Why Do Babies and Children Get Black Tongues?

If your child has a black tongue, you might be worried that something is really wrong. While it can be frightening, it's usually harmless and easy to explain. Still, you should know certain warning signs to look for.

This article will go over what can cause black tongue in children, when you should get medical care for it, and how to get rid of it if it doesn't go away on its own.

Causes of a Black Tongue in Children

Some causes of a black tongue in children are medical while others aren't. Non-medical causes include:

• Drinking or eating something with a black dye or food coloring
• Drinking or eating something with natural colors that stain (like blackberries)

Among medical causes, they can either be related to illnesses or medications. Some illness that can cause a black tongue are:

• Bacteria in the mouth that produce sulfur compounds
• A condition called black hairy tongue or lingua villosa nigra, in which too much bacteria or yeast grows on the tongue

Pepto-Bismol

The most common cause of a black tongue in kids is the popular over-the-counter (OTC) medication Pepto-Bismol. This drug is used to treat:

• Upset stomach
• Acid indigestion
• Diarrhea
• Symptoms of Helicobacter pylori (H. pylori) infection, which causes ulcers in the digestive tract
  

Pepto-Bismol contains an ingredient called bismuth subsalicylate. When bismuth mixes with sulfur (a natural component of saliva) it forms bismuth sulfide. This substance can make your tongue look black.

This discoloration typically goes away on its own a few days after you stop taking the medication.

Bismuth and Reye's Syndrome in Kids

Kids under 12 shouldn't take Pepto-Bismol or other drugs containing bismuth subsalicylate. The ingredient has been linked to a condition called Reye's syndrome in kids.

Reye's syndrome is a serious—and potentially fatal—illness. It causes:

• Fluid build-up in the brain
• Swelling and fatty deposits in the liver and other organs
• Low blood sugar (hypoglycemia)
• High ammonia and acidity levels

Symptoms include:

• Ongoing or repeated vomiting
• Listlessness
• Irritability or combativeness
• Confusion
• Delirium
• Seizures
• Loss of consciousness

This illness usually comes on soon after a viral illness. If you see these symptoms in your child when they're recovering from something, get medical treatment right away.

Pepto-Bismol and Children

Due to the risk of Reye's syndrome, regular Pepto-Bismol isn't approved or recommended for kids under 12. Alternate medications are used for treating digestive problems and H. pylori infections in children.

Children's Pepto-Bismol doesn't contain bismuth subsalicylate and is considered safe for kids as young as 2. If your baby or toddler has diarrhea or digestive issues, ask your pediatrician how best to treat it.

With its distinctive pink color and minty flavor, some children decide to drink Pepto-Bismol. If your child has a black tongue and you don't know why, it may be wise to ask them if they've drunk Pepto-Bismol or check to see if some is missing from the bottle.

Also, watch for dark stool (poop). Bismuth causes that when it mixes with sulfur in the intestines.

Be sure to keep Pepto-Bismol and all other medicines where children can't get to them.

When to Call a Healthcare Provider

Usually, most causes of black tongue are harmless, and the only concern is how it looks. However, watch for warning signs of a medical condition, including:

• Bad breath (halitosis)
• Bitter or unpleasant taste in the mouth
• Bleeding
• Burning sensation of the tongue
• Dark gums
• Diarrhea
• Discharge from or anywhere in their mouth
• Pain
• Swelling
  

Get urgent medical care if your child has a black tongue plus:

• Abdominal pain
• Throwing up (especially if they have bloody vomit)
• A high fever that doesn't go away
• Symptoms of Reye's syndrome.

Call your healthcare provider if you notice any of these symptoms along with a black tongue.

Treatment for a Black Tongue

A black tongue from food usually clears up quickly on its own. If it's caused by medication, it should go away soon after the child stops taking it. If not, their dentist can gently scrape the tongue to get rid of the color.

If the black tongue is caused by an illness, it may last until the condition is properly treated. This may involve prescription antifungals or antibiotics.

Summary

A black tongue is usually harmless. If your child eats or drinks something with a dark color (such as candy or berries), it might make their tongue black for a short time.

Some infections can also cause a black tongue. So can Pepto-Bismol or other medications containing salicylates. Regular Pepto shouldn't be taken by kids under 12. The children's formulation of Pepto-Bismol is safe for children over 2.

A black tongue caused by food/drink should go away quickly. If it's caused by medicine, it should clear up within days of when they stop taking it. If not, their dentist can gently scrape it away.

A black tongue caused by an infection may require antibiotics or antifungal medications.