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Oral Problems Issues
Oral Problems Paediatric Palliative Care For Home Based Carers Funded by British High Commission, Pretoria Small Grant Scheme Oral Problems Oral problems are common in children with HIV Often a sign that HIV disease is progressing Type, frequency and severity of problems depend on the child ©TALC Issues Oral problems are commonly painful and distressing for a child A child may refuse to drink or eat Children are therefore at risk of dehydration and/or malnutrition ©TALC Early diagnosis and treatment is essential to prevent complications ©TALC 1 Oral Thrush Common in children Caused by candida infection White patches on roof of mouth, inside cheeks, back of tongue or throat May be very painful ©TALC May be in corners of mouth or in throat Oral Thrush Pain is distressing for child May be difficult to swallow Child may not want/ be unable to eat or drink May lead to dehydration and/or malnutrition If severe, recurrent or in throat, suggestive of HIV ©TALC Management of Oral Thrush Wash hands Wet a clean soft cloth with salt water and use to wash child’s mouth Refer for: Daktarin oral gel (4-6 hourly x 7-14 days) and /or Nystatin 6 hourly Try both if severe/persistent If N/A, paint with Gentian Violet Avoid feeding for 20 minutes after medication 2 Management of Oral Thrush If breast fed, check mother’s breasts for thrush If thrush present, treat breasts with nystatin or Gentian Violet Advise mother to wash breasts after feeds ©TALC If bottle fed, change to cup and spoon Management of Oral Thrush Ensure regular pain relief to relieve discomfort and encourage drinking/eating Encourage small, frequent drinks and food to prevent dehydration & malnutrition Management of Oral Thrush If thrush is no better / worse or swallowing is painful: refer child to clinic for investigations & medication 3 Preventing Oral Thrush Thorough washing of bottles, teats, cups, spoons Daily Tooth brushing Breastfeeding Nutritious foods Vitamins ©TALC Herpes Simplex Painful, small blisters or open sores on lips or in mouth May also be around nose May be accompanied by fever Herpes >1 month = AIDS defining condition CDC/J.D.Millar Herpes May be very painful Child may not want/be unable to eat or drink May lead to dehydration or malnutrition ©TALC May last long time/recur Can be spread from one person to another 4 Management of Herpes Paracetemol (Panado) Encourage fluids Hand Washing Soft diet Thorough cleaning of utensils Management of Herpes Refer for oral Acyclovir May need IV Acyclovir if severe May need antibiotics for secondary infection Child needs clinic/ hospital urgently if: - Child is not drinking - Child is dehydrated - Signs of difficulty breathing, jaundice or behaviour change Preventing Herpes Nutritious Foods Vitamins Hand Washing Avoid touching mouth Avoid kissing if herpes present Thorough cleaning of feeding implements and utensils 5 Mouth Ulcers Painful blisters on tongue or in mouth Size 2-3mm to 2-3 cm Occur as single blister or in ‘clusters’ Occur on roof of mouth, tongue, inner cheek, tonsils Child may be reluctant to eat or drink ©TALC Management of Mouth Ulcers Wash hands Wet a clean soft cloth with salt water and use to wash child’s mouth Paint mouth with Gentian Violet, twice daily Continue using Gentian Violet until 48 hours after ulcers have been cured Give Paracetemol for pain relief Dental Problems Inflammation of gums Tooth abscesses Painful May not want to eat/drink ©TALC Secondary infection 6 Managing Dental Problems Daily Tooth Brushing Water and Salt mouth wash Chlorhexidine mouthwash Dental checks Antibiotic treatment Preventing Oral Problems Regular tooth brushing Vitamins Nutritious foods Avoid sugary foods that will rot teeth Encourage calcium Managing Oral Problems Encourage diet and fluids Pain relief (Paracetemol) Salt and water mouth wash Gentian Violet Chlorhexidine Regular checks ©TALC 7
