Oral thrush in babies

Oral thrush also known as oral candidiasis, oral moniliasis, “thrush” or oropharyngeal candidiasis, is a common and usually harmless yeast (fungal) infection of the mouth or throat (the oral cavity). Oral thrush mostly affects children under two years of age. Oral thrush is very common in the first year of life and usually isn’t anything to worry about. Sometimes it doesn’t even make babies uncomfortable. Oral thrush is a common condition, affecting around 1 in 20 babies. It is most common in babies around four weeks old, although older babies can get it too. Premature babies (babies born before 37 weeks) have an increased risk of developing oral thrush.

Oral thrush is caused by a strain of yeast fungus called Candida albicans, which lives on the skin, in the bowel and inside the mouth of most people. It doesn’t cause symptoms usually, but it can cause an infection in people with a weakened immune system. When too much Candida grows, thrush occurs. As the immune systems of newborn babies are still developing, they are more vulnerable to infection.

If a baby has oral thrush, there is a chance that the baby also has a yeast infection in the diaper area.

Babies can pass oral thrush on through breastfeeding. This can cause nipple thrush in mothers.

A mother who is breastfeeding may also need to be treated if she has a fungal infection on her breasts. This will help decrease the chance of re-infecting the infant.

The following are the most common signs and symptoms of candidiasis. However, each child may experience symptoms differently.

Signs and symptoms of thrush in babies include:

In the mouth (thrush):

• Creamy, white spots on the tongue, gums, on the inside of the cheeks or roof of the mouth (if you gently try to wipe the spots with a clean cloth, they won’t come off)
• There may be a white gloss on your baby’s tongue or lips
• White patches on the cheeks or throat (these white lesions do not scrape off easily)
• Your baby might feed for shorter periods, or seem unsettled during and between feeds

In the diaper area:

• Very red lesions with well-defined edges (lesions may be raised)
• Sores that have pus in them

Yeast infections in the diaper area usually have additional lesions away from the diaper area (i.e., on the stomach or thighs). A boy’s scrotum may also be affected.

The symptoms of candidiasis may resemble other dermatologic conditions or medical problems. Always consult your child’s physician for a diagnosis.

If you think your baby has thrush, make an appointment with your doctor as soon as possible. After examining the lesions, your doctor may want to take swabs from your nipple and your baby’s mouth to perform cultures of the lesions to help verify the diagnosis and to help in selecting the best treatment.

Figure 1. Thrush in babies

Footnote: A white coating on the tongue like cottage cheese – this can’t be rubbed off easily. Sometimes there are white spots in their mouth.

Can I breastfeed if I have thrush?

Yes, carry on breastfeeding if you can. If you can’t because it’s too painful, try expressing your milk instead. You can give your baby freshly expressed milk, but throw away any leftovers – and don’t freeze it, freezing does not kill off the thrush and you could re-infect your baby. If you are in the early days of breastfeeding, it’s very important to continue breastfeeding, or expressing your milk. By pausing, or taking a break, you’ll reduce the amount of breast milk you produce.

What causes thrush?

There are over 20 species of Candida yeasts that can cause infection in humans. Thrush is most commonly caused by a fungus called Candida albicans. It occurs commonly in the neonate and infant. Older children with thrush often have another health problem that causes the condition to develop. The following are some of the factors that may increase the chance of the infant developing thrush:

• Antibiotics. Antibiotics can cause yeast to grow, because the normal bacteria in tissues are killed off, letting the yeast grow unhampered.
• Steroids. Steroids may decrease the child’s immune system and decrease the ability to fight normal infections.
• Poor immune system. If the infant has a poor immune system and an inability to fight infection from another chronic disease, he or she is at an increased risk for developing thrush.

Thrush in babies prevention

In most cases, there is no known cause for oral thrush infections in babies. As almost everyone, including babies, has Candida in and on their bodies, you can’t really protect a baby from thrush. The steps below may help to prevent infection:

• If your baby uses a dummy, sterilize all their pacifiers (dummies) regularly, as well as any toys designed to be put in their mouth, such as teething rings. It is wise not to allow anybody to wet the baby’s dummy in their own mouth.
• If you bottle-feed your baby, sterilize the bottles and other feeding equipment regularly, especially the teats.
• Give your baby a drink of sterilized water after a feed, to rinse away any milk left in their mouth.
• Wash your baby’s clothes at 60 degrees Celsius to kill the fungus
• If you are breastfeeding, wash your nipples with water and dry them thoroughly between feeds.

Stop thrush spreading

Thrush spreads easily (and can spread to other members of the family) so you’ll need to be extra careful with hygiene. Things you, and everyone else in your household should do:

• wash hands thoroughly, especially after nappy changes
• use separate towels
• wash and sterilize pacifiers (dummies), teats, and any toys your baby may put in their mouth
• change your breast pads often
• wash all towels, baby clothes, and bras (anything that comes into contact with the infected area) at a high temperature to kill off the fungus

Oral thrush signs and symptoms

Symptoms of oral thrush can include one or more white spots or patches in and around the baby’s mouth and tongue.

