Toddlers always seem to have runny noses. So when do you need to worry about it? When it is draining clear? Or yellow? Or green? When it has been dripping for a week? A month?
A clear runny nose is commonplace for a toddler. It may represent teething or allergies, or it may just come out of the blue. Most parents — and certainly most pediatricians — don’t pay much attention to a clear runny nose unless it has persisted for many weeks or is associated with other symptoms.
But when that clear runny nose turns yellow and then green, there tends to be more concern. A yellow discharge can mean just about anything from a mild viral infection to some irritation in the nose. Yellow usually does not indicate a serious or a bacterial infection.
A green discharge, however, can signify a bacterial infection. A green discharge also can be caused by dried blood. The blood usually results from irritation inside the nose.
When the blood is exposed to oxygen and mixed with mucus, it can look green rather than red. Green stuff coming out of your child’s nose should not cause you to panic, but it is worth keeping an eye on. It alone does not necessarily mean there is a sinus infection.
A diagnosis of sinusitis (or sinus infection) requires that your child have at least one of the following symptoms: persistent upper respiratory symptoms, such as congestion, cough, and runny nose lasting more than 10 to 14 days or getting significantly worse after 7 days; increasing headache, especially at the forehead or around the nose; persistent daytime cough; fever; ear pain; or just plain fussiness.
Many of these symptoms are nonspecific, so the bigger picture becomes important. For instance, a child with a fever may have any number of things going on, but a child with a fever, green nasal discharge, and headache on one side of the forehead or face is fairly likely to have sinusitis.
Remember that sinusitis is usually a secondary infection. First the nose gets congested, then the mucus and fluid plugging the nose filter back into the neighboring sinuses. Or the nose is plugged, and the mucus that forms in the neighboring areas cannot drain properly. Either way, congestion has backed up into the sinuses.
It is estimated that 5 to 10 percent of upper respiratory infections (URIs) are followed by a sinus infection. This range represents an average for people of all ages. The sinuses are very small and underdeveloped at birth. They grow through the childhood years, maturing by adolescence. The bigger the sinuses, the more likely they are to become infected. Therefore, even though toddlers get an average of six URIs per year, most never have a sinus infection.
Certain medical issues predispose a child to sinusitis. Allergic rhinitis — an allergy present in the nose — can cause mucus pooling. Gastroesophageal reflux disease (GERD) is another predisposing factor. And immunodeficiency can certainly lead to a sinus infection. If the immune system cannot fight viruses or bacteria efficiently, there is a greater chance that infections will occur.