Canker sores in children treatment tips and when to see a doctor

Mouth ulcers (canker sores) in children are a common and bothersome problem, especially for young kids who may experience pain while eating or talking. Although they are usually mild and not dangerous, many parents get worried when they see their child in discomfort or notice sores in the mouth.

In this Dalili Medical article, we will cover:

The causes of canker sores in children.
The symptoms that indicate their presence.
Their types and stages.
Treatment options using medications, herbal remedies, and prevention methods.

This topic is very important for every parent who wants to maintain their child’s oral health and relieve their pain quickly and effectively. We will also learn how to distinguish between ordinary mouth sores and canker sores, and when it’s necessary to visit the doctor.

1. What Are Canker Sores?

Canker sores are small ulcers that appear inside the mouth—on the tongue, inner lips, or inner cheeks.
They are usually white or gray with a red border and can cause mild to moderate pain for the child.

2. What Causes Canker Sores in Children?

Deficiency in certain vitamins like B12, iron, or folic acid.
Stress or psychological pressure.
Minor injuries inside the mouth, like biting the cheek or friction from a toothbrush.
Sometimes genetic factors or immune system issues.

3. Are Canker Sores Contagious?

No, canker sores are not contagious and do not spread between children or family members through play or food.

4. How Long Do They Usually Last?

Small sores usually heal within 7–10 days.
Larger sores may take two weeks or more, depending on size and inflammation severity.

5. Do They Always Require Medication?

Not always. Most cases improve with good oral care and simple pain relievers.
However, if pain is severe or sores are recurrent, a doctor may prescribe:

A topical anesthetic gel to reduce pain.
An antibacterial mouthwash.
Vitamin supplements to address deficiencies.

6. Can Herbs Help Heal Canker Sores?

Yes, some herbs are safe for children, such as:

Chamomile
Aloe Vera
Sage
They reduce inflammation and promote healing, but should be used under parental supervision, considering the child’s age and any allergies.

7. When Should You See a Doctor?

If the sore lasts more than two weeks.
If it is very large or extremely painful.
If it appears with other symptoms like fever or severe fatigue.
If sores are recurrent, it may indicate immune deficiencies or vitamin shortages.

8. Do Canker Sores Cause Fever?

Most of the time, no. Canker sores are not associated with fever.
However, if fever or severe fatigue occurs, a doctor’s visit is necessary to rule out other infections.

9. Can Multiple Sores Appear at the Same Time?

Yes, some children may have several small sores in the mouth simultaneously, especially with herpetiform ulcers.

10. Do They Affect Speech or Pronunciation?

Initially, they may slightly affect pronunciation of some sounds, but children usually adapt quickly.

11. Can Canker Sores Recur?

Yes, canker sores can recur, especially if the child has vitamin deficiencies, stress, or minor injuries in the mouth.

12. Difference Between Ordinary Sores and Canker Sores

Canker sores are small, white or gray, with a red border.
Ordinary sores may result from infection or injury and are usually larger or more painful.

13. Does Diet Affect Canker Sores?

Yes, deficiencies in iron, zinc, or vitamin B12 can make children more prone to sores.
Spicy or acidic foods may irritate the sores and increase pain.

14. Does Toothbrushing Affect the Sore?

Children can brush their teeth with a soft toothbrush without applying strong pressure.
Good oral care does not increase pain; it actually helps sores heal faster.

Stages of Canker Sores in Children

Stage 1: Warning Stage (Before the Sore Appears)

The child may feel a mild burning or tingling in a specific area inside the mouth, often on the tongue, inner lips, or cheek.
After about a day, the area becomes slightly red and swollen—an early sign of an emerging sore.

Stage 2: Ulcer Stage (Sore Appears)

The sore becomes visible, circular or oval, white or gray in color with a red border.
Pain is noticeable, especially when eating, talking, or touching the sore.
This stage is the most uncomfortable and usually lasts 3–7 days for small sores.

Stage 3: Healing Stage

Pain gradually decreases.
The sore’s color changes from white to light pink.
Skin regenerates, and the area returns to normal.
Small sores typically disappear within 7–10 days; large ones may take up to 3 weeks.

