Thrush in a 3 year old

Causes, Treatment and When to See a Doctor

Nationwide Children’s Hospital

Thrush is an infection caused by a fungus called candida (CAN-did-ah). Candida is naturally present in the mouth and body and is usually harmless. But, if conditions are right, it can grow out of control and cause an infection.

A candida infection in the mouth is called oral thrush; in the diaper area, a yeast diaper rash; in other places on or in the body, a yeast infection.
Candida is the same fungus that causes vaginal yeast infections.
Oral thrush is more common in infants and toddlers, but older children can get it too.
Thrush is contagious (catching) and can be passed to others.

Risk Factors for Getting Thrush Are:

Age – born early (premature) or younger than 6 months or low birth weight
Getting it during birth from the parent who has an unknown vaginal yeast infection
Breastfeeding with an untreated yeast infection of the breast
Using human milk from a pump that has not been properly sterilized
Sucking on a pacifier or bottle too often and for too long
Using an inhaler for asthma without rinsing the mouth after use
Recent history of child or nursing parent taking antibiotic medicine to treat a bacterial infection
A weakened immune system

Signs and Symptoms

Thrush in the mouth:
- Can be on the tongue, gums, roof of the mouth, or inside of the cheeks.
- Begins as tiny, flat, white, or creamy yellow spots. These spots come together and form cheesy patches that look like cottage cheese. The spots are often mistaken for milk patches. Sometimes it looks like a white coating.
- Cannot be removed with a soft cloth or a cotton-tipped swab without causing bleeding.
- May cause pain while sucking or swallowing. Your child may not drink or eat as much as usual.
Yeast infections in the diaper area look like diaper rash. The skin can have:
- Small or big red patches, be entirely bright red, or have raised edges or small bumps
- Pimples that ooze pus
A vaginal yeast infection can cause the skin to be red, itchy, and burn. Often, there is a creamy discharge from the vagina.

Treatment

Thrush is easily treated with an antifungal medicine such as nystatin (Mycostatin^®), fluconazole (Diflucan^®), or itraconazole (Sporanox^®). Your child may get these medicines as a syrup or a pill.
Thrush usually clears up in 4 to 5 days. It is important to use all of the medicine for the length of time that is recommended.
An antifungal cream is usually recommended for yeast infections in the diaper area, in the vagina, or other places on the skin. You can buy some of these medicines without a prescription.
Avoid using any home remedies without asking your child’s health care provider first.

How to Give Oral Drops

A liquid medicine comes with a dropper in the box. Use it to give the oral drops.
You will put the drops directly in the mouth on the sores. The medicine needs to stay in the mouth for a while. It will not hurt your child to swallow it.
Plan to give the drops right after you feed your baby.

Follow These Steps:

Wash your hands well.
For an infant or young child, place them on their back. Turn their head sideways so that the cheek with the white patches faces down toward the bed (Picture 1).
Gently open your child’s mouth and drop half of the medicine inside the cheek. Turn your child’s head the other way and repeat squirting the medicine inside the other cheek.
Using a cotton-tipped swab, spread the medicine inside the mouth over the white patches.
For an older child, have them swish the medicine in their mouth for 30 seconds and then swallow.
Wait 30 minutes before giving your child anything to eat or drink.

Other Advice for Oral Thrush

Always wash your hands well before and after touching your child’s mouth or things that have touched their mouth. This is so you do not pass the infection to others.
Be sure your child drinks plenty of liquids so that they do not get dehydrated (lose too much fluid).
Sterilize baby bottle nipples after each use. Do this by placing the nipples in boiling water for 10 minutes. Let the nipples cool before using them.
Limit breastfeeding and bottle feeding to 20 minutes. Sucking for a long time can increase irritation.
If your baby uses a pacifier:
Let them use it only when they cannot be calmed in any other way.
Buy several extras that can be sterilized between uses. Sterilize pacifiers the same way as the bottle nipples.
Do not put your child’s pacifier in your mouth or let other children do this.
Do not share bottles, cups, or toys that your child has used with others.
If you are breastfeeding:
Clean each breast with water and air-dry after each feeding.
If your breasts show any signs of infection, such as soreness or redness, call your health care provider. You may need to be treated at the same time.
If using human breast milk from a pump, all pump parts need to be sterilized.

Treatment of a Yeast Rash

If your baby has a yeast diaper rash or yeast infection on the skin, the health care provider will prescribe a cream or recommend an over-the-counter one.

