Oral Problems Issues


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