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Children's Health

Milk breath



My almost 4 year old son`s breath smells like milk. He does not drink milk or even eat very much dairy at all, but I always notice that his breath smells like milk. Is there any reason you know of that would make his breath smell this way? I know certain breath smells can be a symptom of disease, this is why I ask. He has multiple food and environmental allergies(not milk), asthma and a ventricular septal defect. Also he very rarely has a "normal" bowel movement. He is small for age(29lbs,36 inches), has had 2 sets of ear tubes and an adenoidectomy/tonsillectomy. Thank you for any input!


You are correct that the odor of a person's breath may reflect a health problem, most often a problem with the metabolism or body's processing of amino acids, fatty acid. I am happy to say that mild, milky breath odors are exactly how young children's breath does smell. Their breath typically is never unpleasant when they are healthy. Unpleasant breath occurs when children mouth breathe due to allergies, upper respiratory infection, and sinus infections.

I checked your son's measurements on a growth chart. He is below the 5th percentile for weight and below the 3rd percentile for height, which means he is among the smallest and lightest weight boys his age. Food allergies can make good growth difficult if he has many food restrictions. There are many immune cells in the intestine to protect us from illness. Part of the way they do this, both in response to germ invasion as well as in response to allergens, is to pour more fluid into the intestine and move the offending germs and foods along faster. This means that there is a lot less time for the intestines to absorb nutrients from food to fuel growth.

Many immune cells also live in the lymph tissues of the body, including the tonsils and adenoids. Their job is to remove allergens from the respiratory tract and protect the lungs from inflammation. When they are very active in doing this as they are in children with allergies, they become too large for a child's small airways and need to be removed. Also, the inflammation from allergies creates a constant wet environment in the upper airways that promotes ear infections.

So, don't worry about his breath, but do focus on working with his allergist to identify and control allergens. If you have not done so, you might consider asking for a nutrition consultation to make his diet the best it can be for good growth and a pediatric gastrointestinal consult to make sure your son does not have a malabsorption problem, that is a problem with absorption of one or more nutrients, that is slowing his growth.

In his four short years of life you have already dealt with many health problems. It can be exhausting. I hope you and your partner take time to rest and renew together. The good news is that many allergies to lessen in number and severity as a child gets older. I hope this information is helpful to you.

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Response by:

Mary M Gottesman, PhD, RN, CPNP, FAAN Mary M Gottesman, PhD, RN, CPNP, FAAN
Professor of Clinical Nursing
College of Nursing
The Ohio State University