bad breath

Unpleasant odor to the breath, technically halitosis, is a complaint we sometimes see in children. Contrary to popular belief, gastrointestinal disorders do not usually cause halitosis, so breath odor does not reflect the state of digestive system or bowel function (that is, don't blame it on constipation).

The most common normal (physiologic) cause is so-called morning breath, which everybody has to some degree. Regular salivary flow stops with sleep. This allows mouth germs an opportunity to feed on remaining food particles, old shed mouth lining cells, and stagnant saliva. The byproducts of bacterial metabolism produce the foul odor.

The most common cause of bad breath in a young child in the "stick things in the nose" age range is a nasal foreign body - like a piece of foam rubber, or corn, or a bean - whatever.

If it isn't that situation, persistent bad breath may be caused by a number of factors in children both relating to organic disease and poor oral hygeine:

  • gum disease - not seen in kids very often
  • dental disease - chiefly neglected cavities
  • food fermentation in mouth - let's be sure to floss, kids 8-)
  • systemic diseases
    • sinusitis
    • tonsillitis - especially streptococcal infections, which produce a peculiar smell
    • pneumonia - bad breath would not jump into my mind as a major symptom
    • diabetic acidosis - not exactly bad breath, but a peculiar fruity smell (like acetone nail-polish remover) immediate medical attention required
    • bronchiectasis and lung abscess - incredibly foul smelling
    • helicobacter pylorii infection (the ulcer-causing bacterium) has been suspected of causing bad breath in children but this is not well documented
  • esophageal reflux - which could additionally lead to the lung problems of bronchiectasis and lung abscess listed above
  • no cause determined - unfortunately, a likely finding in an investigation into the cause of a child's bad breath. We often cannot identify any specific cause.


  • Mouthwashes are a poor substitute for good oral hygiene.
  • Oral hygiene is particularly important for any child with bad breath. Floss and brush regularly, which helps remove trapped food particles and promote healthy gums.
  • Regular dental checkups are essential.
  • A thorough medical exam for other oral or especially sinus disease if the teeth and gums are in good shape and clean.

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