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What are symptoms of thrush in babies


Thrush in newborns Information | Mount Sinai

Candidiasis - oral - newborn; Oral thrush - newborn; Fungal infection - mouth - newborn; Candida - oral - newborn

Thrush is a yeast infection of the tongue and mouth. This common infection can be passed between a mother and baby during breastfeeding.

Causes

Certain germs normally live in our bodies. While most germs are harmless, some can cause infection.

Thrush occurs when too much of a yeast called Candida albicans grows in a baby's mouth. Germs called bacteria and fungi naturally grow in our bodies. Our immune system helps keep these germs in check. But babies do not have fully-formed immune systems. That makes it easier for too much yeast (a type of fungus) to grow.

Thrush often occurs when mother or baby has taken antibiotics. Antibiotics treat infections from bacteria. They can also kill "good" bacteria, and this allows yeast to grow.

The yeast thrives in warm, moist areas. The baby's mouth and the mother's nipples are perfect places for a yeast infection.

Babies can also get a yeast infection on the diaper area at the same time. The yeast gets in the baby's stool and can cause a diaper rash.

Symptoms

Symptoms of thrush in the baby include:

  • White, velvety sores in the mouth and on the tongue
  • Wiping the sores may cause bleeding
  • Redness in the mouth
  • Diaper rash
  • Mood changes, such as being very fussy
  • Refusing to nurse because of soreness

Some babies may not feel anything at all.

Symptoms of thrush in the mother include:

  • Deep-pink, cracked, and sore nipples
  • Tenderness and pain during and after nursing

Exams and Tests

Your health care provider can often diagnose thrush by looking at your baby's mouth and tongue. The sores are easy to recognize.

Treatment

Your baby might not need any treatment. Thrush often goes away on its own in a few days.

Your provider may prescribe antifungal medicine to treat thrush. You paint this medicine on your baby's mouth and tongue.

If you have a yeast infection on your nipples, your provider may recommend an over-the-counter or prescription antifungal cream. You put this on your nipples to treat the infection.

If both you and your baby have the infection, you both need to be treated at the same time. Otherwise, you can pass the infection back and forth.

Outlook (Prognosis)

Thrush in babies is very common and can easily be treated. Let your provider know if thrush keeps coming back. It may be a sign of another health issue.

When to Contact a Medical Professional

Contact your provider if:

  • Your baby has symptoms of thrush
  • Your baby refuses to eat
  • You have symptoms of a yeast infection on your nipples

Prevention

You may not be able to prevent thrush, but these steps may help:

  • If you bottle feed your baby, clean and sterilize all equipment, including nipples.
  • Clean and sterilize pacifiers and other toys that go in baby's mouth.
  • Change diapers often to help prevent yeast from causing diaper rash.
  • Be sure to treat your nipples if you have a yeast infection.

Balest AL, Riley MM, O'Donnell B, Zarit JS. Neonatology. In: Zitelli BJ, McIntire SC, Nowalk AJ, Garrison J, eds. Zitelli and Davis' Atlas of Pediatric Physical Diagnosis. 8th ed. Philadelphia, PA: Elsevier; 2023:chap 2.

Harrison GJ. Approach to infections in the fetus and newborn. In: Cherry JD, Harrison GJ, Kaplan SL, Steinbach WJ, Hotez PJ, eds. Feigin and Cherry's Textbook of Pediatric Infectious Diseases. 8th ed. Philadelphia, PA: Elsevier; 2019:chap 66.

Last reviewed on: 12/12/2021

Reviewed by: Neil K. Kaneshiro, MD, MHA, Clinical Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

Thrush

Is this your child's symptom?

  • A yeast infection of the mouth in young babies
  • White patches in the front of the mouth

Symptoms of Thrush

  • White, odd shaped patches in the mouth
  • Coats the inner cheeks or inner lips
  • Sometimes also coats the tongue
  • Sticks to the mouth. It can't be washed away or wiped off easily like milk curds.
  • Sometimes causes a painful mouth, decreased sucking and reduced milk intake
  • Mild discomfort or no symptoms in most newborns
  • The infant is bottle-fed or breast-fed

Cause of Thrush

  • Caused by a yeast (called Candida)
  • Occurs on parts of the mouth involved with sucking
  • Made worse by friction from too much time sucking on a pacifier

White Tongue Alone: Not Thrush

  • If a white tongue is the only finding, it's not due to thrush.
  • A milk diet often causes a white coated tongue.
  • This is normal.
  • It will go away after your baby starts eating solid foods.
  • If white patches occur inside the lips or cheeks, call your child's doctor. It's safe to call during office hours.

