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Elise Herman , MD

The Importance of a High Fiber Diet for Kids

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Kids have an increasingly processed diet, which contributes to higher risk of obesity and Type 2 diabetes, as well as overall poor nutrition. There is another concern: inadequate dietary fiber. Fiber is very important for kids’ health and may play a role in decreasing colorectal cancer in young people, which although still uncommon, has alarmingly tripled in 15-19 year olds in the last 20 years. A high fiber diet is associated with a lower rate of all cancers, so starting this habit in childhood can pay off in the long run.

There are 2 types of fiber: soluble and insoluble. Soluble fiber dissolves in water, binds to fats and lowers cholesterol, thereby helping to prevent heart disease.  The beneficial  bacteria in the gut feed on the soluble fiber, increasing the health of the microbiome (microorganisms in the intestinal tract). By controlling the blood sugar, soluble fiber also decreases the risk of Type 2 diabetes. Since soluble fiber causes a feeling of fullness, it helps regulate the appetite and assists with weight control.

Insoluble fiber does not dissolve in water. It softens stool, helping keep bowel movements soft and waste going through the intestinal tract. By preventing constipation, insoluble fiber also decreases the risk of hemorrhoids and diverticulitis.

Getting fiber through a healthy diet is better than relying on fiber supplements. Healthy fiber-containing foods also have other nutrients and vitamins that a fiber supplement does not. Good sources include fruits, vegetables, nuts, lentils, beans, and whole grains. Avoid peeling fruit if possible (except for oranges, etc.) and serve the whole fruit instead of juice which has no fiber but is high in sugar. Avoid processed foods which usually have little fiber.

Include a fruit and/or veggie at each meal and emphasize fiber-containing snacks such as nuts, dried fruits, and carrot/celery sticks. Not all whole grain foods contain adequate fiber, so do look at nutrition labels, aiming for at least 3 grams of fiber per serving.  Popcorn (ideally without butter) has 6 grams of fiber per serving so is fine as an occasional snack.

To estimate how much fiber your child should have daily, add 5-10 to their age. As an example, a 5-year-old should take in 10-15 grams of fiber per day. For comparison, an adult should have about 25-30 grams daily. Go slowly as you increase the fiber, otherwise bloating and discomfort may occur. If your child is old enough, you can look up recipes together using beans, lentils, and other high fiber foods and then have fun cooking up healthy meals. The whole family should make this change to a healthier high fiber diet together, with parents, as aways, leading by example.

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Dr. Elise Herman

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Dr. Herman is passionate about community health outreach, school programs, and child/family health and wellness. She has more than 31 years of experience as a pediatrician in Ellensburg, Washington, the last 3 with KVH Pediatrics. In 2022 Dr. Herman mostly retired from practice and continues to contribute blog posts and remain a visible advocate for kids in the community.

Sore Throats in Kids

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As we move into fall, viruses and bacteria begin to circulate. Kids often complain of a sore throat this time of year, which is usually caused by a virus. Viral sore throat occurs with typical cold symptoms including runny nose, congestion, cough, low grade fever, and hoarseness. Because this is due to a virus, antibiotics do not help, but the illness typically resolves on its own in about a week. Home care includes encouraging adequate fluids and Tylenol or Advil if needed for pain and discomfort; dosing depends on your child’s age and weight.

In children the most common bacterial throat infection is due to Group A streptococcus, known simply as “Strep throat”.  This illness comes on quickly and is not accompanied by cold symptoms. Strep throat causes pain with swallowing, redness of the throat, and swollen neck glands. The tonsils, which are located on both sides of the back of the throat, become red and swollen with white pus on them. There may be bright red spots on the back of the roof of the mouth. Headache, nausea and vomiting, abdominal pain, and a sandpaper-like red body rash may also occur.

