Why Do Babies and Children Get Black Tongues?

Table of Contents
View All
Table of Contents

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.

Doctor using tongue depressor to look in girl's mouth
KidStock / Blend Images / Getty Images

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

Possible Birthmark

Some children are born with a black tongue. It's considered a birthmark and is called pigmented nevus.


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:

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.

Other Salicylate-Containing Drugs

These medications also can cause Reye's syndrome. Ask your healthcare provider before giving them to a child.

  • Kaopectate
  • Aspirin
  • Oil of wintergreen

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.

Adult Causes of a Black Tongue

In adults, causes of a black tongue include smoking, cancer, side effects of chemotherapy, or bleeding. These causes are rare in children.

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:

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.


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.

Frequently Asked Questions

  • Can Pepto-Bismol turn your tongue black?

    Yes. The Pepto-Bismol that's made for adults can turn your tongue black.

    The children's version of Pepto should not turn your tongue black because it does not contain bismuth, the ingredient that causes the discoloration.

  • How do I get rid of my child's black tongue?

    If your child's black tongue is caused by medication, ask their healthcare provider if they can switch to a different medication. Sometimes, a gentle scraping at the dentist's office can remove the color.

    If it is caused by an infection, the black tongue should go away once it's treated with antibiotics or antifungals.

  • How long does black tongue last?

    That depends on what is causing it. If it's from a medication, the color should go away within days of when they stop taking it.

    A black tongue caused by infection should get better quickly once your child gets on the right treatment.

  • What deficiency causes a black tongue?

    A severe niacin (vitamin B3) deficiency can cause a condition often referred to as Black Tongue, also called pellagra. It's uncommon due to the modern diet's niacin content.

11 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Madhushankari GS, Yamunadevi A, Selvamani M, Mohan Kumar KP, Basandi PS. Halitosis - An overview: Part-I - Classification, etiology, and pathophysiology of halitosisJ Pharm Bioallied Sci. 2015;7(Suppl 2):S339–S343. doi:10.4103/0975-7406.163441

  2. Owczarek-Drabińska JE, Radwan-Oczko M. A case of lingua villosa nigra (black hairy tongue) in a 3-month-old infant. Am J Case Rep. 2020 Dec 26;21:e926362. doi:10.12659/AJCR.926362

  3. Goldman RD. Bismuth salicylate for diarrhea in children. Can Fam Physician. 2013;59(8):843–844. 

  4. Pacifico L, Osborn JF, Anania C, Vaira D, Olivero E, Chiesa C. Review article: Bismuth-based therapy for Helicobacter pylori eradication in children. Aliment Pharmacol Ther. 2012 May;35(9):1010-26. doi:10.1111/j.1365-2036.2012.05055.x

  5. National Institutes of Health, National Institute of Neurological Disorders and Stroke. Reye's syndrome.

  6. Kim-Jung L, Holquist C, Phillips J. FDA safety page: Kaopectate reformulation and upcoming labeling changesDrug Topics. 2014:58-60.

  7. U.S. Food and Drug Administration. How to treat diarrhea in infants and young children.

  8. National Institutes of Health, U.S. National Library of Medicine: DailyMed. Pepto Kids-calcium carbonate tablet, chewable.

  9. Cecchi C, Mariniello A, Carnio S, Delcuratolo MD, Novello S. Black hairy tongue after immune checkpoint inhibitors in NSCLC: A case report and review of the literature. Clin Lung Cancer. 2021 Mar 26:S1525-7304(21)00062-0. doi:10.1016/j.cllc.2021.03.008

  10. Gurvits GE, Tan A. Black hairy tongue syndrome. World J Gastroenterol. 2014 Aug 21;20(31):10845-50. doi:10.3748/wjg.v20.i31.10845

  11. Harvard University T.H. Chan School of Public Health. Niacin - Vitamin B3.

By Vincent Iannelli, MD
 Vincent Iannelli, MD, is a board-certified pediatrician and fellow of the American Academy of Pediatrics. Dr. Iannelli has cared for children for more than 20 years.