Guide for Parents: Managing Your Child's Recurrent Canker Sores
What You Need to Know
Your 9-year-old's recurrent canker sores (aphthous ulcers) should be managed primarily with topical treatments including steroid gels, barrier agents, and pain control, with attention to identifying and avoiding triggers. 1
What Are Canker Sores?
Canker sores are painful, shallow ulcers with red borders and yellow or gray centers that appear inside the mouth on soft tissues like the inner cheeks, lips, or tongue. 2 They are extremely common, affecting 10-20% of the population, and typically first appear in childhood or adolescence. 3 Unlike cold sores (herpes), canker sores are not contagious and don't appear on the outside of the lips. 3
What Causes Them?
While the exact cause is unknown, several factors can trigger canker sores in children: 2, 4
Common Triggers:
- Local trauma from accidentally biting the cheek, sharp foods (chips, crackers), or dental braces 5, 4
- Stress (school exams, social pressures) 5
- Certain foods - particularly hard, acidic, or salty foods, citrus fruits, tomatoes, and carbonated drinks 4
- Toothpaste containing sodium lauryl sulfate (SLS) - check your child's toothpaste ingredients 4
- Nutritional deficiencies - iron, folate, or B vitamins 5, 6
- Food allergies or sensitivities 5
- Genetic predisposition - there may be a family history 2
When to Investigate Further: If ulcers persist beyond 2 weeks or don't respond to treatment, blood tests should be performed to check for nutritional deficiencies (B vitamins, iron, folate), inflammatory bowel disease, or other systemic conditions. 6, 7
Home Management Strategies
Step 1: Avoid Triggers
- Switch toothpaste to one without sodium lauryl sulfate (SLS-free brands are available at most pharmacies) 4
- Avoid trigger foods: hard chips, acidic foods (citrus, tomatoes), salty snacks, carbonated drinks, and alcohol-containing mouthwashes 4
- Protect from trauma: If your child has braces, ask the orthodontist about dental wax to cover sharp edges 6
- Keep a food diary to identify specific food triggers 5
Step 2: Pain Relief (Available Over-the-Counter)
- Topical anesthetic gels containing benzocaine 2% can be applied to the ulcer up to 4 times daily before meals (supervise use in children under 12 years) 8, 1
- Benzydamine hydrochloride rinse or spray every 3 hours, especially before eating 1, 9
- Oral pain medication: acetaminophen or ibuprofen at age-appropriate doses for severe pain 9
Step 3: Promote Healing
- Warm saline rinses (1/2 teaspoon salt in 8 oz warm water) - have your child swish and spit 2-3 times daily 1, 9
- Apply white soft paraffin ointment (petroleum jelly) to lips every 2 hours if ulcers are on the lips 1, 9
- Barrier gels like Gelclair or Orabase can protect the ulcer and reduce pain (apply 3 times daily) 1
When to See a Doctor
See your child's doctor or dentist if: 7
- Any ulcer lasts longer than 2 weeks 6, 7
- Ulcers are very large (>1 cm) or extremely painful 5
- Your child has frequent recurrences (4 or more episodes per year) 1
- Ulcers don't respond to 1-2 weeks of home treatment 7
- Your child develops fever, difficulty swallowing, or refuses to eat or drink 5
- Ulcers appear in unusual locations or have irregular borders 6
Prescription Treatments Your Doctor May Recommend
If home measures aren't sufficient, your doctor can prescribe: 1, 4
First-Line Prescription Options:
- Triamcinolone acetonide 0.1% paste applied directly to dried ulcer 2-4 times daily 1
- Clobetasol 0.05% ointment mixed with Orabase for more severe ulcers 1
- Betamethasone sodium phosphate rinse (0.5 mg in 10 mL water) used as rinse-and-spit 2-4 times daily for multiple ulcers 1, 9
- Dexamethasone mouth rinse (0.1 mg/mL) for widespread ulcers 1
For Severe or Frequent Recurrences:
- Colchicine may be considered for children with 4 or more episodes per year 1
- Short course of oral corticosteroids (prednisolone 1 mg/kg for 1 week with tapering) for highly symptomatic cases 1
Important Safety Notes
- Never use aspirin directly on ulcers or gums in children - it can cause chemical burns 4
- Supervise use of topical anesthetics in children under 12 years 8
- Avoid antiseptic mouthwashes containing alcohol as they can irritate ulcers 4
- Don't stop prescribed steroids abruptly - follow your doctor's tapering instructions 1
Expected Timeline
- Most canker sores heal on their own within 7-14 days without scarring 5, 3
- Treatment can reduce pain within 24-48 hours and may shorten healing time 4
- Recurrence rates can be as high as 50% within 3 months, but identifying and avoiding triggers can reduce frequency 5
Red Flags Requiring Urgent Evaluation
Seek immediate medical attention if your child develops: 6, 7