Wash your hands well before and after treating your child’s yeast infection.
To help the skin heal, keep it clean and dry.

For a Yeast Diaper Rash:

Change the diaper as soon as your baby pees or poops. You may also want to change the diaper once during the night.
Rinse your baby’s bottom after each diaper change. Gently clean the diaper area from front to back and inside the skin folds with warm water and a soft washcloth (Picture 2).
Try to avoid baby wipes, but especially those with alcohol, propylene glycol, and fragrances.
Use mild soap and water only if the poop (stool) does not come off easily.
Avoid scrubbing or rubbing. It can damage the skin more.
If the rash is severe, use a squirt bottle of water to clean and rinse without rubbing. Or you can soak your baby’s bottom in a tub of warm water after each diaper change.
Pat the skin dry and let it air dry fully.
Apply a thin layer of antifungal cream. Most should be used only 2 to 3 times a day.
You can also use an over-the-counter skin barrier or zinc oxide cream over the antifungal cream on the baby’s bottom and in the skin folds. Apply a thick layer each time the diaper is changed. Popular ones are petroleum jelly (Vaseline^®) or a cream with zinc oxide like Desitin^®, Triple Paste^®, A+D^®, or Balmex^®. These creams do not have to be completely washed off with each diaper change.
Do not use steroidal creams, corn starch, talc, or baby powder on your baby’s bottom.
Let your baby play or nap with their diaper off. The air helps dry and heal the rash (Picture 3).
Avoid rubber pants or plastic liners over the diaper.
Put the diaper on loosely so it does not rub against the skin as much.
Call your child’s health care provider if thrush gets worse after 3 days of treatment, if it lasts more than 10 days, or you have any questions.

Thrush and Yeast Infections (PDF), Somali (PDF), Spanish (PDF)

Oral Thrush (for Parents) - Nemours KidsHealth

Reviewed by: Michelle P. Tellado, MD

en español Muguet (candidiasis oral)

What Is Oral Thrush?

Oral thrush is a very common yeast infection in babies. It causes irritation in and around a baby's mouth.

What Are the Signs and Symptoms of Oral Thrush?

Oral thrush (also called oral candidiasis) can affect anyone, but is most common in babies younger than 6 months old and in older adults.

A baby with oral thrush might have cracked skin in the corners of the mouth or white patches on the lips, tongue, or inside the cheeks that look a little like cottage cheese but can't be wiped away.

Some babies may not feed well or are uncomfortable when sucking because their mouth feels sore, but many babies don't feel any pain or discomfort.

What Causes Oral Thrush?

Oral thrush is caused by the overgrowth of a yeast (a type of fungus) called Candida albicans.

Most people (including infants) naturally have Candida in their mouths and digestive tracts, which is considered normal growth. Usually, a healthy immune system and some "good" bacteria control the amount of this fungus in the body.

But if the immune system is weakened (from an illness or medicines like chemotherapy) or not fully developed (as in babies), Candida in the digestive tract can overgrow and lead to an infection. Candida overgrowth also causes diaper rash and vaginal yeast infections. Babies can have oral thrush and a diaper rash at the same time.

Candida overgrowth also can happen after a baby has been given antibiotics for a bacterial infection because antibiotics can kill off the "good" bacteria that keep the Candida from growing. Oral thrush also can happen after the use of steroid medicines.

How Is Oral Thrush Treated?

See your doctor if you think your baby may have thrush. Some cases go away without medical treatment within a week or two, but the doctor may prescribe an antifungal solution for your baby's mouth. This medicine is usually applied several times a day by "painting" it on the inside of the mouth and tongue with a sponge applicator.

Depending on your baby's age, the doctor also might suggest adding yogurt with lactobacilli to your baby's diet. The lactobacilli are "good" bacteria that can help get rid of the yeast in your child's mouth.

If your baby keeps getting oral thrush, especially if he or she is older than 9 months old, talk with your doctor because this might be a sign of another health issue.

Can Oral Thrush Be Prevented?

Oral thrush is a common infection in babies, but you can help prevent it:

If you formula-feed your baby or use a pacifier, thoroughly clean the nipples and pacifiers in hot water or a dishwasher after each use. That way, if there's yeast on the bottle nipple or pacifier, your baby won't be reinfected. Store milk and prepared bottles in the refrigerator to prevent yeast from growing.
If you breastfeed and your nipples are red and sore, you might have a yeast infection on your nipples, which you and your baby can pass back and forth. Talk to your doctor, who might recommend using an antifungal ointment on your nipples while your baby is treated with the antifungal solution.