Strep causes 20-30% of pediatric sore throats. It is most common in kids aged 5-15 years and is very unlikely in those under age 3. Testing is done with a rapid test on a swab from the back of the throat with results are ready in minutes. Sometimes a throat culture is done to confirm a negative result though this takes 1-2 days. If there are ulcerations in the mouth or cold symptoms with a sore throat, strep testing is not usually done since the cause is almost certainly a virus.

Some kids and adults are ‘strep carriers’ meaning they carry a light amount of strep but do not typically get sick with it or spread it to others. Up to 1 out of 5 children are strep carriers. They will have a positive strep test, but do not need treatment. If kids do not have strep signs and symptoms, it is best to not test since you may pick up a carrier state which does not need antibiotics.

Strep throat is treated with antibiotics, usually a 10-day course. It is paramount to finish the antibiotics, even though kids usually feel better within 2 days. The full course of antibiotics shortens the illness and decreases the risk of spreading strep to others. Antibiotics also cut the risk of inflammatory complications after strep throat such as kidney disease and rheumatic heart disease. Kids may return to school and activities after 12-24 hours on antibiotics if they are improving and without fever. Your child should also switch to a new toothbrush after antibiotics are completed.

Home care for strep includes ensuring your child is drinking adequately and getting some nutrition, which may be challenging in view of the throat pain. Cool soft foods like smoothies or popsicles are usually easiest to swallow. Avoid acidic foods like orange juice. Tylenol or Advil are fine for fevers and discomfort but follow age and weight guidelines. Aspirin is not safe for children.

Strep spreads quickly and easily by respiratory droplets when an infected person sneezes or talks and by sharing personal items like cups or water bottles. Since strep can be transmitted for 3 days before someone develops symptoms, it is best to routinely avoid sharing silverware, glasses, etc. Frequent handwashing and avoiding touching one’s eyes, nose and mouth help limit spread of strep and other illnesses- especially important this time of year.

Pediatric Influenza and Vaccination

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As school starts up again, it is inevitable that kids will pass around lots of viruses, including influenza. Influenza (often called “the flu”) is a very contagious respiratory virus which causes fever up to 103-105 degrees, muscle aches, runny nose, and sore throat. A dry cough which can become severe is common, and fatigue is often extreme.  Nausea, vomiting, and diarrhea may also occur.

Influenza is passed from one person to another by sneezing, coughing, touching objects that are contaminated like countertops, and sharing cups or silverware.  The time between being exposed and getting sick with influenza is 1-4 days, so it moves quickly through a community. Influenza symptoms usually last 7-10 days in kids, though the cough and tiredness can take longer to resolve. Influenza activity peaks between December and February but may start earlier in the fall.

Though influenza may feel just like a severe cold, for many it can be very dangerous, especially older adults and young children. Over 40,000 adults died last year from influenza and its complications. There were 266 reported deaths due to influenza in children this past flu season, a new record high.

Children under age 5 are most at risk of complications, including severe pneumonia caused by bacteria. Kids can also develop bronchiolitis (swelling and inflammation of the small airways) and croup due to influenza. 

Decreased appetite and fluid intake along with vomiting and diarrhea can cause dehydration, signs of which include decreased urination, dry mouth, and sunken appearing eyes. Neurologic complications may include brain inflammation and seizures. A rare complication called Guillain-Barre Syndrome causes progressive and severe weakness, resulting in respiratory distress that can be life-threatening.

Annual influenza vaccination (of you, other family members, and your child) is your best bet to protect your kiddo. All children over age 6 months (with rare exceptions) should get vaccinated ideally before Halloween. The vaccine effect lasts about 6 months and protects up to 60% of those vaccinated from becoming infected. Although not totally protective against getting influenza, the vaccine is very effective at decreasing the severity of infection, with lower rates of hospitalization and complications including pneumonia. Flu vaccine can be given with other childhood vaccinations.

