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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.

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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.

Kids & Allergies

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Contributor Dr. Elise Herman

Spring is here, the weather is improving and it’s great for kids to be outside, unless your child is itchy, congested, and miserable due to allergies. Seasonal allergies are rare under age 2 years but very common after that, affecting up to 40% of children. If your child struggles with allergies, there are strategies and treatments that can have them happily outside and relatively symptom-free this spring and summer.
Allergies are the immune system’s response to things such as pollens, grasses, dust, cat dander, and more. The immune system makes antibodies called Immunoglobulin E which then cause the release of histamines, chemicals in the body which cause allergy symptoms.

The typical culprits for seasonal allergies are flower and tree pollens (like cottonweed) which cause symptoms from spring through early summer. Grass pollen starts to cause problems in the spring and lasts the entire summer. Ragweed and mold spores (often found in hay) are typically problematic in late summer to fall.
Itchiness is the ‘hallmark’ of allergy and can involve the nose, eyes, and skin. Runny or stuffy nose, sneezing, throat clearing, and itchy pink, watery eyes are common. Children do not develop a fever with allergies. Kids can get raised pink itchy bumps called hives if their skin is exposed to something they are allergic to, like grass. Allergies can make asthma worse, causing wheezing, cough, and shortness of breath.

Allergies are often diagnosed by simply recognizing the symptoms and when they occur. Classic symptoms, which occur in spring and summer and worsen with outdoor exposure, do not need testing to make the diagnosis. Testing is indicated if allergy symptoms do not improve with typical treatments or if symptoms are severe or confusing. Skin testing is usually done in an allergist’s office with results in about 15 minutes. Allergy meds need to be stopped for at least 5 days before skin testing. Blood testing, which is best for kids who cannot stop their allergy meds or who have a skin condition like severe eczema which would make skin testing difficult, looks at the amount of Immunoglobulin E for certain allergens.

So how to help your itchy, allergic kiddo?

  • Rinsing off from head to toe and changing clothes helps, both when they are having lots of allergy symptoms and routinely before bed.
  • They should also wash their hands and face when they come in from playing outside to remove pollens.
  • Cool moist compresses to those itchy eyes provide relief, too.

There are multiple long-acting over-the-counter antihistamines which are safe and effective. Cetirizine (Zyrtec) is for kids 6 months and older, and Loratadine (Claritin) and Fexofenadine (Allegra) are approved for those 2 years and up. Loratadine and Fexofenadine are non-sedating; Cetirizine may cause mild sedation in a small percentage of people. Benadryl is not ideal since it only lasts 6 hours and typically is sedating.

If an oral medication is not adequate treatment, there are other options including nasal sprays such as Flonase and Astelin, and eye drops such as Zaditor and Pataday. Young kids may resist these at first but become more accepting as they get older. If allergies are severe, allergy immunotherapy (injections) may be recommended by the allergist. For kids 5 and above with severe grass or ragweed allergies, the allergist might prescribe immunotherapy pills that are placed under the tongue daily.

Every kid deserves to be able to get outside this spring and summer! Discuss your child’s allergies with their health care provider for more information.

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.