Stage 4: Post-Healing (Prevention)

After healing, some large sores may leave a slight mark.
It is very important to:

Maintain good oral hygiene.
Avoid spicy or acidic foods to reduce recurrence.

Common Causes of Canker Sores in Children

Vitamin and Mineral Deficiencies

Deficiency in B12, iron, or folic acid weakens the oral lining and increases the likelihood of sores.

Stress or Fatigue

Psychological stress or sleep problems can trigger mouth ulcers.

Accidental Bites or Trauma

Biting the cheek or tongue while eating or chewing quickly can cause small injuries that turn into painful sores.

Food Sensitivities

Certain foods like chocolate, tomatoes, strawberries, or spicy meals may irritate the oral lining.

Weak Immunity

Children with weak immunity, due to frequent colds or poor nutrition, are more prone to developing sores.

Injuries During Toothbrushing

Using a hard brush or brushing too aggressively can cause minor scratches that develop into ulcers.

Genetic Factors

Sometimes there is a hereditary predisposition—if a parent frequently had canker sores, the child may also be affected.

Hormonal Changes or Mild Viral Infections

Some mild viruses that cause fever or colds can make the mouth more sensitive and trigger small sores.

Symptoms of Canker Sores in Children

Canker sores appear as small painful spots or ulcers inside the child’s mouth, white or gray in color with a red border. Key signs include:

Pain or Burning Sensation in the Mouth
The child may complain of pain, especially while eating, speaking, or drinking juice.
Visible Small Spots
The sores are usually circular or oval, white or yellowish in the center, with a red halo.
Common locations: inner lips, tongue, or gums.
Difficulty Eating or Swallowing
The child may avoid solid foods and prefer soft foods due to pain while chewing or swallowing.
Excess Saliva or Mild Mouth Odor
Inflammation may increase saliva production or cause a mild unpleasant odor.
Irritability or Unexplained Crying
Persistent pain can make the child anxious, refusing to eat or speak, especially if there are multiple sores.
Mild Swelling in Neck or Jaw Lymph Nodes
In severe cases, lymph nodes may swell slightly as a natural immune response.

Types of Canker Sores in Children

Minor Aphthous Ulcers

Most common type in children.
Size: Small (2–5 mm), superficial, leaves no scars.
Healing time: 7–10 days.
Common sites: inner lips, tongue, inner cheeks.

Major Aphthous Ulcers

Size: Larger than 1 cm, deeper, and very painful.
Healing time: Up to 3 weeks or more; may leave a slight mark.

Herpetiform Ulcers

Very small multiple ulcers (~1 mm) that cluster to form a larger painful area.
Common sites: tongue or floor of the mouth.
Rare in children but may occur in severe cases or with weakened immunity.
Requires special care and medical follow-up.

Diagnosis of Canker Sores in Children

Diagnosis is relatively easy due to the distinctive appearance of canker sores. A doctor typically follows these steps:

Oral Examination

Thorough inspection of inner lips, tongue, cheeks, and palate.
Focus on the sore’s shape, color, and number.
Typical canker sores: small, white or gray, with red borders.

Parent Interview

Ask about pain or burning before the sore appeared.
Ask about difficulties with eating or speaking.
Determine if this is a first occurrence or recurrent.

Excluding Other Causes

Sometimes mouth sores are caused by:
- Viral infections (e.g., herpes)
- Vitamin deficiencies (iron or B12)
- Injuries from toothbrushes or hard foods
For unusual or recurrent sores, the doctor may request simple tests.

Tests and Lab Work

Blood tests to check vitamin or mineral deficiencies.
Iron and zinc levels.
In rare cases, a swab may be taken to rule out bacterial or viral infections.

