Q&A:
What could be causing my 20-month-old's gums to swell and bleed?

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Answered by Stephen Muething M.D.

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"I love being a pediatrician," says Stephen Muething, medical director of the Pampers Parenting Network. "Through my special role, I get to partner with families in the very important job of helping children develop and grow. My task is to help parents raise their children to be as healthy, happy, and successful as they can be."

Dr. Muething received his B.S. degree from the University of Notre Dame and his medical degree from the University of Cincinnati College of Medicine. After completing his pediatric residency and chief residency at Cincinnati Children's Hospital Medical Center, he served as the lead physician of a five-pediatrician practice in Southeast Indiana for 13 years.

Dr. Muething is currently the associate director in the Division of General Pediatrics, Cincinnati Children's Hospital Medical Center, leading a team that performs more than 60,000 primary care visits and cares for more than 3,500 inpatients annually. He is also the director of the Diagnostic Clinic for Cincinnati Children's Hospital. Since 2001, Dr. Muething has served as one of the key physicians in the Pursuing Perfection initiative at Cincinnati Children's, funded by the Robert Wood Johnson Foundation in conjunction with the Institute for Healthcare Improvement. Dr. Muething is now a graduate of the Advanced Training Program in Healthcare Delivery Improvement at Intermountain Health Care in Salt Lake City, Utah.

Dr. Muething has been a co-leader for the Acute Care Team at Cincinnati Children's, which has focused on designing an evidence-based, family-centered care system for children in the Cincinnati area. Results of the work have been presented at the annual meetings of the National Association of Children's Hospitals and Related Institutions (NACHRI), the National Initiative for Children's Healthcare Quality (NICHQ), the Institute for Healthcare Improvement (IHI), and the Pediatric Academic Societies (PAS).

As "Dr. Steve," Dr. Muething hosts two radio programs for families in the Cincinnati area and is the pediatric consultant for The Health Show, a nationally syndicated radio show. Other community activities include serving as moderator for the "Centering on Families: Tools for Practical Parenting" series at the Cincinnati Museum Center.

Family life is central for Dr. Muething and his wife, Meg, both of whom were raised in large families. They have four children—ranging from elementary school age to college graduate—and more than 40 nieces and nephews.

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Question

Your son's teeth and gums seem to be developing very well, but from your description I believe he has an infection.

Answer

Your son's teeth and gums seem to be developing very well, but from your description I believe he has an infection. It could be one of several different infectionsnone of them seriousthat can affect children's gums.

He likely has a viral infection of the mouth caused by the herpes virus. This is the virus that causes cold sores and fever blisters and sometimes fever and pain. The first time children have the herpes virus they typically have an active infection throughout the mouth that lasts about a week. The immune system will clear the virus on its own. We usually treat the infection with pain medicine and gentle cleaning of the gums. If the virus comes back, it will produce one cold sore or fever blister.

This virus is contagiousyour son probably picked it up from someone with a cold sore or fever blister. Make sure other family members do not become ill by insisting on frequent and thorough hand-washing. Also, keep your son away from any newborns or individuals with immune problems until he is healed.

There are other viruses that can cause blisters in the mouth, too. In addition, infants and toddlers can get thrush, which is a yeast infection in the mouth. Thrush can make the gums red, swollen, and painful and produce white, cottage cheese-like patches on the gums and mouth surface. Thrush often needs medicine to clear.

When dealing with sores or bleeding of the gums, if the problem lasts more than two or three days or the pain is severe, have your son seen by his health care provider.

Good luck! I hope he feels better quickly.