Oral Ulcers in Toddlers and Young Children

Oral ulcers refers to the little sores that come up inside the mouth, on the tongue or on the gums. There are many causes of oral ulcers in toddlers and young children, but they usually occur following some trauma to the mouth such as:

• Accidental biting of the tongue or inside of the cheek
• Over-chewing on hard foods
• Vigorous brushing of the teeth
• Thermal injury from consuming hot foods

Oral ulcers can also happen when children feel tired or stressed or if is a family history of recurrent oral ulcers.

Infections are another major cause of oral ulcers in children. Common viral infections include hand-foot-and-mouth disease (HFMD), chickenpox, and herpes gingivostomatitis (otherwise known as cold sore). If an infection is the cause, symptoms such as fever, malaise, or rashes may accompany in some cases.                                                               

Dr Tan Zhen Han, Paediatrician, SBCC Baby & Child Clinic said: “Although rare, mouth ulcers can sometimes with associated with an underlying medical condition, in which there may be recurrent mouth ulcers together with other associated features.  Some of these conditions include vitamin deficiencies (For example, Iron, vitamin B12, folate, vitamin C, zinc, magnesium), impaired immune system, and gastrointestinal tract disease.”

Preventive measures

A good oral hygiene practice is extremely important. Be sure your child uses a toothbrush with soft bristles, and brushes gently, and do take them to visit the dentist regularly.

If your child has a habit of sucking their thumbs, remember to cut their nails regularly. For younger children, watch out for toys or objects with sharp edges that your child may put into their mouth

Similarly, having a good hand hygiene is equally important. Parents and teachers should start teaching children regular hand washing at home and in school from young as this can help reduce the spread of infections such as HFMD.

When to visit a doctor?  

You should bring your child to the doctor if:

• The ulcers are more than 1cm in diameter in size
• There are multiple ulcers at one time (As a precaution to prevent spread of HFMD, it is recommended to bring your child to a doctor if there are more than one ulcer)
• The ulcer has not healed after two weeks
• The ulcers appeared after starting a new medication
• Your child looks and feels very sick
• Your child is unable to eat or drink property due to the pain
• There are signs of dehydration such as dry lips, dry tongue, lethargy or decreased urine output
• There are signs of accompanying symptoms such as fever, rash, neck swelling or pain, bloody crusts on the lips, or red, swollen and tender gums
• If ulcers occur frequently (more than 4 episodes a year).

Treatment for oral ulcers

If your child is in significant pain, your doctor may prescribe a topical local anaesthetic (washes, gels, drops or sprays). Such forms of remedy may provide some short term symptomatic relief, which also help improve oral intake.

Give your child small frequent sips of water every now and then as this will help to prevent dehydration.

What can parents do to help the child ease the discomfort?

• Encourage your child's oral intake by giving cool fluids, or even frozen juice popsicles
• Using a straw to drink can help the pain by minimizing the fluids from touching the ulcer
• Cook soft, bland foods that are easy to chew and swallow or alternatively, mash, blend, or puree foods
• Avoid salty or spicy foods, citrus fruits, nuts, tomatoes and chocolates, as they may cause more pain to the ulcers
• Remember that fluid intake is more important than eating any solids

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Dr Tan Zhen Han

Paediatrician

SBCC Baby & Child Clinic

MBBS (S’pore), MRCPCH (UK), FAMS (Paediatrics)

This article is brought to you by Healthway Medical.