You cannot get influenza from flu vaccine, but mild side effects like a runny nose and low-grade fever can occur; these are due to the appropriate response of your immune system to the vaccine. Influenza vaccines have been well studied and are extremely safe.  In the past some have been concerned about thimerosal, a vaccine preservative, because it contains ethyl mercury. Ethyl mercury is entirely different from methylmercury, which can be harmful in high levels. Ethyl mercury poses no risk, but to minimize concern, thimerosal was removed from most childhood vaccines in 2001. It is present now only in multi-dose flu vaccine vials, which are not commonly used.

Along with influenza vaccination, don’t forget other simple ways to avoid illness during flu season such as good handwashing and avoiding sharing water bottles, drinks, or food. Influenza home care includes encouraging adequate fluids and fluid-containing foods like soup, Jello, or popsicles. Acetaminophen (Tylenol) and ibuprofen (Advil, Motrin) can help with fever and discomfort; be sure to follow age and weight guidelines.

Call your provider if your child has influenza symptoms and has difficulty breathing, appears dehydrated, or has fever for more than 3 days. You should also reach out to your provider if your child has extreme fatigue or irritability, or is under 3 months old with a fever of 100.4 or higher. 

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Dr. Elise Herman

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Dr. Herman is passionate about community health outreach, school programs, and child/family health and wellness. She has more than 31 years of experience as a pediatrician in Ellensburg, Washington, the last 3 with KVH Pediatrics. In 2022 Dr. Herman mostly retired from practice and continues to contribute blog posts and remain a visible advocate for kids in the community.

Help Build Your Child’s Self-Esteem

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Self-esteem is the way we feel about ourselves and is central to how we move through the world. If someone has high self-esteem, they feel confident and capable, and are more able to rise to a challenge and persevere. They can handle making mistakes, and do better overall in terms of school, work, and social interactions.

Those with low self-esteem feel negatively about themselves and their abilities. They may seem withdrawn, avoid challenges, and berate themselves if they feel they have fallen short. They do not stand up for themselves and may have more difficulty maintaining friendships and interacting with others.

Kids with low self-esteem may be moody or irritable. They may be hesitant to try something new, often predicting failure. If they make a mistake, they can be very self-critical, even calling themselves “stupid” or a “loser”. Self-harm (i.e. cutting of the skin) may occur as a way to deal with the negative feelings.

You can help build high self-esteem in your child by being loving, positive, and encouraging them to take on challenges. Don’t have them aim for perfection, an impossible goal, but instead celebrate when they try something hard or make progress towards a goal. Don’t give false high praise- -kids can often see through this which will make them feel less confident in their abilities.

Speak out about what makes them special and unique; avoid comparing them to others. As the parent, model good self-esteem, voicing self-confidence and your ability to tackle something challenging. Let your child hear that you are kind to yourself when you make a mistake and see that you still have self-respect.

Low self-esteem can be improved by getting out in nature (and off of phones and social media). Exercise, time with friends, and playing games can help your child feel more positively about themselves too. A volunteer activity (which you may do together depending upon their age) helps put the focus on others and how we can help instead of feeling negatively about ourselves. Your child may benefit from clubs or classes such as dance or karate that bring them together with peers they can relate to.

If your child is displaying signs of low self-esteem, talk with them about what you are noticing, and empathize with their feelings. Try to understand how the world seems to them even if what is concerning them may seem minor. If things do not improve over time, consider having your child speak with the school counselor or a therapist comfortable treating children.

By showing your child unconditional love, acknowledging their progress towards a goal, and encouraging them to challenge themselves, you can help boost your child’s self-esteem. Your child will be more confident and better able to handle what comes their way as a result.

more about The contributor

Dr. Elise Herman

Blog Posts
Profile

Dr. Herman is passionate about community health outreach, school programs, and child/family health and wellness. She has more than 31 years of experience as a pediatrician in Ellensburg, Washington, the last 3 with KVH Pediatrics. In 2022 Dr. Herman mostly retired from practice and continues to contribute blog posts and remain a visible advocate for kids in the community.

