Herpes Gingavostomatitis Pediatric Care Plan

By David Shafran, MD
Medically reviewed
January 12, 2021

What is Gingivostomatitis?

Gingivostomatitis is the initial manifestation of a herpes virus infection of the mouth. It usually happens in children less than 5 years old and is characterized by painful, small ulcers on the gums and inner lining of the mouth including the cheeks, tongue, and palate.

Usually, before the lesions appear a child might have 3-4 days of fever, fussiness, headache and disrupted sleep. 

Symptoms once the lesions emerge can include:

  • Bleeding gums
  • Bad breath
  • Refusal to eat and drink
  • Fever
  • Headache

After the lesions get better, the virus continues to live in the nerves surrounding the face and can emerge later during periods of stress, illness, or sun exposure as ‘cold sores.’

Gingivostomatitis Diagnosis & Treatment

Gingivostomatitis is diagnosed based on medical history and physical exam. Sometimes some of the fluid from one of the lesions can be sent for a culture to confirm the diagnosis.

Usually herpes gingivostomatitis can be managed supportively: 

  • Encourage hydration 
  • Pain control with tylenol and ibuprofen 
  • Give your child cold foods like popsicles or ice cream
  • Magic mouthwash (maalox, benedryl, viscous lidocaine) is not routinely recommended because it has not been proven to be effective and ingestion of lidocaine can be toxic. Ask if this is appropriate to try this in your child.

Depending on how your child is doing with these supportive measures, your child’s provider might choose to use an antiviral medication. These medications are most effective when given as early in the course of disease as possible.

The most common reason for hospitalization is dehydration. Signs of dehydration include:

  • urinating less
  • dry mouth
  • very fussy or sleepy
  • marked decrease in activity
  • few or no tears when crying
  • wrinkled skin
  • sunken eyes

Check in With K If…

  • You have general questions about your child’s condition
  • You want general followup for your child
  • You have questions about supportive care
  • Your child’s symptoms don’t go away after treatment but are not alarming

See a Doctor in Person If…

  • Your child has a fever for greater than 7 days
  • If the rash spreads and worsens
  • Your child cannot drink because of mouth pain
  • Your child seems lethargic or unusual tired
  • If your child is immunocompromised
  • If the lesions spread to the eye
K Health articles are all written and reviewed by MDs, PhDs, NPs, or PharmDs and are for informational purposes only. This information does not constitute and should not be relied on for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.

David Shafran, MD

Dr. Shafran is a board-certified pediatrics physician. He joins K Health from the Cleveland Clinic, where he led a pediatrics practice and completed a fellowship in transplant ethics. He has completed multiple fellowships, including one in pediatric nephrology at Rainbow, Babies & Children's University Hospitals. He received his medical degree from the Sackler School of Medicine in Tel Aviv and completed his medical residency at the Jacobi Medical Center.