What are the treatment options for pediatric oral ulcer pain (mouth ulcers)?

From the Guidelines

For a child with oral ulcer pain, I recommend starting with oral acetaminophen as the first line of treatment, as it is effective in managing the pain of ulceration, as suggested by 1. When considering treatment options for kid oral ulcer pain, it's essential to prioritize the child's comfort and pain management.

• The use of oral acetaminophen is supported by the study 1, which highlights its effectiveness in managing pain associated with ulcerated infantile hemangiomas.
• Topical treatments, such as 2.5% lidocaine ointment, may also be effective in managing pain, but should be used cautiously, as noted in 1.
• Additionally, the study 1 provides expert opinion recommendations for managing stomatitis, including the use of sodium bicarbonate mouthwash, chewing gum, and analgesics, which may also be applicable to kid oral ulcer pain.
• It's crucial to avoid acidic, spicy, or rough foods that may irritate the ulcer further and encourage soft, cool foods like yogurt, smoothies, or ice pops to help manage pain and promote healing.
• Ensuring the child stays hydrated is also vital, as painful ulcers might discourage drinking, and using a soft toothbrush will help maintain oral hygiene without causing additional pain.
• If the ulcer persists beyond two weeks, is unusually large, or is accompanied by fever or difficulty swallowing, it's essential to consult a healthcare provider for further evaluation and treatment.

From the FDA Drug Label

◆ Apply to affected area not more than 3 to 4 times daily children under 12 years or younger: ask a doctor For kids with oral ulcer pain, consult a doctor for treatment, as the label instructions for lidocaine (TOP) 2 advise asking a doctor for children under 12 years or younger.

• The drug label does not provide specific dosage instructions for children under 12 years.
• Lidocaine (TOP) 2 is used to temporarily relieve minor pain.

From the Research

Treatment Options for Kid Oral Ulcer Pain

• The use of topical lidocaine to improve oral intake in children with painful infectious mouth ulcers has been studied, with mixed results. A study published in 2014 found that 2% viscous lidocaine was not superior to a flavored gel placebo in improving oral intake in children with painful infectious mouth ulcers 3.
• A review of the literature in 2020 found that in otherwise healthy pediatric patients with painful oral ulcers, treatment with viscous lidocaine does not improve oral intake, although it may provide some pain relief 4.
• Other treatment options, such as mouthwashes, have been studied for their efficacy in treating oral ulcers. A study published in 2020 found that a new mouthwash was effective in reducing oral ulcer severity and improving quality of life in patients with Behçet's disease 5.
• A case report published in 2022 described the use of mouthwashes containing lidocaine, followed by photobiomodulation therapy, in the treatment of oral lesions associated with COVID-19. The patient experienced a 90% improvement in oral lesions and tongue sensitivity after using the mouth rinse therapy for 1 month 6.
• A review of the differential diagnosis and management of oral ulcers, published in 2015, emphasized the importance of correctly establishing a definitive diagnosis and understanding the immunopathologic nature of the lesion in order to provide effective treatment and management 7.