WE TEND to think of bad breath — also known as halitosis — as an adult problem. So it is always a shocker when parents smell foul breath coming from their little angel. If it persists, they often worry that something is seriously wrong with their child. As one mother said to me recently when she brought her son to my clinic, “I’m afraid that my child is rotting inside.”

Chronic bad breath in adults can indeed be an ominous sign, which in extreme cases can even indicate stomach cancer. But in children, though, halitosis is hardly ever connected with anything that serious. A study published in the March 2009 issue of the Journal of Paediatrics reveals that most times bad breath in children comes either from the mouth itself or from the nasal cavity.

Several things in the oral and nasal cavities can cause bad breath in kids.

· The most common cause is simply poor dental hygiene. Bacteria feeding on stagnant saliva and food particles is the cause of classic “morning breath.” And we all know that morning breath can turn into “afternoon and evening breath” if your child doesn’t get a good tooth and tongue brushing in the morning and at night. Sometimes food particles get caught in little crypts in the tonsils. This too can cause foul odour.

· Tooth decay can also be a culprit. If the decay hasn’t yet affected the dental root, your child won’t experience pain, but may just have smelly breath.
Both acute and chronic sinusitis have been associated with bad breath. In these cases, though, bad breath isn’t the only symptom. Sinusitis is usually accompanied by a daytime and night-time cough and possibly a fever, face swelling, or a thick yellow-green nasal discharge.

· Bad breath can signal pharyngitis — a throat infection. Usually your child will also complain of a sore throat. As with sinusitis, the odour is probably coming from the bacterial infection itself and from bacteria feeding on stagnant saliva because your child is mouth-breathing.

· Seasonal allergies could be the cause. Allergies can cause pooling of mucus in the back of the throat (postnasal drip), which can be accompanied by halitosis. In this case your child may also complain of such symptoms as a dry cough which gets worse at night, itchy eyes, and a runny nose.

· Finally, it’s practically a rite of passage for a child to shove something — typically a corn kernel, a pea, or a dime — up into his or her nose. If this foreign body is left there, it can begin to rot or cause a surrounding infection. In this instance, the bad smell will come predominantly from the nose and not the mouth.

1. First of all, try not to make your child feel self-conscious. Children will have lots of time as they grow older to obsess about bad breath, and there’s no need to get them started prematurely. Instead, use this as an opportunity to teach your child good self-care habits. Explain that washing teeth is as necessary as washing other parts of the body.

2. Let your child pick out a toothbrush and toothpaste. Just make sure that the toothbrush has soft or medium bristles and is small enough for the child’s mouth. The toothpaste should contain fluoride. Commercial mouthwashes and breath-freshener lozenges are poor substitutes for brushing teeth and are not recommended for kids.

3. Supervise your child’s toothbrushing twice a day, something many parents overlook in the rush to get out the door in the morning or to get kids in bed at night. Brushing your teeth with your children is a good way to teach them how to do it properly.

4. Once any two of your child’s teeth touch, you should start them on flossing, says the American Dental Association (ADA). This will make gums healthier and remove decaying food particles.

5. If you see food caught in your child’s tonsils, have him or her try gargling with warm water to dislodge the food.

6. Make sure that your child gets regular dental checkups–at least once a year– beginning with his or her first birthday, recommends the ADA.

If you suspect that your child has shoved something up his nose, then contact your health provider for further advice. Generally, it isn’t a great idea for parents to try to fish out the object, because they usually succeed only in shoving it further up the nostril. Bad breath doesn’t go away with careful dental hygiene, consult your dentist. If the bad breath is accompanied by a cough that lasts more than 10 to 12 days, or by a fever or thick nasal discharge, then contact your health provider.