Bee and Wasp Stings in Children

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Being outside in spring and summer is terrific, but it does come with the risk of bee and wasp stings. It is important to know how to treat stings, what to watch for, and even better, steps you can take to decrease your child’s risk of being stung.

Most bees and wasps can sting multiple times since they do not lose their stinger. Honeybees have a barbed stinger, which remains embedded in the skin so they can only sting once. The honeybee stinger looks like a small black dot in the area of the sting.

The immediate symptoms of a sting are pain and burning; itching may follow. The area becomes red and swollen and this may increase over the next 3 days. A sting on the face can cause severe swelling including around the eye.

If there is bee allergy, anaphylaxis may occur within 15-60 minutes. Anaphylaxis is a severe allergic reaction which may be life threatening and needs emergency treatment with epinephrine, available only by prescription. Signs and symptoms include wheezing, hives, respiratory distress, throat tightness, nausea and vomiting, and swelling of the lips and/or tongue. There may be paleness and fainting. An allergic reaction typically happens after one has had previous stings though can happen with the first sting. Bee allergy occurs in less than 1% of children.

Home care of bee/wasp stings:

  • If you see a stinger, try to remove it by scraping gently with a credit card or fingernail. Do not squeeze or pinch as this can release more venom. Wash with soap and water.
  • Apply a paste of meat tenderizer or baking soda for 20 minutes. Aluminum-based deodorant on the area is another option.
  •  Tylenol (acetaminophen) or Advil (ibuprofen) helps discomfort. Topical or oral Benadryl (do not use these together as it can cause oversedation) helps with itching. 1% hydrocortisone also decreases itching, is available without a prescription, and may be used 2-3 times a day.
  • Cool cloths or an ice pack can help relieve the pain.
  • Use an epinephrine product (injection or nasal spray) as directed if your child has a history of bee allergy

When to call your child’s provider:

  • If there is increasing redness and swelling after 3 days
  • If your child was stung in the mouth or eye
  • If the area of swelling is more than 4 inches across

When to go to the ER/ call 911:

  • If your child has known bee allergy and was stung, even if you treat with an epinephrine product (only available with a prescription)
  • If there are more than 5 stings per 10 pounds of body weight (or more than 50 stings in a teen)
  • If your child appears severely ill

How to help prevent bee/wasp stings:

  • Avoid scented lotions and perfumes
  • Avoid clothes with a floral print or floral colors
  • Have your child always wear shoes since some bees live in the ground
  • Keep food and drink covered; make sure there are no bees in open drink cans or on a straw

more about The contributor

Dr. Elise Herman

Blog Posts
Profile

Dr. Herman is passionate about community health outreach, school programs, and child/family health and wellness. She has more than 31 years of experience as a pediatrician in Ellensburg, Washington, the last 3 with KVH Pediatrics. In 2022 Dr. Herman mostly retired from practice and continues to contribute blog posts and remain a visible advocate for kids in the community.

When is it OK for Kids to Have a Smartphone?

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Seemingly everyone has a smartphone, and kids are drawn to these at a very early age. Parents do their best to supervise and set appropriate boundaries for their kids around phones, but may wonder when it is OK for their child to have their own phone. Making this decision can seem daunting, especially as younger and younger kids seem to have a phone in their pocket. According to Common Sense Media/Research, 43% of kids age 8 to 12 and 88% to 95% of teens up to age 18 have their own smartphone. If you are the parent of a 10-year-old, the begging may have already started. The general recommendation has been “Wait Until 8th (the end of 8th grade)”, but many kids get phones earlier.

Parents often see the benefit of staying in touch as a reason to give their child a phone. Other positives include use in an emergency and socializing. As kids get older, phones can help them stay connected to their friends and communicate about school work, sports, and other activities.

There is no perfect age for a child to have a phone. It may depend on the child’s maturity and sense of responsibility as well as family values. Is the child impulsive? Do they generally respect rules and limits? Are they generally honest? Are they good about following the rules regarding other tech, such as a Chrome book use at school? ATT and the American Academy of Pediatrics have partnered on an online ‘quiz’ to assess a child’s readiness (see resources, below).

