Magic mouthwash

In infants, do NOT use oral lidocaine due to risk of methemoglobinemia and FDA black box warning[1][2]


  • Some experts recommend Magic Mouthwash / oral Lidocaine in children if not tolerating PO intake, although evidence suggests no better than placebo[3]


  • DO NOT EXCEED dosing limits especially for lidocaine.
  • DO NOT use under 2 years old
  • Never give a family an amount that can be toxic if unintentionally swallowed in its entirety


  • 1 cc Viscous 2% lidocaine = 20mg lidocaine
  • Max dose = 5mg/kg
  • For a 10 kg child = 50mg lidocaine = 2.5 cc


  • Diphenhydramine 6.25mg/5cc or 12.5mg/5cc
  • Max dose = 5mg/kg/day
  • For a 10 kg child = 50mg benadryl =20 cc of 12.5mg/5cc


Equal parts:

  1. Viscous lidocaine 2%
  2. Diphenhydramine
  3. Maalox
  • May also omit lidocaine


0.5-1mL before feeds

See Also


  1. FDA recommends not using lidocaine to treat teething pain.
  2. Curtis LA, Dolan TS, Seibert HE. Are one or two dangerous? Lidocaine and topical anesthetic exposures in children. J Emerg Med 2009;37:32-39
  3. Hopper S. et al. Topical lidocaine to improve oral intake in children with painful infectious mouth ulcers: a blinded, randomized, placebo-controlled trial. Ann Emerg Med. 2014 Mar;63(3):292-9