Children with complaints of mouth and/or throat pain may have infections that range from mild and self-limited in nature to severe and life threatening. With the advent of childhood immunizations and the increased availability of effective antimicrobials, we have seen improved outcomes and decreased incidence of many serious, life-threatening infections.1-4 Despite this, infections of the neck and oral cavity remain a significant cause of childhood morbidity and reason for admission to the hospital. This chapter focuses on common oral cavity and neck infections that result in hospitalization or have potential for serious complications.
Stomatitis is the term used to describe inflammatory lesions of the oral mucosa, usually presenting as small, shallow, painful ulcerations. It has infectious and noninfectious causes. The location of lesions and accompanying findings from the history and physical exam can help to identify the underlying cause and guide further management. Most cases of stomatitis are isolated, benign, and self-limited. However, some cases can cause significant morbidity that require inpatient treatment and others may be a sign of an underlying systemic condition.
Three of the most common causes of stomatitis in children are recurrent aphthous ulcers, herpangina, and herpetic gingivostomatitis. These can usually be distinguished based on clinical findings alone.
Recurrent Aphthous Ulcers
Commonly referred to as “canker sores,” recurrent aphthous ulcers are the most common cause of inflammatory ulcerations of the oral mucosa.5 They typically present as small (<5 mm), round, painful ulcerations with clearly defined and erythematous borders on the mucosal surface of the inner lip or buccal mucosa. Lesions heal spontaneously within 10 to 14 days of onset without any scarring, but commonly recur. Familial tendencies have been noted, but the cause remains unknown. There are hypotheses that there may be a relation to alterations in local cell-mediated immunity, trauma, emotional stress, and possibly nutritional deficiencies. Other systemic symptoms, such as fever, are usually absent.
This condition, usually caused by group A coxsackieviruses, is found commonly in young children during the summer and early fall. It presents with sore throat and mouth pain, occasionally accompanied by fever, with clusters of small vesicles that progress to small ulcerations. Mucosal involvement characteristically involves the hard palate, tongue, buccal mucosa, and gums. Involvement of the hands and feet is characteristic, and lesions favor the lateral aspects on the fingers and toes as well as periungual (Figure 100-1). Lesions may also appear in other areas, particularly the buttocks and knees. While these lesions typically will heal spontaneously over 3 to 5 days, oral intake can be markedly decreased during the illness due to severe odynophagia and lead to dehydration.
Typical cutaneous manifestations of hand, foot, and mouth disease on a toddler. (A) Inflammatory vesicles on the foot; (B) inflammatory vesicle on the hand; (C, D) numerous small erythematous papules and vesicles on the knees and buttocks. (Reproduced with permission from Shah KN. Case 9-6. In: Shah SS, Ludwig S eds. Symptom-based Diagnosis in Pediatrics. New York: McGraw-Hill Medical; 2014:254, Figure 9-6.)