When to Call for Thrush

Call Doctor or Seek Care Now

  • Dehydration suspected. No urine in more than 8 hours, dark urine, very dry mouth and no tears.
  • Age less than 1 month old and looks or acts abnormal in any way
  • Your child looks or acts very sick
  • You think your child needs to be seen, and the problem is urgent

Contact Doctor Within 24 Hours

  • Fever occurs
  • Bleeding in the mouth
  • Drinking less than normal
  • You think your child needs to be seen, but the problem is not urgent

Contact Doctor During Office Hours

  • Thrush, but none of the symptoms above. Reason: may need a prescription medicine to treat it.
  • You have other questions or concerns

Seattle Children's Urgent Care Locations

If your child’s illness or injury is life-threatening, call 911.

  • Bellevue
  • Everett
  • Federal Way
  • Seattle

Care Advice for Thrush

  1. What You Should Know About Thrush:
    • Thrush is common during the early months of life.
    • It's caused by a yeast infection in the mouth. Most often, it's due to prolonged sucking.
    • Thrush causes only mild discomfort. It's easy to treat at home.
    • Here is some care advice that should help until you call your doctor.
  2. Anti-Yeast Medicine (Prescription):
    • Your doctor will probably prescribe an anti-yeast liquid medicine. Use it as follows:
    • Age Under 1 Month: Use 1 mL.
    • Age Over 1 Month: Use 2 mLs.
    • Place in the front of the mouth on each side. Also, put it wherever 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 getting better, rub the medicine directly on the thrush. Use a cotton swab to do this.
    • Don't feed your baby anything for 30 minutes after the medicine.
    • Keep this up for at least 7 days. Also, continue it until all thrush has been gone for 3 days.
  3. Decrease Sucking Time to 20 Minutes per Feeding:
    • Reason: Too much sucking can irritate the lining of the mouth. This makes it more prone to a yeast infection. A common example of this is when a baby sleeps with a bottle.
    • For severe mouth pain with bottle feeding, don't use a bottle. Reason: The nipple can make pain worse.
    • Try giving fluids in a cup, spoon or syringe instead.
  4. Limit Pacifier Use:
    • Too much 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 cause more friction in the mouth.
    • Special washing or boiling of pacifiers or bottle nipples is not needed or helpful.
  5. Special Washing of Pacifiers and Nipples - Not Helpful:
    • Pacifiers and bottle nipples can be washed the usual way with soap and water.
    • They do not need to be boiled or sterilized.
    • They do not need to be thrown out.
    • Yeast is a germ that is found in normal mouths.
    • It only causes thrush if the lining of the mouth is irritated or damaged.
    • Get better results by reducing nipple time and pacifier time.
    • Note: Follow your doctor's advice if it is different.
  6. Breastfeeding and Yeast Symptoms:
    • If the mother's nipples are red and sore, it's probably a yeast infection.
    • Use an anti-yeast cream (such as Lotrimin) on the nipple area.
    • No prescription is needed.
    • Put it on 4 times per day after feedings.
    • Wash the cream off the nipples before each nursing. Avoid soap which dries out the skin.
    • Many mothers will need treatment with an oral anti-yeast medicine (such as Diflucan). Call your PCP or OB within 24 hours for advice.
  7. Diaper Rash Treatment:
    • If there's a bad diaper rash, it can also be due to yeast.
    • Use an anti-yeast cream (such as Lotrimin) on the diaper rash.
    • No prescription is needed.
    • Put it on 4 times per day.
    • See Diaper Rash care guide.
  8. Return to Child Care:
    • Thrush cannot be spread to others, since it does not invade normal skin.
    • Your child can go to child care with thrush.
  9. What to Expect:
    • With treatment, thrush usually clears up in 4 to 5 days.
    • Without treatment, it clears up in 2-8 weeks.
  10. Call Your Doctor If:
    • Starts drinking less than normal
    • You think your child needs to be seen
    • Your child becomes worse

And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.

Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.

Last Reviewed: 01/24/2023

Last Revised: 12/30/2022

Copyright 2000-2023. Schmitt Pediatric Guidelines LLC.

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 infants. What is Thrush in Infants? nine0001

IMPORTANT
The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.

Thrush is one of the clinical variations of fungal diseases caused by yeast-like fungi from the genus Candida. In infants, the most common oral form is candidal stomatitis. Clinical manifestations include a white cheesy coating on the mucous membranes of the cheeks, tongue and palate. In severe cases, the entire oral cavity is affected, the general condition of the child is disturbed. Diagnosis involves the identification of specific symptoms during examination, confirmation of the diagnosis by microscopic, bacteriological and cultural methods. Treatment is carried out with the help of local and systemic application of antimycotic drugs. nine0003

  • Causes of thrush in infants
  • Symptoms of thrush in infants
  • Complications of thrush in infants
  • Diagnosis of thrush in infants
  • Treatment of thrush in infants
    • Prognosis and prevention of thrush in infants
  • Prices for treatment

General

Candidiasis or thrush in infants is a fungal pathology that is caused by opportunistic or pathogenic strains of fungi of the genus Candida. At 80-90% of her cases are caused by C. albicans. For newborns and infants, oral candidiasis is most common. Candidiasis stomatitis was first described by Hippocrates around 400 BC. The pathology got the name "thrush" because of the white plaque on the mucous membranes, which looks like curdled milk, and also because of the curdled discharge. The incidence depends on a decrease in immunity against the background of underlying pathologies or external circumstances: candidiasis develops in 20-25% of children with type I diabetes, in 25-30% of oncological patients and in 70-90% of babies with AIDS.

Thrush in infants

Causes of thrush in infants

The cause of thrush in infants, as in adults, are fungi from the genus Candida. Most often, C. albicans acts as the causative agent, less often - C. tropicalis, C. parapsilosis, C. glabrata, C. krusei. These yeast-like fungi are included in the list of opportunistic agents, since they are contained in the normal microflora of the oral cavity and small intestine. With the full functioning of the immune system, they do not have a negative effect. Against the background of a decrease in the body's resistance, fungi begin to grow and multiply rapidly, damaging the mucous membrane and underlying tissues. nine0003

Many exogenous and endogenous factors can contribute to the development of thrush in infants. Internal factors include prematurity, formula feeding, surgeries, hypo- and beriberi, alimentary dystrophy, anemia, rickets, disruption of normal intestinal microflora, SARS, chronic viral diseases (including HIV), metabolic disorders of proteins, fats and carbohydrates , endocrine pathologies (including diabetes mellitus), malignant neoplasms, frequent regurgitation and vomiting. External factors provoking the development of candidiasis are chemical or physical damage to the mucous membrane, prolonged antibiotic therapy, taking immunosuppressive drugs, hormonal drugs and cytostatics, vulvovaginal candidiasis during pregnancy and / or childbirth in the mother, contact with patients with candidiasis or carriers of pathogenic strains, IVL and being in the conditions of the RIT department. nine0003

Symptoms of thrush in infants

The incubation period for thrush in infants ranges from 2 days to 2 months, with an average of 3-6 days. The clinical picture depends on the severity of the lesion. There are mild, moderate and severe forms of candidal stomatitis. The mild form is the most common. It is characterized by damage to the oral cavity in the form of foci of curdled plaque. The most common localization is the inner surface of the cheeks, the upper part of the tongue, less often the hard and soft palate. Formations are effortlessly separated by scraping. The general condition of the child is not disturbed, there is no discomfort, no specific smell is observed. nine0003

Moderate and severe forms of thrush in infants are less common, since they develop only in the absence of regular preventive examinations by a pediatrician or a conscious refusal of parents to treat. Candidiasis stomatitis of moderate severity is manifested by a cheesy or film-like plaque, diffusely spreading over all typical lesions. Adjacent tissues are sharply hyperemic. When trying to separate plaque from the mucous membrane, only some of its parts are removed, in place of which drops of blood remain. The general condition is somewhat disturbed: restless sleep, the child is naughty. nine0003

In a severe form of thrush in infants, a total lesion of all mucous membranes of the oral cavity, including the posterior pharyngeal wall, gums, and lips, is revealed. The plaque is tightly soldered to the underlying tissues, therefore, when scraping, it is possible to separate only small areas, under which a whitish film remains. On examination, a strong unpleasant odor is detected from the mouth. The general condition of the child is sharply disturbed: he is restless, sleeps badly, often cries, refuses his mother's breast.

