Canker sores in children, which are basically ulcers on the interior flesh of the mouth, hide at the base of the gums or on the inside of the cheeks and tend to manifest as whining. Unfortunately, because the causes of canker sores are diverse, it’s not always easy to track down why a child might have them. Thankfully, treating canker sores in children isn’t particularly complicated, although it’s important to note that parents should approach the task with a heart full of empathy. A kid wailing about their first canker sore probably isn’t exaggerating the pain, which can be shockingly severe.

“The first bout of canker sores that a human gets is usually the worst case of canker sores they will ever experience,” says Dr. Yasser Armanazi, of Mentor Pediatric Dentistry in Mentor, Ohio. “The whole mouth may be compromised. The gums may be fiery red, they will literally look like they are on fire, and it is very painful.”

Canker sores are common in toddlers and school-age children. They are rare but possible for kids under 3 years old. Armanazi says he has seen them in younger children, but it is not common.

What Causes Canker Sores?

Parents might see signs of canker sores after irritability or complaints from their children. Sometimes they say their mouth is burning. The pain is heightened when swallowing. There will also be ulcerations on the gums, lips, tongue, or inner cheeks.

Canker sores can be caused by a wide variety of issues, Armanazi says. That includes intense stress, gastrointestinal problems, accidentally biting the tongue or cheeks and dehydration. It’s also possible for canker sores to be related to the cold sore virus (primary gingival herpetic virus). Rarely, they are a sign of a potentially severe medical issue.

“Some kids get canker sores as often as every 3 months,” he says. “Some kids get large canker sores and some kids only experience small sores. But they are painful and should be treated.”

Should Parents Worry About Canker Sores?

Most canker sores are not a big deal, but they should all be looked at. Not only is the child in pain, but it could be a sign of something more serious.

“There is thought that severe mouth ulcers in young children can be an early symptom of leukemia,” Armanazi says. “Now, I don’t want to scare parents with this information, because generally speaking canker sores are benign ulcers, but it is a consideration if the sores are quickly recurring or severe in number and size.”

That said, treating canker sores as benign is a good first step. However, if they are chronic and no one is raising questions, it is worth asking the pediatrician about other potential causes.

How to Get Rid of Canker Sores

Treating canker sores can be done at home, but don’t be surprised if it takes a week and a half to go away. Pushing fluids is a great first step. “Dehydration is a major factor in the cause and treatment of canker sores,” Armanazi says.

If the child is old enough to hold around liquid in his or her mouth and not swallow it, no younger than 4 years old, a liquid antacid can help. “I suggest that a child swish a liquid antacid in their mouth 2 to 3 times a day,” he says. “It’s very important that they do not swallow the antacid. This gives a protective coating over the canker sores to prevent further irritation and pain.”

This treatment should be coupled with syrup antihistamine or acetaminophen if the child is still experiencing a lot of pain. Parents should make sure to check with a pediatrician to be sure they are administering the correct dosage.

This article was originally published on July 5, 2018