A sinus infection is a bacterial infection of one of the sinuses that normally drain into the nose. When someone has a cold or allergies and the nasal passages become swollen and make more mucus, so do the sinus tissues. The drainage system for the sinuses can get blocked, and mucus can become trapped in the sinuses. Bacteria, viruses, and fungi can grow there and lead to sinusitis.

Sinus congestion commonly occurs without an infection when one of the sinus openings becomes blocked from a cold or hay fever. Sinus congestion usually goes away on its own. If bacteria multiply within the sinus, a sinus infection can occur. The main symptom is facial pain. Other symptoms of a sinus infection are:

• swelling of the skin over the sinus
• fever that begins 3 or more days after your child gets a cold
• yellow/green nasal discharge lasting more than 10 days

Understanding the signs and symptoms of a sinus infection can help us know when we need to seek medical advice, however, the symptoms vary according to what sinuses are infected and if the infection is acute or chronic.

Younger kids often have cold-like symptoms, including a stuffy or runny nose and slight fever. If your child develops a fever 5-7 days after cold symptoms begin, it could signal sinusitis or another infection (like bronchitis, pneumonia, or an ear infection), so call your doctor.

Many parents mistake cold-related headaches in young kids for sinus infections. But the sinuses in the forehead don’t start developing until kids are 6 or 7 years old and aren’t formed enough to get infected until the early teen years, so headaches in kids who have colds usually aren’t sinus infections.

In older kids and teens, the most frequent symptoms of sinusitis are a daytime dry cough that doesn’t improve after the first 7 days of cold symptoms, fever, worsening congestion, dental pain, ear pain, or tenderness in the face. Sometimes teens who have sinusitis also develop upset stomachs, nausea, headaches, and pain behind the eyes.

The following treatment should reduce pain and fever within 48 hours or less.

• Antibiotics: This medicine will kill bacteria that are causing the sinus infection. Try not to forget any of the doses. If your child goes to school or to a baby sitter, arrange for someone to give the afternoon dose. If the medicine is a liquid, use a measuring spoon to make sure that you give the right amount. Even though your child will feel better in a few days, give the antibiotic until the bottle is empty to prevent the infection from flaring up again. Do not save the antibiotic for the next illness because it loses its strength.
• Nasal washes: Use warm water or saline nose drops followed by suction or nose blowing to wash dried mucus or pus out of the nose. Do nasal washes at least 4 times a day or whenever your child can’t breathe through the nose. If the air in your home is dry, run a humidifier.
• Decongestant nose drops or spray: To drain the sinuses, use a generic, long-acting decongestant nose drop or spray (such as oxymetazoline). You don’t need a prescription for the nose drops or spray. The usual dose for adolescents is 2 drops or sprays per nostril twice a day. For younger children use one drop or spray a day. Use the medicine routinely for the first 2 or 3 days of treatment. After that, don’t use the spray or nose drops unless the sinus congestion or pain recurs. Stop the drops or spray after 5 days to prevent rebound swelling.
• Pain-relief medicines: Your child can take acetaminophen (Tylenol) or ibuprofen (Advil) for a few days for sinus pain or any fever over 39°C (102°F).
• Oral antihistamines: If your child also has hay fever, she should take allergy medicine (antihistamine). Otherwise avoid using antihistamines because they can slow down the movement of secretions out of the sinuses.
• Contagiousness: Sinus infections are not contagious. Your child can return to school or day care when she is feeling better and the fever is gone.

Pneumonia is an inflammation of the lung, usually caused by an infection. Three common causes are bacteria, viruses and fungi. You can also get pneumonia by accidentally inhaling a liquid or chemical. People most at risk are older than 65 or younger than 2 years of age, or already have health problems.

About 80% of pneumonia cases are caused by viruses and 20% by bacteria. Viral pneumonia is usually milder than bacterial pneumonia. Bacterial pneumonia tends to occur more suddenly and cause higher fevers (often over 40°C, or 104°F). Pneumonia is usually a complication of a cold. Although colds can be passed from person to person, bacterial pneumonia is not considered contagious.

Symptoms of pneumonia vary, depending on the age of the child and the cause of the pneumonia. Common symptoms include:

• fever
• chills
• cough
• unusually rapid breathing
• breathing with grunting or wheezing sounds
• labored breathing that makes a child’s rib muscles retract (when muscles under the rib cage or between ribs draw inward with each breath)
• vomiting
• chest pain
• abdominal pain
• decreased activity
• loss of appetite (in older kids) or poor feeding (in infants)
• in extreme cases, bluish or gray color of the lips and fingernails

Sometimes a child’s only symptom is rapid breathing. Sometimes when the pneumonia is in the lower part of the lungs near the abdomen, there may be no breathing problems, but there may be fever and abdominal pain or vomiting.

Most cases of pneumonia can be treated without hospitalization. Typically, oral antibiotics, rest, fluids, and home care are sufficient for complete resolution. However, people with pneumonia who are having trouble breathing, people with other medical problems, and the elderly or children may need more advanced treatment. If the symptoms get worse, the pneumonia does not improve with home treatment, or complications occur, the person will often have to be hospitalized.

Vaccines can prevent infections by viruses or bacteria that cause some types of pneumonia. Kids usually receive routine immunizations against Haemophilus influenzae and pertussis (whooping cough) beginning at 2 months of age. (The pertussis immunization is the “P” part of the routine DTaP injection.) Vaccines are now also given against the pneumococcus organism (PCV), a common cause of bacterial pneumonia.

Children with chronic illnesses, who are at special risk for other types of pneumonia, may receive additional vaccines or protective immune medication. The flu vaccine is strongly recommended for kids with chronic illnesses such as chronic heart or lung disorders or asthma, as well as otherwise healthy children ages 6 months through 19 years.