Stomatitis

What is it?

Stomatitis means inflammation (soreness) of the mouth. It has many different causes, and can appear in several different ways. The most common kinds of stomatitis are caused by viruses, and some have no known cause (though doctors think they are also caused by viruses). Some children with stomatitis develop large sores in their mouths or on their lips. Other children have smaller sores, and some have sores in the back of the throat or on the gums. Stomatitis itself is not contagious (catching), but the viruses that cause it usually are. Stomatitis usually lasts for 3 to 5 days. Most children get stomatitis only once, but some children get a form that breaks out again repeatedly throughout life. This is called "recurrent stomatitis." The good news is that usually the first episode is the worst one. Later episodes are often only small cold sores.

Pain and hydration are the two biggest concerns for children with stomatitis. Pain can begin even before the sores break out. Often this explains a young child who has been fussy or had a fever for a day or two without any obvious cause. Once the sores are present, babies and children often have very severe mouth pain and often have pain when they swallow. This can make them avoid eating or drinking, which can lead to dehydration. On rare occasions babies or younger children need to be hospitalized to control their pain or give them fluids.

Most of the treatment for stomatitis is about keeping your child hydrated and comfortable. Except for a few kinds of stomatitis, there is no medicine available that will make it go away faster. Pain medicine usually helps make the child comfortable enough to be able to drink and eat. Your doctor may suggest that you use over-the-counter medications like Tylenol® or ibuprofen. Many doctors also prescribe a more powerful medication like codeine or a related medicine. These drugs are very safe and work well to control pain. They can cause some constipation, though. Give the medicine as prescribed on a round the clock schedule. That way you will control your child’s pain continuously.

Give lots of liquids to your child with stomatitis. Avoid sour or acid liquids like citrus juices, and avoid high-sugar liquids. Milk, ice cream, milkshakes, pudding, or soft baby foods are all good ways to get both liquid and nourishment to your child. Older children may find that using a straw to drink helps get the liquid past the sore spots in their mouth. Your doctor may also recommend using a pain relieving gel or mixture to apply in your child’s mouth. These medications work especially well if you give them five to ten minutes before you feed your child. Use only the small amount of medicine that is directed, and make sure you spread it around in your child’s mouth as much as you can. These medicines only work directly in the mouth. If they are swallowed they do not help. Some of these medications, such as xylocaine, can be dangerous if your child swallows too much.

For stomatitis that is caused by some viruses, your doctor may prescribe a medication such as acyclovir or famciclovir. These medicines work best if you give them as early as possible in the illness. For children with recurrent stomatitis, parents often learn the early signs of the illness and can give the medicine right away. If your child develops certain kinds of recurrent stomatitis, your doctor may prescribe a mild steroid rinse to use every day to prevent the episodes.

Dehydration is the biggest worry with stomatitis. It is usually caused when the child has so much pain that s/he can’t drink enough fluids. Signs of dehydration include:

• Sunken appearance of the eyes
• Dry tongue and mouth (dry lips are common and are not a sign of dehydration)
• A sunken fontanel (soft spot) in an infant
• Less than normal urination, or dark or strong-smelling urine
• Being too sleepy (lethargic) or being very irritable or fussy
• Cold, pale hands and feet even if the room is warm

If any of these occur, please be sure to call your doctor’s office right away. If your child or infant is difficult to awaken or seems unconscious, go directly to the emergency room.

Stomatitis is usually almost all better after 3-5 days. If your child continues to have new sores after that much time, be sure to talk with your doctor.

Stomatitis causes bad breath. The bad breath will go away when the illness gets better – do not try to get rid of it by brushing or using mouthwashes! Most children with stomatitis find it very painful to brush their teeth, especially if they have sores on their gums. For the few days that the illness lasts, it is fine to skip tooth brushing and flossing. Your child may be able to use a mild mouth rinse with some anesthetic in it such as Cepacol®. Regular mouthwashes are very painful to use during stomatitis.

Some of the viruses can spread by contact to other parts of your child’s body. This makes it very important to keep the child’s hands clean, and to keep the hands away from the eyes. If your child’s eyes become red or painful please see your doctor immediately – an eye infection with these viruses can be very dangerous. Some doctors also recommend washing hands before using the toilet, to decrease the risk of spreading the virus to the genitals. For the same reason, if your child is currently toilet training, you might want to interrupt that process and pick it up again after the infection in the mouth clears completely.

Because the viruses that cause stomatitis are contagious, your child should not go to school or daycare while the sores are present. Most children have too much pain to go to school anyway. Your doctor will tell you when it is safe to send your child back to school.

Stomatitis is usually a mild illness caused by one of the many viruses that also cause colds and fevers. Rarely, stomatitis or gingivitis (swollen, red gums) can be an early sign of serious illnesses like leukemia. Also rarely, children whose immune system is not working well may develop stomatitis. Children with any of these conditions are more likely to have very high fevers and to appear generally sick. Their stomatitis does not get better as quickly as it does in most cases. Simple blood tests will usually reassure both the parent and the doctor when these things are of concern.

A much less serious condition called "hand-foot-and-mouth disease" often occurs with stomatitis in summer months. Children with this disease have tiny sores in the back of their throat, and then develop small, round, red spots or bumps on their palms and soles. Children with this condition often have very high fevers (over 103°F/39.4°C). You can read our Aftercare Instructions on Hand, Foot, and Mouth Disease.

Having a sick child at home can be tiring and frustrating. As badly as you feel for your child, you yourself may feel out of control, inadequate, or even angry – these are normal feelings. Babies and children who are sick are often fussy and irritable, and parents often feel stressed to the breaking point, especially when there are other children or adults to take care of. One of the best things you can do for your child is to be sure you take care of yourself. If possible, try to have other adults take care of your child for an hour or two each day so you can get some rest or just some quiet time. If you get so stressed that you are worried about your baby’s safety, call your local Parents’ Anonymous Hotline or visit the Parents Anonymous website to find a group near you.