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Should Your Child See a Doctor?

Mouth Ulcers

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Definition

  • Painful, shallow ulcers (sores) on the lining of the mouth
  • The gums, the inner sides of the lips or cheeks are the usual sites.
  • Sores on the outer lips (e.g., recurrent fever blisters) are excluded

Causes 

  • Canker Sores: The main cause of 1 or 2 mouth ulcers after age 5. Not contagious.
  • Hand-foot-mouth disease: The most common cause of multiple ulcers in the mouth, mainly on the tongue and sides of the mouth. Due to the Coxsackie A-16 virus. It is common between ages 1 to 5 years.
  • Herpes Virus (Cold sore virus): The first infection can be severe and cause 10 or more ulcers on the gums, tongue and lips. Key findings are ulcers on the outer lips or skin around the mouth. Also, fever and difficulty swallowing. Usually occurs age 1 to 3.

Return to School 

  • Canker sores are not contagious. Children with fever or many mouth ulcers need to be examined before returning to child care or school.

When to Call Your Doctor for Mouth Ulcers

Call 911 If…

 
  • Your child is not moving or too weak to stand
 

Call Your Doctor Now (night or day) If

  • Your child looks or acts very sick
  • Chemical in the mouth could have caused ulcers
  • Signs of dehydration (very dry mouth, no tears and no urine in more than 8 hours)
 

Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If

  • You think your child needs to be seen
  • 4 or more ulcers
  • Bloody crusts on lips
  • Red, swollen gums
  • Ulcers and sores also present on outer lips
  • One ulcer on the gum near a tooth with a toothache
  • Fever or swollen face
  • Large lymph node under the jaw
  • Began after starting a medicine
 

Call Your Doctor During Weekday Office Hours If

  • You have other questions or concerns
  • Mouth ulcers last over 2 weeks
 

Parent Care at Home If

  • Probable canker sores and you don't think your child needs to be seen
 

Home Care Advice for Canker Sores (Harmless Mouth Ulcers)

  1. Canker sores are the #1 cause of mouth ulcers:
    • 1 to 3 painful, white ulcers of the inner cheeks, inner lip or gums (no fever).
    • Causes include injuries from rough food, tooth brushes, biting, food irritants, etc.
     
  2. Liquid Antacid for Pain Relief:
    • Use a liquid antacid 4 times per day for pain relief. (Avoid regular mouth washes, because they sting).
    • Children over age 4 can use 1 teaspoon (5 ml) as a mouth wash after meals
    • For younger children, put ½ teaspoon (2.5 ml) in the front of the mouth after meals.
     
  3. Pain Medicine: Give acetaminophen (e.g., Tylenol) or ibuprofen for severe pain (especially at bedtime).
  4. Fluids :
    • Offer a soft diet.
    • Encourage favorite fluids to prevent dehydration. Cold drinks, milkshakes, and popsicles are especially good.
    • Avoid salty foods, citrus fruits and foods that need much chewing.
    • For infants, give fluids by cup, spoon or syringe rather than a bottle (Reason: The nipple can cause pain).
     
  5. Contagiousness: Canker sores are not contagious. Children with fever or many mouth ulcers need to be examined before returning to child care or school.
  6. Expected Course: They heal up in 1 to 2 weeks on their own. Once they occur, no treatment can shorten the course, but treatment can reduce the amount of pain.
  7. Call Your Doctor If:
    • Mouth ulcers last over 2 weeks
    • Your child becomes worse
     

And remember, contact your doctor if your child develops any of the "When to Call Your Doctor" symptoms.


References

  1. American Academy of Pediatrics: Committee on Infectious Diseases. Herpes simplex. In Pickering L, ed. 2009 Red Book. 28th ed. Elk Grove Village, IL: 2009.
  2. Annunziato PW and Gershon A. Herpes simplex virus infections. Pediatr Rev. 1996;17:415-423.
  3. Armon K, Elliott EJ. Acute gastroenteritis. In: Moyer V, Davis RL, Elliott E, et al, eds. Evidence Based Pediatrics and Child Health. London, England: BMJ Publishing Group; 2000. p. 273-286
  4. Dilley DC, et al. Diagnosing and treating common oral pathologies. Pediatr Clin North Am. 1991;38:1227-1264.
  5. Dunlap CL, et al. Ten oral lesions you should know. Contemp Pediatr. 1991 Dec;8:16-28.
  6. Krol D, Keels M. Oral conditions. Pediatr Rev. 2007;28(1):15-22.
  7. Peter JR and Haney HM. Infections of the oral cavity. Pediatr Ann. 1996; 25:572-576.
  8. Rees TD and Binnie WH. Recurrent aphthous stomatitis. Dermatol Clin. 1996;14:243-256.
  9. Slavin KA, Frieden IJ. Hand-foot-mouth disease. Arch Pediatr Adolesc Med. 1998;152: 505-506.
  10. Waggoner-Fountain LA, Grossman LB. Herpes simplex virus. Pediatr Rev. 2004; 25(3):86-93.

Disclaimer

This information is not intended to be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.


Author and Senior Reviewer: Barton D. Schmitt, M.D.

Last Reviewed: 8/1/2010

Last Revised: 10/1/2010 3:29:53 PM

Copyright 1994-2011 Barton D. Schmitt, M.D.

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