Q: My 8-year-old son has been complaining of stomach ache with mouth ulcers. We took him to a child specialist who prescribed a gel with vitamin tablets (cip cal) and also gave Nice kid tablets for fever. The mouth ulcers below the front jaw have decreased but fever persists at 101 degrees with head ache. The doctor is suspecting malaria and has given medicines for it. Is it malaria? If so how many days will it last?

A:The most common cause of mouth ulcers in children is primary infection with herpes simplex virus. The ulcers develop on the tongue and lips accompanied by inflamed gums. It is painful and lasts usually 4-9 days. Aphthous ulcers are single or multiple lesions affecting the loose oral mucosa (not lips and gums). They are painful and some times recurrent. Minor ones last for 5-10 days. Some major ones may even last longer. Aphthous ulcers are not the result of virus infection, but the cause is unknown, probably secondary to deficiencies of iron, vitamin B1, B2, B6 or B12, or folate. Mouth ulcers can occur in a variety of other viral illnesses and children with immunodeficiencies and following drug intake (actinomycin, cotrimoxazole). Mouth ulcers with abdominal pain are uncommon and need evaluation. Malaria per se does not cause abdominal pain and mouth ulcers, but any child with recurrent fever needs evaluation for malaria especially in endemic areas.