Ah, stinky breath. When did it happen? When your child was born his or her breath was so yummy. It has this little sweet smell, straight from Heaven. Then seemingly overnight, it happens, toilet breath. The medical term is Halitosis. Is it something to worry about? Maybe, depends on a lot of things.  Here’s the quick scoop. Consider breath by age.

Babies:

Babies don’t have teeth, developed sinuses, or mouths colonized with the typical bacteria that causes cavities. Hence, your baby should have good breath. It shouldn’t be stinky. If your child has smelly breath, there is usually a problem (think medical type problems-anatomic malformations, illness, reflux, etc.). If your child at this age has stinky breath, you need to see your pediatrician.

Toddlers:

This is a tricky age. Most toddlers don’t have sticky breath either. Stinky breath in this age is typically an indicator of a problem. When I see kids this age with halitosis, I have to play detective. Did the child stick something up his or her nose (this is a favorite in this age group). Is there a throat or sinus infection? Is the child suffering from tooth decay (from bottle rot or continually drinking juice in sippy cups)? On occasion, I can’t see a cause and it ends up being something like chronically infected adenoids (not visible in traditional examinations).  If your child at this age has stinky breath, you need to see the pediatrician.

School-age and up:

This is the age when kids’ breath starts to stink. The mouth is usually colonized with bacteria by this age (leading to morning breath), the sinuses are well developed, and kids have mouths full of teeth, of which they may not be taking good enough care. All of these reasons can cause mouths to stink. In figuring out this age, I usually start with some basic questions.

1. Is the kiddo sick?
2. Does the child have normal anatomy (e.g., able to breath easily out of the nose [septum isn’t deviated])? Any throat problems, like enlarged tonsils?
3. Are there cavities (perhaps ones you can’t readily see)? Looking for cavities in a kiddo with bad breath with a normal physical exam is a common reason I send kids to dentists.
4. Does the child have a dry mouth or is he or she a mouth breather (getting again to his or her ability to breathe out of the nose)? Mouth breathers can have bad breath.
5. Does the child have good oral hygiene? I know it seems obvious, but the number one reason kids have bad breath is not routinely cleaning the mouth (simply brushing teeth and tongue twice a day).

Don’t feel bad about (tactfully) telling your child that his or her breath stinks. If there is an underlying medical reason, address it with your pediatrician. If it’s just bad hygiene, fix it. Kids are brutal and you don’t want your child to be the victim of mockery.