What is the recommended treatment for canker sores in infants?

Treatment of Canker Sores in Infants

For infants with canker sores, topical 2.5% lidocaine ointment should be applied cautiously to the affected area for pain relief, along with barrier protection using white soft paraffin ointment applied every 2-4 hours throughout the healing process. 1

First-Line Treatment Approach

Pain Management

• Apply topical 2.5% lidocaine ointment cautiously to the affected area 1
  • Use sparingly and only when necessary for pain relief
  • For children under 12 years, consult a doctor before application 2
  • Do not apply more than 3-4 times daily 2
  • Wash hands with soap and water after application 2

Barrier Protection

• Apply white soft paraffin ointment (petroleum jelly) to the affected area 1
  • Apply immediately after diagnosis and then every 2-4 hours
  • Creates a protective barrier over the ulcer
  • Promotes healing and reduces discomfort

Supportive Care Measures

Oral Hygiene

• Gently clean the mouth with warm saline solution using a soft cloth or gauze 1
• Avoid alcohol-based mouth rinses as they can cause further irritation 1
• Maintain adequate hydration to keep the mouth moist 1

Dietary Modifications

• Offer soft, moist, non-irritating foods 1
• Avoid acidic, spicy, salty, or rough/coarse foods that may irritate the ulcer 1
• Ensure adequate fluid intake to prevent dehydration 1

Monitoring and Follow-up

• Monitor oral intake to prevent dehydration 1
• Follow up within 3-5 days if symptoms are not improving 1
• Assess for signs of secondary infection:
  • Increased redness
  • Swelling
  • Fever
  • Difficulty feeding or drinking

Special Considerations for Infants

• Infants have more sensitive oral mucosa and are at higher risk for systemic absorption of topical medications
• Use minimal amounts of topical anesthetics to avoid potential toxicity
• Monitor for signs of difficulty feeding or dehydration
• Consider timing application of pain relief before feeding to improve oral intake

When to Seek Additional Medical Care

• If the infant refuses to eat or drink
• If ulcers persist beyond 2 weeks
• If ulcers are numerous or unusually large
• If the infant develops fever or appears ill
• If there are signs of dehydration (decreased urination, dry mouth, lethargy)

Common Pitfalls and Caveats

• Avoid using adult-strength over-the-counter canker sore medications in infants without medical supervision
• Do not use topical corticosteroids in infants without specific medical direction
• Avoid tetracycline-based medications in children under 8 years of age due to risk of teeth staining 3
• Be cautious with antiseptic mouthwashes in infants as they may swallow the solution
• Remember that recurrent canker sores may indicate an underlying condition requiring further evaluation

Canker sores (aphthous ulcers) typically resolve spontaneously within 7-14 days. The treatment approach focuses on pain management and supporting the natural healing process while preventing complications in this vulnerable population.