Our 3 year old daughter's breath is often bad. What smells should we look for, are there any that we should watch out for?

Most kids would go out of their way to avoid eating garlic or onions, yet it is not unusual for a child to wake up with very smelly breath. Throughout the day, a child's saliva, swished by the mouth muscles, washes away unwanted debris. As soon as a child falls asleep, saliva production plummets, and the muscles relax. The longer a child sleeps, the higher the bacterial count in the mouth rises, resulting in "morning breath."

In children, smelly breath that persists throughout the day is most often the result of mouth-breathing, which dries out the mouth and allows the bacteria to grow. Children who consistently breathe through their mouths might have colds, sinus infections, allergies, or enlarged tonsils or adenoids blocking the nasal passages, so a visit to the pediatrician is in order. Thumbsucking or sucking on a blanket can also dry out the mouth. Tonsillar stones, collections of food and bacteria that get stuck in the crevices of the tonsils, can also cause bad breath.

To improve most cases of bad breath, the goal is to decrease mouth bacteria and increase saliva. The better your daughter's toothbrushing technique, the smaller number of bacteria will be present. Make after-meal brushing a habit. Use a timer to help her brush for at least two minutes. Be sure she brushes her tongue. You might also try a rotary electric toothbrush. I do not recommend mouthwashes or fluoride rinses in young children, since they tend to swallow them. Breath mints may mask the problem, but don't get at the source. As your daughter gets older, sugarless sour candy or sugarless chewing gum can get the saliva flowing and get those mouth muscles moving.

If the problem persists, she should see her doctor. Bad breath in children that doesn't respond to the above measures should be investigated. Here is a list of some very uncommon, but telltale, odors (mostly from Mace, Goodman, Centerwall, et al: The child with an unusual odor. Clinical Pediatrics 15:57-62, 1976).