Causes

• Canker Sores. The main cause of 1 or 2 mouth ulcers after age 5.
• Hand-Foot-Mouth Disease. The most common cause of multiple ulcers in the mouth. These ulcers are mainly on the tongue and sides of the mouth. Due to the Coxsackie virus. It is common between ages 1 to 5 years.
• Herpes Virus (Cold sore virus). The first infection can be severe. It can cause 10 or more ulcers on the gums, tongue and lips. Key findings are additional ulcers on the outer lips or skin around the mouth. Also, fever and difficulty swallowing. Usually occurs age 1 to 3.

Return to School

• Canker sores cannot be spread to others. Children with fever need to be checked before going back to school. Also, children with many mouth ulcers should be checked before returning.

1. Canker sores are the #1 cause of mouth ulcers:
   • 1 to 3 painful, white ulcers of the inner cheeks, inner lip or gums (no fever).
   • Causes include injuries from rough food, tooth brushes, biting, or food irritants.
   • Here is some care advice that should help.
2. Liquid Antacid for Mouth Pain:
   • For mouth pain, use a liquid antacid such as Mylanta or the store brand. Give 4 times per day as needed. After meals often is a good time. Age: For children over 1 year old.
   • For children over age 6, can use 1 teaspoon (5 ml) as a mouth wash. Keep it on the ulcers as long as possible. Then can spit it out or swallow it.
   • For younger children age 1 to 6, put a few drops in the mouth. Can also put it on with a cotton swab.
   • Caution: Do not use regular mouth washes, because they sting.
3. Pain Medicine:
   • To help with the pain, give acetaminophen (such as Tylenol) or ibuprofen. Use as needed. See Dose Table.
4. Fluids and Soft Diet :  
   • Try to get your child to drink adequate fluids.
   • Goal: keep your child well hydrated.
   • Cold drinks, milk shakes, popsicles, slushes, and sherbet are good choices.
   • Solids. Offer a soft diet. Also avoid foods that need much chewing. Avoid citrus, salty, or spicy foods. Note: Fluid intake is more important than eating any solids.
   • For infants, you may need to stop the bottle. Give fluids by cup, spoon or syringe instead. Reason: The nipple can increase the pain.
5. Return to School:
   • Canker sores cannot be spread to others.
   • Children with fever need to be checked before going back to school.
   • Also, children with many mouth ulcers should be checked before going back.
6. What to Expect:
   • They heal up in 1 to 2 weeks on their own.
   • Once they occur, no treatment can shorten the illness.
   • Treatment can help with the pain.
7. Call Your Doctor If:
   • Mouth ulcers last more than 2 weeks
   • Your child becomes worse