Herpetic gingivostomatitis in children: symptoms, how long it lasts, how to help and when to see a doctor

What is herpetic gingivostomatitis?

Herpetic stomatitis, or more precisely herpetic gingivostomatitis (inflammation of the gums and mouth), is the symptomatic form of a first infection with the herpes simplex virus (HSV), usually type 1. The virus is very widespread: the World Health Organization (WHO) estimates that 3.8 billion people under the age of 50, or 64%, are infected with HSV-1.

A first infection often causes no symptoms. The systematic review by Coppola et al. (2023) reports that herpetic gingivostomatitis develops in 13 to 30% of first HSV-1 infections, and the guideline of the Royal Children’s Hospital in Melbourne gives the typical age as 6 months to 5 years.

Medycyna Praktyczna reports that children up to the age of 4 are affected most often, and close contact in nurseries increases how often it occurs. Children usually catch the virus from a person who is shedding it, often without visible sores, and after infection the virus stays in the body and can later cause cold sores.

What are the symptoms of herpetic gingivostomatitis in a child?

Herpetic gingivostomatitis in a child starts suddenly, with a high fever, feeling unwell and loss of appetite. Medycyna Praktyczna describes swollen, red and painful gums, blisters or sores on the lining of the mouth, the tongue, the lips and the skin around the mouth, and enlarged lymph nodes.

The blisters burst and leave painful sores or ulcers, which may bleed. The pain can be so severe that the child refuses to eat and drink. Swelling and redness of the gums help to tell this illness apart from herpangina, in which the gums are usually not affected.

The time from infection to symptoms is 3 to 6 days, according to Medycyna Praktyczna. In a child who sucks their thumb, the virus can spread to the finger and cause a painful infection around the nail, and less often to the eye, which is why frequent handwashing by the child and carers matters.

How long does herpetic gingivostomatitis last?

Herpetic gingivostomatitis usually lasts about 2 weeks: according to Medycyna Praktyczna, the acute symptoms last 5 to 7 days and the sores heal within about 2 weeks. The Royal Children’s Hospital guideline gives healing in 10 to 14 days, and in severe cases up to 3 weeks.

The sores heal without scarring, and the illness usually clears up by itself without complications. The most common complication is dehydration, which sometimes needs hospital treatment and intravenous fluids, stresses a doctor answering readers’ questions on the Medycyna Praktyczna website.

A child stays infectious for longer than the symptoms last: Medycyna Praktyczna reports that the virus is shed in saliva for about 3 weeks. The Royal Children’s Hospital recommends that a child who cannot control their drooling should not go to nursery or pre-school until the sores have dried up.

How can you help your child at home?

The mainstay of treatment for herpetic gingivostomatitis is keeping the child hydrated and relieving pain, the Royal Children’s Hospital guideline stresses. Most children with a mild illness are cared for at home, provided they drink enough and are followed up by a doctor.

A painkiller and fever reducer, and its dose for the child, are chosen by a doctor or pharmacist. Mouth gels containing salicylates are not used in people under 16, and products containing benzocaine are not used in children under 2; the Royal Children’s Hospital also notes that local anaesthetics have not been shown to work in this illness.

Not every child needs antiviral medicine. A review by Coppola et al. (2023) points to limited evidence of its effectiveness. According to the Royal Children’s Hospital, a doctor considers this treatment in a child with normal immunity if no more than 72 hours have passed since the illness began and there is severe pain or dehydration. Children with weakened immunity need antiviral treatment, and the decision to start it rests with a doctor.

• Give fluids often and in small amounts, preferably cool, with a teaspoon, through a straw or from a cup.
• Offer soft, cool or lukewarm food, and leave out sour, salty and crunchy foods for a few days.
• Give the painkiller chosen by a doctor or pharmacist before meals, so that it is easier for your child to drink.
• Apply petroleum jelly to the lips, which according to the Royal Children’s Hospital stops them sticking together.
• Count wet nappies or trips to the toilet, because according to the NHS passing urine less often may mean dehydration.
• Wash your child’s hands and your own, and do not share a spoon or cup with your child.

When to take your child to a doctor, and when to the emergency department?

A child with a fever and many ulcers in the mouth should be seen by a doctor, and urgently if they are drinking little or passing urine less often. The Royal Children’s Hospital guideline treats as warning signs dehydration, involvement of the eye, spread of sores on skin with atopic eczema, weakened immunity, and drowsiness, lethargy or a change in behaviour, which may indicate encephalitis.

The NHS adds that a doctor may refer a newborn baby with signs of a herpes virus infection to hospital. With the symptoms at the top of the list, call 112, the emergency number, or go to the hospital emergency department (SOR), and with the others see a doctor the same day.

• Drowsiness, lethargy, difficulty waking the child, seizures or unusual behaviour: 112 or SOR.
• The child is hardly passing urine, the urine is dark, the mouth is dry and the child is clearly weak: SOR.
• The child refuses to drink or is passing urine less often than usual: a doctor the same day.
• A red, painful or watering eye, or sores on the eyelid: a doctor the same day.
• Rapidly spreading blisters on the skin of a child with atopic eczema: a doctor the same day.
• A newborn, a child with weakened immunity, or a fever returning after a period of improvement: an urgent consultation.

Is it herpes, hand, foot and mouth disease, herpangina or mouth ulcers?

Herpetic gingivostomatitis is easiest to tell apart by the involvement of the gums and lips. Hand, foot and mouth disease and herpangina are infections with enteroviruses, mainly Coxsackie viruses; in herpangina the sores mainly affect the throat and the soft palate, usually sparing the gums, and in hand, foot and mouth disease the ulcers come with a rash on the hands and feet.

Mouth ulcers (aphthous ulcers) are not an infection and, according to the NHS, are not contagious; minor ulcers heal by themselves within 1 to 2 weeks. Mouth ulcers and their treatment are described in a separate article. The final diagnosis is made by a doctor, usually on the basis of how the sores look.

Cold sores in adults and visits to the dentist

After the first infection the herpes virus stays in the body and can reactivate as a cold sore. The NHS reports that a cold sore starts with tingling, itching or burning, blisters appear within 48 hours, and it usually heals within 10 days; recurrences are triggered by, among other things, illness, sunlight and periods.

A cold sore is contagious from the first tingling until it has fully healed. The NHS advises not kissing anyone during that time, especially babies, because a herpes virus infection is dangerous for a newborn; the WHO estimates that neonatal herpes is rare, occurring in about 10 in 100,000 births.

With an active cold sore, it is better to postpone planned dental treatment. Guidelines from Shropshire Community Health NHS Trust recommend moving planned appointments until the cold sore has turned into a dry scab or gone, because treatment can damage the blister and help the virus spread; emergency care is still provided despite a cold sore. It is worth letting reception know about it before the visit.

How it works at DentalBlue

Herpetic gingivostomatitis in a child with a fever is treated first and foremost by a paediatrician or family doctor. At DentalBlue in Białystok, mouth ulcers that do not go away or keep coming back are assessed by a dentist during a “Wizyta bez bólu” (visit without pain), which includes a panoramic X-ray, a consultation, an examination and a written treatment plan; in the clinic’s price list it costs 300 zł, and the final scope and cost are set by the dentist; prices may change. If a cold sore or a fever appears before a planned appointment, the appointment can be changed by phone on 85 748 00 50, Monday to Friday from 8:00 to 20:00 and on Saturdays from 8:00 to 16:00.