What is the treatment for bad breath, mouth sores, and a rash on the groin in kids?

From the Guidelines

The treatment for bad breath, mouth sores, and a groin rash in children should prioritize addressing potential underlying fungal infections, such as thrush, with antifungal medications, alongside good hygiene practices and symptom management. For bad breath, regular brushing twice daily with fluoride toothpaste, flossing, and tongue cleaning is essential, as suggested by general dental hygiene practices, although not directly mentioned in 1 or 1. A child-appropriate mouthwash may help for children over 6 years old. For mouth sores, treatments include topical anaesthetic preparations like viscous lidocaine 2% 1, or avoiding spicy and acidic foods. Antiseptic oral rinses, such as 1.5% hydrogen peroxide mouthwash or 0.2% chlorhexidine digluconate mouthwash, can be used twice daily to reduce bacterial colonization 1. If a fungal infection like thrush is suspected, nystatin oral suspension 100,000 units four times daily for 1 week, or miconazole oral gel, can be used 1. For groin rashes, keeping the area clean and dry, and applying an antifungal cream like clotrimazole 1% (apply thinly twice daily for 7-10 days) if it's a fungal infection, are recommended approaches.

Given the potential for these symptoms to indicate an underlying condition such as invasive candidiasis, especially if severe or persistent, treatment guidelines from 1 suggest the use of antifungal medications like fluconazole 8–12 mg/kg/day, or other options such as liposomal amphotericin B, depending on the severity and the patient's condition. It's crucial to consult a pediatrician for proper diagnosis and treatment, especially if symptoms persist, worsen, or are accompanied by fever or significant discomfort. The choice of antifungal should be guided by the most recent and highest quality evidence, with consideration of the specific clinical context and potential side effects, as outlined in guidelines like those found in 1.

From the FDA Drug Label

INDICATIONS AND USAGE Nystatin Oral Suspension, USP, is indicated for the treatment of candidiasis in the oral cavity. DOSAGE AND ADMINISTRATION Infants: 2 mL (200,000 units) four times daily (in infants and young children, use dropper to place one-half of dose in each side of mouth and avoid feeding for 5 to 10 minutes). The treatment for bad breath and mouth sores in kids, which could be symptoms of candidiasis, is nystatin oral suspension. For a rash on the groin, the provided information does not directly address this symptom.

• The dosage for infants is 2 mL (200,000 units) four times daily.
• The dosage for children and adults is 4 to 6 mL (400,000 to 600,000 units) four times daily. Treatment should continue for at least 48 hours after perioral symptoms have disappeared 2 2.

From the Research

Treatment for Bad Breath, Mouth Sores, and Rash in Kids

• The treatment for bad breath, mouth sores, and a rash in kids depends on the underlying cause of the symptoms.
• For bad breath (halitosis), treatment is directed towards the identified source, along with instructions on good oral hygiene regime 3.
• Mouth sores (stomatitis) can be caused by viral or bacterial infections, and treatment may include symptomatic relief with lidocaine gel and paracetamol, as well as reassurance of parents 4.
• A rash on the groin can be caused by various conditions, including tinea infection, which is a common fungal skin infection in children that affects the scalp, body, groin, feet, hands, or nails 5.
• Perioral dermatitis is a unique skin disorder of childhood that can cause a rash around the mouth, and treatment consists of discontinuing topical fluorinated corticosteroid use and using topical metronidazole alone or in combination with oral antibiotics 6.
• It is essential to consider the entire clinical presentation, including the appearance and location of the rash, associated symptoms, and laboratory tests to make an accurate diagnosis and provide appropriate treatment 5, 4.

Possible Causes and Treatments

• Possible causes of bad breath in kids include poor oral hygiene, gingivitis, periodontal diseases, dental caries, tongue coating, and mouth breathing 3.
• Possible causes of mouth sores in kids include viral infections such as herpes simplex virus, Coxsackie virus, chickenpox, and infectious mononucleosis, as well as bacterial infections and oral candidiasis (thrush) 4.
• Possible causes of a rash on the groin in kids include tinea infection, impetigo, and other skin conditions 5.

Importance of Accurate Diagnosis

• Accurate diagnosis is crucial to provide effective treatment and prevent complications such as dehydration and hospitalization 4.
• A complete history and thorough physical examination are usually sufficient to make a diagnosis, and further investigations are seldom necessary 4.