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Does Your Child Have Stinky Breath?

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 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.


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.

Baby Teeth: When To Brush And What Toothpaste

Today’s answered questions are all about baby teeth. There seems to be a lot of confusion surrounding when and what to do with those baby teeth. Here’s the quick scoop:

When should I start brushing my baby’s teeth?

The short answer is when they have broken through the gum line. Now I don’t personally get too worked up about the tiny little single tooth that is just barely starting to protrude through the gums. I am much more formal about my twice daily brushing with my kiddos once there is a row of teeth. For some kids that’s as early as 6-8 months, while for others it is more like 10-11 months. It all depends on how quickly the child teethes. Now that doesn’t mean that I’m not paying attention earlier. I find it easy enough to wipe the teeth off after my baby has eaten and I’m already wiping off their face (when they are in that early, super messy, high-chair stage). I’ll also help rinse off the teeth with a final drink of water out of the sippy cup before I get the child out of the highchair.

How do I prevent bottle rot?

“Bottle rot” happens when milk sugars repeatedly sit on the back of the teeth and cause tooth decay. If you’ve seen those kiddos with silver caps all along the front teeth then you know what I’m talking about. Bottle rot is a bit of a misnomer. While it usually happens from babies being put to bed with bottles, it can certainly happen from babies who breastfeed off and on all night (i.e., the babies who co-sleep with mom and breast feed all throughout the night, falling asleep on the boob). Once your baby has some teeth, get the order correct. First, give the milk. Second, brush the teeth. Finally, lay the baby in bed. The key is brushing the teeth between milk and bedtime. Never give a baby a bottle of milk (or juice for that matter) in bed.

What toothpaste should I use?

There are essentially 3 stages of toothpaste:

“Trainer” toothpastes are essentially designed for babies and toddlers (think 6 months to 2 ½ years old). They taste good and are safe for a child to swallow. Trainer toothpastes do not have fluoride (to prevent “fluorosis”– or an excess of fluoride, since the very young child cannot reliably spit it out).

The second stage of toothpaste is the “kid” toothpastes. These toothpastes usually have popular characters on the front and kid-friendly flavors like “tooty-fruity” and “bubble gum.” These toothpastes have fluoride and are designed to be used by children who are old enough to spit and not swallow the toothpaste. (For most kids, that is around 2 ½ years old).

The final stage of toothpaste is essentially the “adult” toothpastes. Most people transition to these toothpastes in the teen years. These toothpastes have more mature flavors like “mint” and are angled at helping things like promoting fresh breath and preventing plaque or tarter build up. These toothpastes also have fluoride in them.