To prevent diaper rash, change diapers often.

Reviewed by: Michelle P. Tellado, MD

Date reviewed: September 2019

Candidiasis in the mouth of a child

Contents

What kind of disease is candidiasisSymptomsCausesTreatmentMethods of therapyPreventive measures

Many parents are aware of such a common problem in children as thrush, which is characterized by the appearance of white plaque on the tissues of the oral cavity. In medicine, this pathological condition has the term "candidiasis" and refers to fungal diseases.

Most often, candidiasis develops in the mouth of a child in the first year of life. Symptoms of thrush greatly disturb the baby, but timely treatment allows you to quickly and without consequences get rid of the fungus. nine0003

What kind of disease is candidiasis

According to statistics, about 30% of infants are faced with candidiasis. The causative agent of the disease is the Candida fungus. These specific microorganisms are normally present in the body of every person, even in the absence of health problems, but only in small quantities.

Oral candidiasis in children is much more common, since the immune system of babies is not yet formed and is not able to withstand pathogenic microorganisms and the effects of negative external factors. nine0003

With a weakened immune system and the concomitant effect of provoking factors, the fungus begins to actively multiply, affecting the mucous membranes. Without therapeutic treatment, candidiasis is eliminated in exceptional cases. If thrush is not treated, complications arise, and the infection itself spreads throughout the body.

Symptoms

Oral candidiasis in children can have a different form of manifestation and severity of symptoms: mild, moderate and severe. As a rule, each form corresponds to the stage of development of the disease. If therapy is not carried out in a timely manner, then the signs of a fungal infection become more intense and the number of symptoms increases. nine0003

With a mild form of the disease, a red rash appears on the oral mucosa, which is covered with a white coating on top. At the next stage, the child has swelling of the tissues and the formation of localized white spots with a touch of curd consistency. Gradually, these spots merge into a large affected area. When plaque is removed, bleeding sores open. If the thrush starts, then the fungus already spreads to the entire oral cavity, including the lips, tongue and throat. All fabrics are completely covered with cheesy bloom. nine0003

Common symptoms of candidiasis in children include:

burning sensation and itching in the mouth;
discomfort and pain when eating;
frequent spitting up in babies;
the formation of cracks in the corners of the lips;
temperature rise. nine0003

Children of the first two years of life report their condition with refusal to eat, constant whims and causeless crying. It is not difficult to see signs of candidiasis, so if a child has a sharp rise in temperature or refuses to eat, pediatricians and dentists recommend checking the oral cavity for white plaque. If you suspect thrush, it is undesirable to delay a visit to a specialist, since the fungal infection progresses rapidly. nine0003

Reasons

The main reason for the development of candidiasis of the oral mucosa in children is a weakened immune system. If a child is born prematurely, then the likelihood of having thrush is very high. Children who are breastfed or have congenital pathologies are also often exposed to fungal infection.

Provoking factors include:

the presence of vaginal candidiasis in the mother during pregnancy - the child can become infected when passing through the birth canal; nine0003
insufficient hygiene of the female breast during breastfeeding - the fungus is often localized precisely on the nipples because of the favorable environment for it;
poor processing of the child's initial things - bottles, nipples, and so on;
the habit of parents to lick the nipples - even if the adult does not have signs of thrush, a fungus may be present in the mouth, which will be transmitted to the child; nine0003
long-term use of drugs of the "antibiotics" group - drugs help to reduce one's own immunity;
frequent regurgitation in infants - after regurgitation, an increased acidic environment, favorable for the fungus, remains inside the oral cavity;
excessive and frequent dry mouth - the absence of saliva, as a protective agent against the activity of pathological microorganisms. nine0003

Infection with Candida fungus in children older than 2 years can occur as a result of unwashed foods, raw milk or running water. If a child over 3 years of age has suddenly developed signs of thrush, one should be examined not only for a fungal infection, but also for other possible diseases that may be accompanied by a “fading” of the immune system.

Treatment

Children's fungal diseases can be dealt with by a pediatrician, infectious disease specialist or dermatologist. If we are talking about the treatment of thrush of the oral cavity, then the dentist can also carry out therapy. nine0003

The diagnosis of "candidiasis" is determined in most cases on the basis of a specialist examination of the oral cavity. If there is any doubt, the doctor directs the patient for additional examinations. To confirm the disease, a laboratory method is used to study a smear taken from the mouth for the presence of a fungus.

