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Ask Dr. Sears: Is it a Sinus Infection?

Q. My 4-year-old has had a cold for more than a week now, and the mucus from her nose has turned thick and yellowish. Could she have an infection, and how can it be treated?

Sinusitis, or a sinus infection, occurs when the fluid that accumulates in the sinuses during a cold or allergy doesn't drain sufficiently through the nose and the back of the throat and eventually becomes infected. That's why it's particularly common during the winter months, when indoor heating dries out and thickens the secretions.

Often, children may not seem very sick when they have a sinus infection. But as a general rule, if a child has had a cold for more than 10 days, seems less energetic, or looks drawn, you should call the doctor -- even if you don't see signs of a sinus infection.

Some common symptoms of sinusitis include:

  • A cold that lingers without any improvement for more than 10 days.

  • Swollen eyes when child wakes up in the morning.

  • A pale, puffy, and peaked face.

  • A thick discharge from the nose. The color may be yellow, green, white, or clear.

  • A phlegmy cough or a tickling sensation in the throat, especially at night, caused by the sinuses draining into the child's throat.

  • A low-grade fever.

  • Bad breath (caused by the infected mucus in the back of the throat).

  • Headaches just above or between the eyes.

To treat a sinus infection, flush each nostril at least four times a day with a saline nasal spray (available over-the-counter at the pharmacy). You can also make your own saltwater solution by dissolving a quarter of a teaspoon of salt in 8 ounces of warm tap water.

Another way to thin the congestion is to have your daughter sit in a steamy bathroom 3 to 4 times a day for about 10 to 15 minutes and to use a vaporizer in her room at night. Once the secretions are loosened, encourage her to blow her nose gently.

Finally, in addition to these home treatments, your child's doctor will usually prescribe an antibiotic, which will take one to two weeks to completely clear up the sinus infection.

Pediatrician William Sears, M.D., is the author of 22 books on childcare.

Breathless Tantrums

Q. I'm concerned about my 2-year-old's breath-holding episodes. Why is he doing this, and what can I do to prevent such scary behavior?

A. Breath-holding is essentially a five-star temper tantrum. It peaks between 18 months and 2 years of age, when a child has intense feelings but gets frustrated because he isn't yet capable of expressing himself clearly in words.

These breath-holding episodes can be frightening, since the child usually cries so intensely that he turns red in the face and then holds his breath so long that he turns pale, or even blue. But rest assured: Breath-holding isn't harmful. Your child will resume normal breathing just as he's about to pass out. And even if he does faint, his body will automatically resume breathing.

You might try preventing such episodes by keeping a tantrum diary. Record what's setting off his rage. Is he bored? Tired? Overstimulated? Do his tantrums occur most often before nap time? Then, try to avoid those situations or change how you approach them. For instance, if your child gets upset whenever something is taken away from him, make sure you offer a substitute -- say, a favorite toy -- when you take an object out of his hands.

As soon as the tantrum starts, intervene with soothing words and gestures and distracting activities. But don't act upset or give in to his demands. If your son sees that you are anxious about his behavior and will do almost anything to stop it, he will learn that breath-holding is an effective way of getting what he wants -- and he'll continue to do it whenever he's upset.

How to Tell When it's Teething

Q. My 7-month-old son has been running a low-grade temperature and has been suffering from diarrhea, but his doctor says he doesn't have the flu. He's also drooling a lot -- could he be teething or is it a cold?

A. I hear this question quite often. That's because it can be difficult to tell the difference between symptoms of teething and those of a cold. As a rule, don't automatically assume that diarrhea and fever are due to teeth coming in; have your doctor check it out.

Some signs of teething include:

  • A drool rash. Sensitive baby skin reacts to excessive saliva, especially when it's rubbing against a drool-soaked bedsheet or shirt collar. Also look for a drool cough or gagging, caused by saliva dripping down your baby's throat.

  • Diarrhea, caused by swallowing the excess saliva, and a mild diaper rash. But the diarrhea associated with teething has no change in color or odor; stools that are green, increasingly odorous, blood-tinged, explosive, or extremely watery are usually a sign of an infection or allergy.

  • Irritability and a low-grade fever. This is produced by the inflammation caused by hard teeth pushing through soft gums (teething rarely causes a fever higher than 101 degrees).

  • Ear-pulling. Though this can also be a sign of an ear infection, many babies pull their ears while teething because the pain from the jaw gets transferred to the ear canal.

  • Finally, babies don't get progressively sicker with teething; they have intermittent periods when they seem completely well.