The potential negatives of cell phones include less time spent with family, less physical activity, and sleep disturbance. Phones offer access to social media which can increase the risk of depression and anxiety. There is the possibility of kids oversharing, experiencing cyberbullying, and being victimized. Phone addiction is a concern for users of all ages.

On-line pornography poses significant risk to kids and teens. The average child is exposed to pornography by age 12 years. Pornography often portrays physical and verbal aggression and sexual violence, usually directed towards women, including women being choked, slapped and spit upon during sexual activity. It is horrific to note that free porn sites carry videos of child rape and assault. Early exposure to pornography is related to anxiety, depression, and difficulty forming healthy intimate relationships later on.

So how to navigate this complicated situation? Communication is key. Have open discussions with your child regarding the pros and cons of a smartphone. Take the “phone readiness quiz” and review the results with your child. Parental controls restricting the amount of usage as well as access to social media and inappropriate sites are vital. Discuss where and when the phone can be used (not at meals, not during family social time, not after bedtime, etc.) Your child should understand your concerns and the importance of respecting these limits when using other devices, for example, the phone of a friend who may not have the same restrictions.

As the parent, you should have your child’s password, be able to track their usage, and maintain the right to take the phone away if rules are not being followed. Having your child contribute to the purchase of the phone or service plan financially or by doing extra chores teaches responsibility.
As a trial, many families opt for a flip phone (calls and texts only) for a year to assess their child’s readiness. If connection to your child is most important, a smart watch, iPad, or tablet is a good way to start without the complications and potential risks of a smartphone.

Resources

Wait unitl 8th: https://www.waituntil8th.org Parents can join together, pledging to avoid phones for kids in elementary and middle school.

Phone Ready Quiz: https://www.healthychildren.org/English/Pages/PhoneReadyQuiz.aspx

more about The contributor

Dr. Elise Herman

Blog Posts
Profile

Dr. Herman is passionate about community health outreach, school programs, and child/family health and wellness. She has more than 31 years of experience as a pediatrician in Ellensburg, Washington, the last 3 with KVH Pediatrics. In 2022 Dr. Herman mostly retired from practice and continues to contribute blog posts and remain a visible advocate for kids in the community.

Dog Safety for Children

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Most kids have a natural attraction to dogs, but we need to teach our children to be safe around them. Of the roughly 4.5 million dog bites annually in the US, the most common victims are kids, and their injuries tend to be more severe. In general, people are most likely to be bitten by a dog they know as opposed to a stray. Talk to your child about dog safety (starting when they are very young) and be a good role model when interacting with dogs. Basic dog safety includes:

  • Always be gentle. This applies to all animals and is a valuable lesson for our kids. Keep voices calm and reassuring as raised voices or screaming are understandably upsetting to dogs and may cause unpredictable actions. Praise your child when you see calm, kind behavior towards any animal. Practicing gentleness at home with a stuffed animal makes kids more confident when interacting with the real thing!
  • Never disturb a dog when sleeping, eating, or caring for puppies. No grabbing at dogs, touching eyes, pulling on ears or tail- even the most patient dog has limits. Stay away from the food bowl, treats, or special toys as any dog can become protective.
  • Never leave a young child (under age 5 years or so) alone with a dog.
  • When out and about, greet a dog’s owner first, and ask about the dog’s temperament and tolerance for children. You or your child can then ask for permission to pet the dog and after greeting the dog by name, can offer the top of a closed hand for a sniff. Stand to the side of the dog and pet gently on the back or side. Keep interactions brief. Commend your child for behaving kindly and gently.
  • If your child is fearful, do not force an interaction. From a comfortable distance, you and your child can chat about the dog, its size, cuteness, etc., to encourage positive feelings.
  • Any treats should be offered with a flat hand. Never tease a dog by offering a treat and then whisking it away.
  • Notice body language: A tucked tail, laid back ears, and a stiff stance may indicate fear. If a dog is trying to hide behind its owner, it is not ready to be social. A wagging tail often indicates friendliness but, in some dogs, may signal being on alert.  If you have concerns, you can say, “It looks like this doggy isn’t ready to meet new friends. Let’s give him some space.”
  • Stay away from strays. If approached by a stray, turn away, avoiding eye contact with arms crossed. Sometimes saying, “Go home!” emphatically will work. Do not scream or run away.