Treatment of thrush in children involves an integrated approach. If the disease is not advanced, then local therapy is carried out in combination with the adoption of measures to strengthen the immune system. In severe form, oral candidiasis in children is treated with systemic drugs, local remedies and compliance with preventive recommendations. nine0003

Methods of therapy

Treatment of candidiasis begins with the treatment of the oral cavity. The first procedure is already performed at the reception. Antiseptic agents are used to remove plaque. The doctor may then apply an antifungal agent.

The parent should carefully monitor the actions of the dentist, as in the future they will have to independently process the oral cavity at home. The necessary drugs will be prescribed by a specialist. Local antifungal agents are dangerous in case of overdose, especially for the child's body, so you must strictly follow the doctor's recommendations. nine0003

In advanced cases, medications are prescribed in the form of solutions, drops or tablets. There are only a few drugs for the treatment of candidiasis in children. Replacing them with adult counterparts is dangerous. The dosage must be strictly observed.

A mandatory addition to the main therapy is hygiene, good sleep, proper nutrition and taking measures to strengthen immunity (eating healthy foods, if necessary, pharmacy vitamins, walking. nine0003

Preventive measures

In order to prevent and even shorten the course of therapy, it is recommended to rinse the mouth (if the child is older than 3-4 years), or use antiseptic sprays several times a day.

It is not difficult to prevent oral candidiasis in children. The responsible approach of parents to the health of the child from the moment of planning conception and pregnancy will help to avoid fungal infections in babies.

Thrush in a child in the mouth in the language of causes - symptoms and treatment of candidiasis

Candidiasis or thrush is an infectious disease caused by yeast-like fungi of the genus Candida albicans. In infants, it manifests itself mainly in the form of candidal stomatitis. If a child shows signs of illness, it is necessary to visit a pediatrician. In a complicated form of the disease, a consultation with a dermatologist, ENT, urologist or gynecologist will be required.

Causes of thrush in children

Fungi of the genus Candida belong to the opportunistic microflora of the oral cavity and small intestine. Uncontrolled reproduction of microorganisms begins with the weakening of the protective functions of the body. Pathogens damage the mucous membrane and nearby tissues. nine0003

Internal factors for the development of thrush:

prematurity;
artificial feeding;
surgical interventions;
beriberi;
alimentary dystrophies;
anemia;
rickets;
imbalance of intestinal microflora;
thyroid dysfunction;
SARS, HIV, chronic viral pathologies;
vomiting and frequent regurgitation.

Internal factors include prematurity, formula feeding, surgery, hypo- and avitaminosis, alimentary dystrophy, anemia, rickets, disruption of normal intestinal microflora, SARS, chronic viral diseases (including HIV), protein and fat metabolism disorders and carbohydrates, endocrine pathologies (including diabetes mellitus), malignant neoplasms, frequent regurgitation and vomiting. nine0003

The external factors of thrush include:

frequent damage to the mucous membranes;
teething in a child;
long-term use of antibacterial, hormonal or immunosuppressive drugs, cytostatics;
non-compliance with the rules of oral care.

Candidal vulvovaginitis in the mother, contact with a carrier of pathogenic strains of the fungus, and mechanical ventilation can provoke the development of thrush in a child. nine0003

Symptoms of thrush in children

Incubation period - 2-60 days, on average - 3-6 days. Clinical manifestations depend on the severity of candidal stomatitis. The main symptom is a white coating on the tongue.

Forms and characteristic signs of thrush in children:

Mild form - most often diagnosed in children. In the oral cavity, areas appear covered with a white coating of a curdled consistency. Localization - the inner surface of the cheeks, the upper surface of the tongue, sometimes - the soft and hard palate. Plaque is easily removed by scraping. The general well-being of the child is within the normal range, there is no specific sour smell from the mouth. nine0030
Moderate form - a child has a dense curd coating on the tongue or in the form of a film. Nearby tissues are red and swollen. The plaque is hardly separated from the mucous membranes, after removal, the affected areas bleed. With this form of candidiasis in the mouth, the mood, sleep and appetite of the child worsens.
Severe form - all mucous membranes of the oral cavity, gums, lips, posterior pharyngeal wall are affected in a child. The plaque is dense, it is practically not removed when scraped off, a light film remains under it. With this form of candidiasis, a pronounced sour smell from the mouth appears. The child is naughty, refuses breast or food, does not sleep well. nine0030

Complications in infants

In infants, thrush develops rapidly, the pathological process spreads to other parts of the body. Signs of candidiasis appear in the perineum, between the buttocks, symptoms of an intestinal fungal infection are observed. A severe form of thrush can cause sepsis.

