Oral Ulcers in Children: Part-I


Acute multiple oral ulcers

Ulcers in oral cavity are always a difficult situation for everyone. Besides functional disturbances it causes, there is lot of emotional disturbances associated with it especially the fear of oral cancer.

If this happens with adult, just imagine what goes in head of parents whose child has an oral ulcer. But then, not every oral ulcer has to be feared of. Most of the oral ulcers are either self-healing or they heal when the causative agent is removed/ treated.

One has to be bit careful if ulcers don’t heal for more than 15 days even after the treatment but then need not worry as there are ways of managing them differently.

Today let’s talk about acute multiple oral ulcers in children, most commonly these are viral ulcers:


What are the symptoms that occur?

  • Common in children, teenagers and young adults.
  • Usually preceded by 2-3 days prodrome of fever, muscle pain, feeling of being unwell, tiredness and decreased desire to eat.
  • Redness and group of fluid filled blisters commonly appear in gums, tongue and palate and less common in inner surface of lips and cheeks. Blisters may also be present at corner of mouth and lips which ruptures to form ulcers and crusts.
  • Blisters inside mouth turn into small ulcers (multiple in number) with marked surrounding redness.
  • Usually in small children the gums turn fiery red and may even bleed sometime with coarse food.
  • This is extremely painful and causes difficulty in speaking, eating and swallowing.
  • Sometimes with these symptoms, rashes may develop in palms of hand and soles of feet.
  • Also these may be associated with pain, inflammation (redness) and ulcerations of throat.
  • These may be recurrent (appear again and again at different time intervals)

What to do?

  • Do not worry, stay calm and composed.
  • Most of the time these ulcers are self-limiting and heal within 10-14 days (it goes off within certain time duration).
  • These ulcers usually just require symptomatic management:
  • Treatment of fever with adequate dose of paracetamol (but avoid Aspirin and related products).
  • Application of topical anesthetic gels like lignocaine 2% or benzocaine 20% over the ulcer (avoid topical steroids).
  • Avoid topical gels with acidic component like salicylic acid as they cause increased burning sensation.
  • Soft bland (non –spicy diet) is preferred, avoid hot and spicy food.
  • Adequate hydration (enough of water) is to be maintained.
  • Avoid touching those areas of ulcers and avoid direct contact with other siblings of child as these can spread from one to other.

When to start anti-viral drugs?

  • Anti-viral drugs (oral or topical) are usually not required.
  • However if severe (multiple ulcers all over the oral cavity, associated severe pain and severely compromised oral function like inability to eat, speak or breathe) may need anti-viral therapy but only if diagnosed within 72 hours of appearance of signs and symptoms.
  • If recurrent (appearing again and again after some time interval) then prophylactic anti-viral therapy is also practiced these days after the onset of prodromal symptoms.

It is natural for parents to get worried when their most dear ones suffer, that too from an oral ulcer which definitely has lots of myths associated with. Most of the oral ulcers in children can be taken care of with home remedies if identified early.

If not, it can easily be treated by oral health professionals with simple measures.Taking over the counter medications like antibiotics (usually prescribed) from local pharmacy will not at all work but just lay a path to antibiotic resistance.“Little knowledge is always dangerous”, being alert is good but being over conscious may sometimes do more harm.

abhinaya dai
Dr Abhinaya Luitel
Government Consultant at
BPKIHS, Dharan


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