Geographic Tongue in Children

Geographic tongue (benign migratory glossitis) is a harmless inflammatory condition of the tongue in which smooth red patches with white margins appear and change shape over days. It affects 1 to 3 percent of the population, and is common in children.

The cause is unknown; atopy, family history, stress and fissured tongue are associated.

It is not infectious and not related to cancer.

It often comes and goes for years.

Irregular red, depapillated patches surrounded by raised white or yellow borders on the tongue surface, moving in position within hours to days.

Most children have no symptoms; some have burning or sensitivity to acidic, spicy or salty foods.

Differential diagnosis: oral candidiasis, lichen planus, scarlet fever (strawberry tongue), Kawasaki disease, iron, B12 or folate deficiency, psoriasis, leukoplakia, drug reaction, herpetic stomatitis.

Complications: rarely pain, taste disturbance and poor feeding.

Clinical, with no investigations in typical cases.

• Full blood count, ferritin, vitamin B12 and folate if the tongue is painful or atypical.
• Swab for candida if white plaques that wipe off.
• Biopsy only for non migrating or suspicious lesions.

Reassure the parents; treatment is for symptoms only.

• Supportive: reassurance that the condition is benign, avoid spicy, acidic and salty foods during flares, soft toothbrush, good oral hygiene.
• Pharmacological: paracetamol 15 mg/kg before meals for pain; benzydamine 0.15 percent mouthwash (children over 6 years) diluted for soreness; triamcinolone 0.1 percent paste applied to painful areas twice daily for 1 to 2 weeks if severe; correct any deficiency found.
• Procedures: none.
• Special groups: infants, avoid mouthwash; children with atopy, treat allergic disease; those with fissured tongue, tongue hygiene.
• Red flags: persistent non migrating ulcer or white patch, weight loss, fever with rash and red tongue, difficulty feeding, lymph node enlargement.
• Follow-up: no routine follow up; review if symptoms persist beyond 4 weeks or the pattern changes.