Without proper treatment, candidiasis becomes chronic. Frequent exacerbations negatively affect the immune system and the general condition of the infant. The risk of developing allergic and atopic diseases increases. In children with chronic candidiasis, bronchial asthma is often detected. nine0003

Fungal tonsillitis is a common complication of oral candidiasis. A characteristic symptom is the appearance of a white cheesy plaque on the tonsils, burning, sore throat.

When a fungus affects the digestive tract, a child develops colic, and the process of food digestion slows down. Disturbed by constipation, pain in the lower abdomen. Mycosis of the respiratory organs is accompanied by frequent bronchitis, prolonged SARS, pneumonia.

Girls with chronic oral thrush often develop vulvovaginal candidiasis. Signs - redness and swelling of the external genital organs, due to the dryness of the mucous membranes, erosions form. In infancy, due to the anatomical features of the structure of tissues, pathology can lead to fusion of the labia and vaginal walls. In such cases, long-term medical treatment and surgery will be required. nine0003

Fungal infection of the genital organs in boys is accompanied by redness of the head of the penis, a secret similar to sour cream is secreted from the urethra. Against the background of thrush, urethritis and cystitis often develop.

Diagnosis of thrush

Thrush has characteristic symptoms. Therefore, there are no diagnostic problems. When collecting an anamnesis, the doctor determines the time of the onset of the disease. Assesses the general condition of the child, finds out the presence of fungal infections in the mother during pregnancy and childbirth. nine0003

During the physical examination of the child, the doctor performs a number of necessary procedures:

examines the condition of the oral mucosa;
detects the presence of specific plaque in the mouth;
determines the severity of the pathological process.

Be sure to examine other parts of the body that may have been infected with a fungus.

Laboratory methods for the diagnosis of thrush:

Microscopy. A scraping is made from the affected area, the resulting biomaterial is studied under an electron or light microscope. The analysis reveals yeast-like cells and mycelial filaments. nine0030
Culture method. Carried out to determine the type of pathogen, its sensitivity to antimycotic drugs.
Serological research methods are used in the absence of clear clinical manifestations, lack of information of other diagnostic methods.

For fungal angina, sputum is analyzed to identify the type of pathogen. With candidiasis of the genital organs, it is necessary to pass a smear on the microflora. If mycosis of the internal organs is suspected, an analysis of feces, blood and urine is prescribed. nine0003

Be sure to carry out differential diagnosis to exclude diphtheria, acute herpetic stomatitis, acute tonsillitis.

Treatment of thrush

The choice of drugs for the treatment of thrush depends on the severity of the pathological process.

Peculiarities of therapy:

In case of mild form, the oral cavity is irrigated with antifungal solutions with clotrimazole, nystatin. Soda or boric solution removes plaque well. Apply local disinfectants and antiseptics - methylene blue, Lugol's solution, Miramistin. When breastfeeding, the mother must treat the breast with a solution of soda, a decoction of calendula or oak bark before each feeding. The average duration of treatment is 2 weeks. nine0030
For moderate to severe disease, oral or parenteral antifungals are prescribed. Additionally, symptomatic treatment of concomitant diseases is carried out.

Older children are given a diet. From the diet it is necessary to exclude sweet and salty dishes, flour. These products create favorable conditions for the reproduction of fungi. Additionally, it is necessary to take folic and ascorbic acid to restore the balance of microflora, drugs to strengthen the immune system. nine0003

With timely treatment, you can completely get rid of thrush in your mouth. Recovery occurs within 7-10 days. Severe forms of the disease and complications occur only in the complete absence of antifungal therapy.

Prevention of thrush in infants

Prevention of candidiasis in children is either specific or non-specific.

Non-specific methods of prevention:

correct and regular care of the child's skin and mucous membranes;
with artificial feeding, choose high-quality mixtures with probiotics and vitamins;
rational use of antibiotics during pregnancy;
timely treatment of fungal infections during childbearing;
do not give sweets to a child under one year, older children - sugar and sweets in limited quantities;
strengthen immunity - hardening, exercise, long walks in the fresh air, adherence to the daily routine.
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