CHRONIC bad breath in adults can indeed be an ominous sign, which, in extreme cases, can even indicate stomach cancer. In children, though, halitosis (bad breath) is hardly ever connected with anything that serious. A study published in the March 2012 issue of the Journal of Paediatrics reveals that the worst breath in children comes either from the mouth itself or from the nasal cavity.

We tend to think of bad breath as an adult problem. So, it is always a shock 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.’

There are several things in the oral and nasal cavities that can cause bad breath in children.

• The most common cause is poor dental hygiene. Bacteria feeding on stagnant saliva and food particles are the cause of classic ‘morning breath’. We all know that morning breath can turn into ‘afternoon and evening breath’ if your child does not 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 a foul odour.
• Tooth decay can also be a culprit. If the decay has not yet affected the dental root, your child will not experience pain but may have smelly breath.
• Both acute and chronic sinusitis have been associated with bad breath. In these cases, though, bad breath is not the only symptom. Sinusitis is usually accompanied by a daytime and night-time cough and possibly a fever, facial 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 breathing through the mouth.
• Seasonal allergies could be the cause. Allergies can cause a 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 symptoms such as a dry cough that worsens at night, itchy eyes, and a runny nose.
• Finally, it is practically a rite of passage for a child to shove something, typically a corn kernel, a pea or a dime, up their nose. If this foreign body is left there, it can begin to rot or cause an infection around it. In this instance, the bad smell will come predominantly from the nose and not the mouth.

1. First, try not to make your child feel self-conscious. Children will have plenty of time to obsess over bad breath as they grow older, and there is no need to get them started prematurely. Instead, use this as an opportunity to teach your child good self-care habits. Explain that washing the 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 the teeth and are not recommended for children.
3. Supervise your child’s tooth-brushing twice a day, something many parents overlook in the rush to get out of the door in the morning or to get children into 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 help keep the gums healthy and remove food debris.
5. If you see food caught in your child’s tonsils, have them try gargling with warm water to dislodge the food.
6. Make sure that your child gets regular dental check-ups, at least once a year beginning with their first birthday, recommends the ADA.

If you suspect that your child has shoved something up their nose, contact your healthcare provider for further advice. Generally, it is not a good idea for parents to try to fish the object out because they usually only succeed in shoving it farther up the nostril. If the bad breath does not go away with careful dental hygiene, consult your dentist. If the bad breath is accompanied by a cough lasting more than 10 to 12 days, a fever, or thick nasal discharge, contact your healthcare provider.