It is important to teach our kids to be kind to animals, and dog safety is particularly vital given the fact that about 65 million US households include at least one dog. So even if you are dogless, your child will undoubtedly have lots of opportunities to interact with them—and you can help those interactions to be positive and safe.

Resources:

more about The contributor

Dr. Elise Herman

Blog Posts
Profile

Dr. Herman is passionate about community health outreach, school programs, and child/family health and wellness. She has more than 31 years of experience as a pediatrician in Ellensburg, Washington, the last 3 with KVH Pediatrics. In 2022 Dr. Herman mostly retired from practice and continues to contribute blog posts and remain a visible advocate for kids in the community.

Measles in Children

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The rise in measles cases recently has many people, parents included, very concerned, and with good reason. Measles is a viral illness that can be very dangerous especially for infants, children under age 5 years, pregnant women, and those with immune system problems. As of 2/26/25, there have been 165 cases in 10 states, including Washington, and sadly one child has died. Although the number of infected people does not sound very high, measles is one of the most infectious viruses known, so numbers are likely to grow. Measles infects 90% of those exposed if they are not vaccinated.

Measles starts with a fever (as high as 104), runny nose, cough, and red watery eyes. These symptoms usually start 7-14 days after exposure though it can take as long as 21 days to show signs. Two- three days later, small white spots inside the cheeks (Koplik spots) may show up. The typical measles rash starts on the face at the hairline about 3-5 days after symptoms begin. This rash consists of red, usually flat, spots that spread head to toe and may join together. Fever may spike to 104 when the rash appears. Diarrhea can also occur.

Complications are common with measles, especially in infants, children under age 5 years, pregnant women, adults over age 20 and those who have immune system deficits. Ear infections occur in 1 out of 10 kids with measles and pneumonia happens in 5% of all people infected. Brain inflammation (encephalitis) afflicts 1 out of 1,000 infected children and can cause brain damage, deafness, seizures, and death.  Nearly 3 in 1,000 kids with measles die, most commonly due to pneumonia or encephalitis. Pregnant women are at increased risk of delivering early and having a low-birth-weight baby.

There is a very rare complication that can occur 7-10 years after measles infection called Subacute Sclerosing Panencephalitis (SSPE). It is a brain disorder related to the earlier measles for which there is no treatment and results in death within 3 years of diagnosis without exception.

The good news is that the measles vaccine (either as MMR [measles, mumps, and rubella vaccines] or MMRV (as above plus varicella [chickenpox] vaccine) is safe and effective. For kids it is a 2-dose series, given at ages 12-15 months and 4-6 years; adults who are unvaccinated may only need one dose. One dose of a measles vaccine is 93% effective at preventing infection, and 2 doses gives 97% protection. Common side effects include muscle soreness at the injection site, low grade fever, and a mild rash. Rarely there can be a brief harmless seizure due to fever, occurring in less than 8 kids per 10,000 vaccinated.

The Health and Human Services Secretary Robert F. Kennedy, Jr, issued a statement on March 3, 2025, with the subheading “MMR vaccine is crucial to avoiding potentially deadly disease” and then noted “Vaccines not only protect individual children from measles, but also contribute to community immunity, protecting those who are unable to be vaccinated due to medical reasons.”

