What is a suitable topical analgesia for gingivostomatitis in a 19-month-old child?

From the Guidelines

For gingivostomatitis in a 19-month-old child, 2% viscous lidocaine applied sparingly to painful areas of the mouth is a suitable topical analgesia. The recommended dose is 0.15 mL/kg (not to exceed 1.25 mL) applied with a cotton swab or clean finger to affected areas up to 4 times daily. Parents should be instructed to apply only a small amount to avoid excessive absorption or numbing that could interfere with swallowing. Although there is limited direct evidence from the provided studies for the use of topical anesthetics in gingivostomatitis, the principle of using topical anesthetics for pain relief, as discussed in the context of minor procedures in neonates 1, can be applied here, considering the need for effective pain management in children. Alternative options include over-the-counter preparations containing benzocaine or dyclonine, though these should be used in age-appropriate doses. It's also important to note the potential risk of methemoglobinemia with certain topical anesthetics, as mentioned in the study 1, emphasizing the need for cautious use. Coating agents like Maalox or Mylanta mixed with diphenhydramine liquid in equal parts can also provide relief by forming a protective barrier over the ulcers. Cold foods like popsicles or ice cream can provide additional comfort. These topical treatments work by temporarily blocking pain signals from nerve endings in the inflamed tissue, providing relief while the viral infection resolves naturally. Key considerations include:

• Adequate hydration
• Soft, non-acidic foods
• Monitoring for potential side effects of topical treatments
• Ensuring the child's comfort to facilitate eating and drinking.

From the FDA Drug Label

Directions Adults and children 2 years of age and older: apply to affected area using applicator tip use up to 4 times daily or as directed by a dentist or doctor children under 12 years of age should be supervised in the use of this product children under 2 years of age: consult a dentist or doctor Directions Adults and children over 12 years: ◆ Apply to affected area not more than 3 to 4 times daily ◆ AFTER APPLYING, WASH HANDS WITH SOAP AND WATER children under 12 years or younger: ask a doctor

For a 19-month-old child with gingivostomatitis, neither benzocaine (TOP) nor lidocaine (TOP) is explicitly recommended for use at this age according to the provided drug labels.

• Benzocaine (TOP) is recommended for children 2 years of age and older 2.
• Lidocaine (TOP) directions specify usage for children over 12 years, and for children under 12 years or younger, it advises to ask a doctor 3. Given the information and to err on the side of caution, it is recommended to consult a dentist or doctor for suitable topical analgesia for a 19-month-old child with gingivostomatitis.

From the Research

Topical Analgesia for Gingivostomatitis in a 19-Month-Old Child

• The management of primary herpetic gingivostomatitis in young children, including the use of topical analgesics, has been studied 4.
• A mixture of Maalox and diphenhydramine, as well as viscous lidocaine, have been used as topical therapies for gingivostomatitis in children 4.
• However, the dosing and administration of these topical agents can be problematic in preschoolers 4.
• Another study found that acute gingivostomatitis is a relatively frequent reason for pediatric emergency department visits, and pain management is a significant challenge 5.
• Before the restriction of codeine, it was widely used for pain management in children with gingivostomatitis, but alternative analgesic regimens are now recommended 5.
• Topical percutaneous local anesthetics, such as eutectic lidocaine-prilocaine cream (EMLA) and tetracaine gel, have been found to be effective and well-tolerated in children 6.
• However, the use of topical anesthetics in children can also be associated with risks, such as toxicity and methemoglobinemia, especially if ingested or applied excessively 7.
• In the context of herpes simplex gingivostomatitis, aciclovir suspension has been shown to be effective in reducing the duration of oral lesions, fever, and viral shedding in children 8.

Suitable Topical Analgesia Options

• Viscous lidocaine may be considered as a topical analgesia option for gingivostomatitis in a 19-month-old child, although its use should be carefully monitored and dosed appropriately 4, 7.
• EMLA cream or tetracaine gel may also be considered as alternative topical anesthetics, but their use should be guided by a healthcare professional and carefully monitored for potential side effects 6, 7.
• It is essential to note that the use of any topical analgesic in children should be approached with caution, and parents or caregivers should be advised on the proper use and potential risks associated with these medications 5, 7.