The main reasons for bad breath in children are failing to brush and breathe through the mouth instead of the nose, which causes dry mouth and bad breath. Although having odorous breath in the morning is common to children and adults, it may indicate a medical condition if it persists during the day, even after a good brushing and rinsing in the morning.

Younger children are not capable of conveying the presence of health issues unless something is causing them pain. As a result, minor allergies or sinus infections, head colds or inflamed tonsils can go unnoticed by parents if the child does not experience fever or persistent vomiting. Breathing through the mouth, even at irregular intervals, will directly affect the saliva content in the mouth, creating an environment conducive to the proliferation of anaerobic bacteria.

Anaerobic bacteria consume food particles in the mouth that have not been removed by brushing or rinsing. The waste excreted by these bacteria is a volatile sulfur compound that produces bad breath in children as well as adults. Found on the tongue, between teeth, at the gumline and in the back of the throat, these same anaerobic bacteria are also responsible for odors emitted by rotten eggs, cabbage, feces and decaying flesh.

The tongue harbors many of these bacteria because hundreds of them cling to epithelial cells that have been shed but still remain on the tongue. Unless rinsed or brushed off the tongue, they will continue to accumulate, forming that white, pasty film often seen on "morning" tongue or on tongues that have not been cleaned.

Conditions contributing to bacterial growth in the mouth include:

• Decreased output of saliva
• Saliva stagnation caused by mouth-breathing, medications or underlying illness
• A diet high in protein (anaerobic bacteria feed on sugars and proteins)
• An increase in the pH level existing in the mouth
• More necrotic mouth cells than usual
• High blood glucose (onset of diabetes)
• Dental problems (gum disease, abscessed teeth)
• Fungal infections (thrush)
• Post-nasal drip caused by a runny nose (bacteria flourish in mucus)

Another common explanation for bad breath in children is the development of tonsil stones within the crevices of a child's tonsils. Tonsil stones are tiny, white specks of calcified oral debris that become embedded in tonsil crevices. Also called tonsilloliths, tonsil stones will produce a foul odor when accidentally chewed or dissolved during the natural disintegration process. Removal of tonsils stones is performed using a toothbrush or water pik. Children suffering from frequent bouts of tonsillitis will experience more tonsil stones than children whose tonsils remain unaffected by inflammation.

How is Bad Breath in Children Measured?

Doctors measure the intensity of bad breath using instrumental and sensory techniques. The sensory or organoleptic method involves a physician standing about five inches from the patient's mouth, having the patient exhale and then rating the odor based on a one to five scale. In addition, scrapings taken from the back of the tongue are also evaluated. Another method is the instrumental technique utilizing a sulfide monitoring device called a Halimeter. It specifically rates the amount of hydrogen sulfide gas in the mouth after the patient inserts a flexible straw into the nostrils or mouth and holds his or her breath for 10 seconds. Anything over 75 PPB presents a diagnosis of halitosis.

Dr. Katz Demonstrates a Halimeter to Measure Bad Breath

In this video, Dr. Harold Katz, founder of TheraBreath? demonstrates how a Halimeter device is used to measure bad breath.

Treatments for Bad Breath in Children

Treatment of halitosis in children depends on the cause of bad breath. Initially, parents should make sure the child is spending enough time brushing his teeth and tongue, flossing and using mouthwash. If halitosis persists, a change in diet may be necessary, especially in regards to the amount of sugary drinks and snacks the child consumes. Regular dental checkups are important to young children as well. Periodontal disease can occur in children as young as one year old due to unchecked oral debris collecting on gum lines.

Eating a healthy, fibrous breakfast every day promotes saliva flow necessary for decreasing the level of oral anaerobic bacteria. Drinking water and chewing sugar-free gum will also activate salivary glands and keep a sufficient flow of saliva circulating in the mouth.

When these methods fail to eliminate bad breath in children, doctors may prescribe blood and urine tests to discover if something else is causing the halitosis. Diabetes, kidney or liver issues can cause halitosis by altering the pH level in the mouth which encourages bacterial growth. Parents may be able to detect an underlying disorder by certain distinct odors.

For example, children suffering from diabetic ketoacidosis often emit a fruity-smelling breath while those with kidney problems have breath resembling the odor of urine. Additionally, livers that are not functioning properly produce fishy-smelling breath due to unprocessed bile accumulating in the body.

Temporarily masking bad breath in children with gum or mints is not advisable since halitosis may be the result of a serious medical problem. Bad breath that persists even after increasing the amount of brushing, flossing and rinsing sessions should be investigated by a pediatrician to rule out any latent health issues.

Safely Eliminating Bad Breath in Children

The majority of mouthwashes for children contain a number of potentially harmful ingredients, such as:

• Alcohol--contributes to dry mouth and proliferation of bacteria producing sulfurous compounds
• Sodium lauryl sulfate--frequently found in detergents and soaps, this foaming agent does nothing to prevent bad breath and may facilitate the formation of canker sores.
• Benzalkonium chloride--used in cleaning solutions such as Lysol and in eye drops, this substance is a preservative designed to retain antibacterial qualities. Some studies suggest that benzalkonium chloride may be responsible for precipitating asthma in children as well as skin allergies resulting in severe dermatitis
• Saccharin--toothpastes often contain saccharin to sweeten the taste and make them more palatable to children. However, saccharin has been implicated in the development of bladder cancer and is counterintuitive to eliminating anaerobic bacteria

TheraBreath® products for children do not contain any of these toxic ingredients. Instead, TheraBreath offers safe, organic mouthwashes and toothpastes made with natural oils for flavoring and non-synthetic ingredients that inhibit bacterial growth and bad breath. Children using Dr.Katz's specially formulated products are not at risk for developing potentially serious medical conditions often caused by over-the-counter oral hygiene products.