These may look white or cream-colored, like curd or cottage cheese. They can also join together to make larger plaques. You may see patches:

• on your baby’s gums
• on their tongue
• on the roof of their mouth (palate)
• inside their cheeks

Unlike bits of milk, the patches do not wash or rub off easily. The tissue underneath will be red and raw. It may also bleed a little. The patches may not seem to bother your baby. But if they are sore, your baby may be reluctant to feed.

Other signs and symptoms of oral thrush in babies are:

• a whitish sheen to their saliva
• fussiness at the breast (keeps detaching from the breast)
• refusing the breast
• clicking sounds during feeding
• poor weight gain
• red rash in nappy area

Some babies may dribble more saliva than normal if they have an oral thrush infection.

Thrush in babies diagnosis

The diagnosis of baby thrush is made by your child’s doctor after a thorough history and physical examination. After examining the lesions, your doctor may want to take swabs from your nipple and your baby’s mouth to perform cultures of the lesions to help verify the diagnosis and to help in selecting the best treatment.

Thrush in babies treatment

Many cases of oral thrush clear up in a few days without the need for treatment. If symptoms persist or they are particularly troublesome, see your doctor. There are several antifungal gels or drops that can treat oral thrush. It is important to speak to your doctor or pharmacist before you use them as some gels are not suitable for very young babies.

Your doctor will probably prescribe antifungal drops or oral gel, which you use after each feed or meal for 10 days.

If your baby is breastfeeding, the mother’s nipples may need to be treated at the same time as the baby to prevent the infection passing back and forth.

Sometimes oral thrush goes along with thrush in the nappy area, which will need treatment at the same time.

You can still breastfeed if your child has oral thrush. Your doctor might advise you to put some antifungal cream on your nipples as well, but you should wipe this off before feeding.

Oral thrush and breastfeeding

If your baby has oral thrush and you’re breastfeeding, it’s possible for your baby to pass a thrush infection to you. The infection can affect your nipples or breasts. It’s commonly called ‘nipple thrush’, mammary candidosis or mammary candidiasis.

If you are breastfeeding and experiencing horrible sharp, shooting pains in both breasts, this could be caused by thrush. It can make breastfeeding very painful, but don’t worry – it’s easily treated.

It’s worth remembering that a thrush infection may not be the cause of nipple pain, it could be that your baby simply isn’t latching on properly. If you think this could be the case, ask your health care provider or lactation nurse for guidance.

What are the symptoms of nipple thrush?

If you are breastfeeding and have the following symptoms, it may be thrush. Make an appointment with your doctor as soon as possible. If you have thrush, you may experience the following symptoms:

• pain in your nipples (burning, sharp, shooting pains) while you’re feeding your baby, which may continue after the feed is finished, can last up to an hour after feeds
• cracked, flaky, itchy or sore nipples and areola (the darker area around your nipple)
• areola that is red or shiny
• a shooting pain, burning or itching sensations in one or both of your breasts, which may continue between feeds

It’s also possible that you may have no symptoms of infection. Symptoms of nipple thrush do not include fever or redness of your breasts. However, these can be symptoms of mastitis (infection of the breast).

It’s more likely that your baby can pass a thrush infection to you if you have had:

• cracked nipples before because your baby was not positioned correctly when feeding, or
• other thrush infections

It may also be more likely if you’ve been taking antibiotics. This can reduce your level of healthy bacteria, allowing the fungus that causes thrush to increase.

A nipple thrush infection is difficult to diagnose because:

• You may have no symptoms, even if it is confirmed that your baby has oral thrush.
• The symptoms you do have may also be found in other conditions. For example, pain in your nipples could also be caused by a bacterial infection.

However, if your nipples are sore, painful or cracked, the most likely cause is that your baby is not attaching to your breast correctly when they are feeding.

How is nipple thrush diagnosed?

After examining the lesions, your doctor may want to take swabs from your nipple and your baby’s mouth to perform cultures of the lesions to help verify the diagnosis and to help in selecting the best treatment.

If it is a thrush infection, you may be prescribed an antifungal cream or tablets. The cream needs to be applied to your nipples after every feed. If your baby has thrush, your doctor will prescribe a gel or cream to apply to the infected area.

Nipple thrush treatment

If you have no symptoms, you’re unlikely to need treatment, even if it’s confirmed that your baby has oral thrush. However, your nipples may need to be treated at the same time as the baby to prevent the infection passing back and forth.

If you do have symptoms, or if the infection is causing problems with feeding, your doctor may prescribe an antifungal cream.

If your infection is more severe, your doctor may recommend a course of antifungal tablets. If your doctor prescribes antifungal cream or tablets for you, your baby will probably be treated at the same time, to prevent re-infection. If the infection does not clear up after a few days, or if feeding problems continue, you should visit your doctor again.