THRUSH
DEFINITION
- A superficial yeast infection of the mouth of young babies
- Causes white patches in the front of the mouth
Symptoms
- White, irregularly shaped patches in the mouth
- Coats the inside cheeks or inner lips
- Sometimes coats the tongue (if the only symptom is a uniformly white tongue, it's due to a milk diet, not thrush)
- Adherent to the mouth (cannot be washed away or wiped off easily like milk curds)
- Occasionally causes a painful mouth, reluctance to suck and reduced milk intake
- Mild discomfort or no symptoms in most newborns
- The infant is bottle-fed or breast-fed
Cause
- Caused by a yeast (called Candida)
- Occurs on parts of the mouth involved with sucking
- Accentuated by friction from frequent pacifier use
Return to Day Care
- Thrush is not contagious, since it does not invade normal tissue. Your child can go to day care with thrush.
See More Appropriate Topic (instead of this one) If
- It doesn't look like thrush, see MOUTH ULCERS.
WHEN TO CALL YOUR DOCTOR
Call your doctor now (night or day) if:
- Your child looks or acts very sick.
- Signs of dehydration (very dry mouth, no tears and no urine in more than 8 hours).
- Age less than 1 month old and looks or acts sick in any way.
Call your doctor within 24 hours (between 9am and 4pm) if:
- You think your child needs to be seen.
- Fever occurs.
- Bleeding is present
- Drinking less than normal
Call your doctor during weekday office hours if:
- Thrush, but none of the symptoms described above (reason: may need prescription medicine to treat it).
HOME CARE ADVICE Pending Talking With Your Doctor)
- Anti-Yeast Medicine: Your doctor will probably prescribe an anti-yeast liquid medicine. Use it as follows:
- Place 1 ml (2 ml if over age 1 month) in the front of the mouth on each side or where ever you see the thrush (it doesn't do any good once it's swallowed). Do this 4 times per day
- If the thrush isn't responding, rub the medicine directly on the affected areas with a cotton swab.
- Don't feed your baby anything for 30 minutes after application.
- Keep this up for at least 7 days, or until all thrush has been gone for 3 days.
- Decrease Sucking Time to 20 Minutes per Feeding: Reason: prolonged sucking (as when a baby sleeps with a bottle) can irritate the lining of the mouth and make it more prone to yeast infection. For severe mouth pain with bottle feeding, offer fluids in a cup, spoon or syringe rather than a bottle (Reason: The nipple increases pain).
- Limit Pacifier Use:
- Again, prolonged sucking on a pacifier can irritate the mouth.
- Limit pacifier use to times when nothing else will calm your baby.
- If your infant is using an orthodontic pacifier, switch to a smaller, regular one (Reason: bigger ones can irritate the mouth more).
- Special washing of pacifiers or bottle nipples is not necessary or helpful.
- Breastfeeding: If the mother's nipples are red and sore, apply Lotrimin Cream (no prescription needed) 4 times per day AFTER feedings.
- Diaper Rash: If there's a bad diaper rash, it's also probably due to yeast. Apply Lotrimin cream (no prescription needed) 4 times per day (see DIAPER RASH topic).
- Contagiousness: Thrush is not contagious, since it does not invade normal tissue. Your child can go to day care with thrush.
- Expected Course: With treatment, thrush usually clears up in 4 to 5 days. Without treatment, it clears up in 2-8 weeks.
- Call Your Doctor If:
- Drinking becomes less than normal
- Your child becomes worse
And remember, contact your doctor if your child becomes worse or develops any of the "Call Your Doctor" symptoms.
REFERENCES
- American Academy of Pediatrics: Committee on Infectious Diseases. Thrush. In Pickering L, ed. 2006 Red Book. 27th ed. Elk Grove Village, IL: 2006.
- Goins RA. Comparison of fluconazole and nystatin oral suspensions for treatment of oral candidiasis in Infants. Pediatr Infect Dis J. 2002;21(12):1165-1167.
- Hoppe JE. Treatment of oropharyngeal candidiasis and candidal diaper dermatitis in neonates and infants: Review and reappraisal. Pediatr Infect Dis J. 1997;16:885-894.
- Hostetter MK. New insights into candidal infections. In: Barness LA et al editors. Advances in pediatrics. Mosby-Year Book; 1996. p. 209-230.
- Krol D, Keels M. Oral conditions. Pediatr Rev. 2007;28(1):15-22.
Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.
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