Oral Ulcers in Children: Causes and Concerns - Otolaryngology

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Oral ulcers, commonly referred to as canker sores or aphthous ulcers, are a frequent concern among children and can arise from various causes. In your case, the child is experiencing recurrent oral ulcers, including a new ulcer under the tongue, and you have noted the presence of a small growth nearby. Additionally, the child has a history of severe iron deficiency, which could potentially be related to the oral health issues.


Causes of Oral Ulcers in Children
1. Nutritional Deficiencies: Iron deficiency, as mentioned, can lead to oral health issues, including ulcers. Other deficiencies, such as vitamin B12, folate, and vitamin C, can also contribute to the development of oral ulcers. Ensuring a balanced diet rich in these nutrients is crucial for maintaining oral health.

2. Viral Infections: Viral infections, such as those caused by the herpes simplex virus or Coxsackie virus (which causes hand, foot, and mouth disease), can lead to painful oral ulcers. These infections can be recurrent, especially in children with weakened immune systems.

3. Trauma or Injury: Accidental biting of the cheek or tongue, or irritation from braces or sharp teeth, can cause ulcers to form. If the child has been experiencing any trauma to the mouth, this could be a contributing factor.

4. Stress and Hormonal Changes: Emotional stress or hormonal changes can trigger the development of ulcers in some children. It's important to consider any recent changes in the child's environment or routine that may have caused stress.

5. Underlying Health Conditions: Conditions such as Behçet's disease, inflammatory bowel disease, or other autoimmune disorders can manifest with recurrent oral ulcers. If the ulcers persist or are accompanied by other symptoms, further investigation may be warranted.


Concerns Regarding the Growth
The presence of a small growth (referred to as a "granulation tissue" or "fleshy growth") near the ulcer could be a reaction to the ulcer itself or a separate issue. Granulation tissue often forms as part of the healing process, but it can also indicate chronic irritation or inflammation. It is essential to have this evaluated by a healthcare professional, especially since the ulcer has not healed after two weeks.


Recommendations
1. Medical Evaluation: Since you are already planning to see an ENT specialist, this is a good step. They can assess the ulcers and the growth, and may recommend further tests or treatments based on their findings.

2. Nutritional Assessment: Given the child's history of severe iron deficiency, it may be beneficial to consult a pediatrician or a nutritionist to evaluate dietary intake and consider supplementation if necessary.

3. Symptomatic Relief: In the meantime, topical treatments such as oral gels or mouth rinses can help alleviate pain and promote healing. Avoiding spicy or acidic foods may also reduce irritation.

4. Monitoring: Keep an eye on the ulcers and any new symptoms that may arise. If the ulcers do not improve or if new symptoms develop, follow up with the healthcare provider for further evaluation.

5. Stress Management: If stress is a potential factor, consider strategies to help the child cope, such as relaxation techniques or engaging in enjoyable activities.

In summary, while oral ulcers in children are common and often benign, recurrent or persistent ulcers warrant further investigation, especially in the context of nutritional deficiencies and the presence of additional growths. Your proactive approach in seeking medical advice is commendable, and it is essential to follow through with the recommended evaluations and treatments.