consider underlying conditions such as asthma, gastroesophageal reflux, cystic fibrosis, obstructive sleep apnea, or allergic rhinitis in children with recurrent or chronic sinusitis. 1