Unusual Breath Odors and What They Mean

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.

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). Take a whiff:

• Acetone – diabetes or acetone, alcohol, phenol, or salicylate ingestion
• Ammonia – some types of urinary tract infections, or kidney failure
• Asparagus – eating asparagus (very unusual in children;>))
• Bitter almonds – cyanide poisoning
• Cat’s urine – odor of cats syndrome (beta-methyl-crotonyl-CoA-carboxylase deficiency)
• Celery – Oasthouse urine disease
• Dead fish – stale fish syndrome (trimethylamine oxidase deficiency)
• Fresh-baked bread – typhoid fever
• Foul – tonsillitis, sinusitis, gingivitis, lung abscess, or dental cavities (some of these are actually quite common)
• Garlic – arsenic, phosphorus, organic phosphate insecticides, or thallium poisoning
• Horse-like (also described as mouse-like or musty) – phenylketonuria
• Rancid butter – odor of rancid butter syndrome (hypermethionemia and hypertyrosinemia)
• Raw liver – liver failure
• Sweaty socks – odor of sweaty feet syndrome (Isovalryl CoA dehydrogenase deficiency)
• Sweaty socks – odor of sweaty feet syndrome II (Green acyldehydrogenase deficiency)
• Violets – turpentine poisoning

Three-year-olds often stuff items in their noses, and then forget about them. When my son Kevin was three, he put five peas up his nose before anyone found out! Watch for the combination of smelly breath and a smelly, yellow nasal discharge — especially from one nostril. You and I might not think of stuffing peas up our noses, but three-year-olds think outside the box!