Earlier concerns about MMR vaccine and autism have been strongly disproved in multiple studies. The doctor who made those claims was found to have fabricated his ‘results’ and lost his medical license. Autism is often diagnosed at around the same age as when kids receive MMR vaccine, but the vaccine does not cause autism.

During a local measles outbreak, students who are unvaccinated are excluded from school for 21 days from the last measles rash identified in the community. If they are given the first dose of the MMR or MMRV series, they may return to school. If an unvaccinated child is exposed to measles, they should be immunized as soon as possible to decrease the risk of infection.

If you have questions about measles vaccination, contact your child’s health care provider. Measles is a very dangerous virus that is unfortunately also extremely contagious. Our best way of protecting our kids and our community is vaccination.

more about The contributor

Dr. Elise Herman

Blog Posts
Profile

Dr. Herman is passionate about community health outreach, school programs, and child/family health and wellness. She has more than 31 years of experience as a pediatrician in Ellensburg, Washington, the last 3 with KVH Pediatrics. In 2022 Dr. Herman mostly retired from practice and continues to contribute blog posts and remain a visible advocate for kids in the community.

Bad Breath in Children

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As a parent, you may occasionally wonder how your sweet child can have such bad breath, but bad breath in kids happens!

As opposed to just ‘morning breath’, chronic bad breath (“halitosis”) can have a variety of causes and occasionally can indicate a true medical problem. The most common reasons for halitosis in children include:

  • Poor dental habits: Without routine brushing and flossing, bacteria on the teeth increase, which can cause a filmy layer called plaque. Plaque can lead to cavities and gum inflammation, both of which can cause bad breath.
  • Dry mouth: This can result from not drinking enough water, sucking of thumbs or fingers, chronic nasal congestion, or chronic mouth breathing.  A dry mouth means saliva is not adequate to wash bacteria and food particles away.
  • Infection or disease: Viral or bacterial throat, tonsil, or sinus infections can cause bad breath. The bad breath should improve once the infection resolves. If your child has fruity breath, this is quite unusual and could indicate a serious problem like diabetes, though other signs like excessive thirst and urination would typically be present as well.
  • Allergies: Chronic nasal congestion or postnasal drip due to allergies can create bad breath.
  • Foreign body: If a bead, piece of tissue, or some other small foreign body is stuck up in the nose, a foul odor and nasal discharge from one side of the nose may develop.
  • Large, pitted (having an irregular surface) tonsils: Although shallow pits are normal, they can trap bacteria, nasal secretions, and bits of food, which can become calcified, resulting in a tonsil ‘stone’ or tonsillith. This looks like a small whitish lump and can have a bad odor. It is not, however, pus and does not indicate a throat infection.
  • Certain foods: Eating foods with strong odors like garlic, onions, etc. can cause bad breath, but it is usually temporary.

There are multiple things to try if your child is having bad breath. Brushing teeth well (begin when teeth are touching) at least twice a day, flossing, and brushing the tongue is important. Make sure your child is drinking plenty of water throughout the day. Older kids can chew sugar-free gum with Xylitol which increases saliva, decreases bacteria, and lowers plaque buildup which can keep the mouth healthier overall.

If you observe chronic nasal congestion or mouth breathing, talk with your child’s health care provider.  If tonsil stones are noted, recall that these are harmless and usually go away on their own. Older kids can try gargling with salt water which may loosen the stone. If your child’s breath has a fruity odor especially if there are signs of diabetes, call your child’s provider right away.

Remember that in most cases bad breath is not serious and can be easily remedied. If your child’s breath is not improved by the above measures, a visit with your child’s healthcare provider and/ or dentist may be in order.

more about The contributor

Dr. Elise Herman

Blog Posts
Profile

Dr. Herman is passionate about community health outreach, school programs, and child/family health and wellness. She has more than 31 years of experience as a pediatrician in Ellensburg, Washington, the last 3 with KVH Pediatrics. In 2022 Dr. Herman mostly retired from practice and continues to contribute blog posts and remain a visible advocate for kids in the community.