Risks of Canker Sores in Children

Canker sores are usually mild and resolve on their own within a few days. However, persistent or recurrent sores may lead to:

Difficulty Eating or Drinking
Pain can make the child avoid certain foods, especially hot or acidic ones, which may affect nutrition or weight.
Dehydration
If the child avoids drinking due to pain, dehydration may occur. Signs: fatigue, dry tongue, dark urine.
Secondary Infections
Touching or biting the sore can introduce bacteria, leading to infection or pus formation.
Chronic Pain or Psychological Stress
Frequent sores can cause discomfort, anxiety, or avoidance of eating and speaking.
Underlying Health Issues
Recurrent sores may indicate:
- Immune deficiencies
- Gastrointestinal conditions such as Crohn’s disease or celiac disease

Medical Treatment for Canker Sores in Children

Topical Gels or Ointments

Examples: Oral Gel, Kamistad Gel
Contain mild anesthetics to relieve pain.
Usage: small amount after meals and before bedtime, applied with clean fingers or a cotton swab.

Antiseptic or Antibacterial Mouthwash

Example: Chlorhexidine Mouthwash
Prevents infection and promotes faster healing.
For younger children, can be applied with a cotton swab instead of rinsing.

Pain Relievers for Children

Examples: Paracetamol, Ibuprofen (dose according to age and weight)
Reduce pain and inflammation, especially during meals or sleep.

Vitamins and Supplements

To compensate for deficiencies in B12, folic acid, or iron.
Help prevent recurrence of sores.

Severe or Recurrent Cases

Mild topical corticosteroids to reduce inflammation.
Only under strict medical supervision.

Surgical Treatment (if necessary)

Minor Aphthous Ulcers: Usually no surgery required; heal in 7–10 days with simple medication or natural remedies.
Major or Recurrent Ulcers: If very large, extremely painful, or bleeding, minor surgical procedures under local anesthesia may be performed to remove damaged tissue and speed healing.
Herpetiform Ulcers: Rare, but if persistent, may require laser therapy or minor removal techniques to reduce pain and recurrence.

⚠️ Important Notes:

Surgery is a last resort for very severe cases.
Most children recover with topical medication, pain relief, and nutritional supplements without surgery.
Any procedure must be performed by a pediatric dentist or oral specialist.

Herbal Treatment for Canker Sores in Children

Herbs can relieve pain and promote natural healing, but should be used carefully based on the child’s age:

Minor Aphthous Ulcers

Chamomile Rinse: Boil chamomile flowers, let cool, and rinse the mouth twice daily.
Honey: Apply directly to the sore 2–3 times daily; has antiseptic properties and accelerates healing.

Major Aphthous Ulcers

Aloe Vera Rinse: Apply natural aloe gel on the sore with a clean swab.
Sage Tea: Rinse twice daily to clean the mouth and reduce inflammation.

Herpetiform Ulcers

Parsley Rinse: Boil parsley, let cool, and rinse twice daily; contains natural antioxidants that reduce inflammation.
Chamomile + Honey: Gentle mixture for soothing and antiseptic effect, reduces pain and promotes healing.

⚠️ Herbal Tips:

Herbs must be 100% natural and clean.
Children under 2 should not use herbs without consulting a doctor.
Stop using immediately if the child shows any allergic reaction.
Herbs are supportive and can be used alongside medical treatment if advised by a doctor.

Tips for Managing Canker Sores in Children

Proper care can reduce pain and speed up healing. Follow these tips:

Maintain Oral Hygiene

Brush teeth daily with a soft toothbrush and mild, alcohol-free toothpaste.
This prevents bacteria from entering the sores and promotes faster healing.

Avoid Irritating Foods

Spicy, acidic foods (like oranges or lemons), fried foods, and salty snacks can increase pain.
Prefer soft, easy-to-swallow foods: yogurt, soup, mashed potatoes.

Encourage Fluid Intake

Water and cold or natural juices help keep the mouth moist and soothe pain.

Cold Compresses or Small Ice Pieces

Sucking on ice chips or drinking cold beverages can reduce inflammation and discomfort.

Use Child-Safe Oral Gels or Mouthwash

Products containing soothing and antiseptic ingredients like benzocaine or chlorhexidine.
Use only as recommended by a doctor.

Reduce the Child’s Stress

Psychological stress can trigger recurring sores.
Ensure the child rests well, sleeps enough, and stays relaxed.

Visit the Doctor When Needed

If the sore lasts more than two weeks, increases in size, or prevents the child from eating.
The doctor can determine the cause and prescribe the appropriate treatment quickly.