Complications of thrush in infants

In children, unlike adults, there is a tendency to the rapid development and spread of pathological processes. Because of this, candidal stomatitis is often accompanied by damage to other parts of the body - candidiasis of the perineum, intestines, intergluteal and inguinal-femoral folds, candidal vulvovaginitis occur. In severe forms of thrush in infants, hematogenous and lymphogenous dissemination of fungi often occurs - sepsis develops. Ineffective treatment of acute candidiasis can lead to its transition to a chronic form. In addition to constant exacerbations and violations of the general condition of the child, this condition causes a further decrease in immunity, a tendency to allergic reactions and atopic diseases, such as bronchial asthma. nine0003

In girls, against the background of oral thrush, vulvovaginal candidiasis very often develops. Clinically, it is manifested by hyperemia, swelling and dryness of the external genital organs with erosions of the mucous membranes. In pediatrics and neonatology, this pathology is of great danger, since in infancy, due to the special tenderness of tissues, there is a high risk of fusion of the labia and vaginal walls with each other. Such a complication, in addition to massive pharmacotherapy, requires surgical intervention. nine0003

Diagnosis of thrush in infants

Diagnosis of thrush in infants is based on a full collection of anamnestic data, an objective and laboratory examination of the child. Instrumental studies are usually not required. When collecting an anamnesis, the pediatrician establishes the etiological and contributing factors, determines the time of the onset of the disease, and evaluates the characteristics of the child's condition. The specialist must pay attention to the fungal pathologies of the mother during pregnancy and childbirth. The physical examination includes a thorough examination of the oral cavity, identifying characteristic deposits, determining the severity of the process, and examining other parts of the body that can potentially develop candidiasis. The leading role is played by laboratory diagnostics, which consists in microscopy, bacteriological and serological examination. nine0003

Microscopic diagnosis is the first stage at which the material obtained during scraping is examined under a light or electron microscope. It makes it possible to identify the characteristic filaments of mycelium and yeast-like cells. The cultural method allows you to determine the type of fungus and its sensitivity to specific antimycotic drugs. This method is also used when initial empiric treatment with common agents has failed. Serological reactions (most often RSK) are indicated in the absence of a clear clinical picture and low informativeness of other studies. Based on the above studies, differential diagnosis of candidal stomatitis with acute tonsillitis, diphtheria and acute herpetic stomatitis in children is carried out. nine0003

Treatment of thrush in infants

Treatment of thrush in infants depends on the prevalence of the pathological process. In the early stages, with a local lesion, local therapy is indicated - the oral cavity is irrigated with anti-candidiasis (clotrimazole, nystatin) alkalizing (2% baking soda solution, 0. 25% boron solution) and disinfectant (aniline dyes - Lugol's solution, methylene blue) means. When breastfeeding, the mother's breast is treated with a 2% soda solution and herbal infusions (oak, calendula, and others). Such treatment is carried out until the complete recovery of the child, but for a period of at least 14 days. nine0003

In moderate and severe forms, systemic therapy is recommended by oral or parenteral administration of antimycotic drugs. When using anti-candidiasis drugs through the mouth, preference is given to powders for injection (fluconazole), since the prepared solution has not only a general, but also a local effect on the mucous membranes of the oral cavity. In parallel, the treatment of concomitant diseases and symptomatic therapy according to indications is carried out in full. According to current recommendations, this approach should also be used for mild forms, since it allows to reduce the treatment time to 3-6 days. nine0003

Prognosis and prevention of thrush in infants

The prognosis for thrush in infants is favorable. With timely rational therapy, complete recovery occurs within 7-10 days. Severe forms and the development of complications are observed only against the background of the complete absence of antifungal treatment. Nonspecific prevention of candidal stomatitis consists in the full care of the skin and mucous membranes of the child, especially against the background of severe pathologies that reduce immunity. An important role is given to the rational use of antibacterial agents and the treatment of fungal diseases in the mother during the period of bearing a child. nine0003

Specific prevention of thrush in infants is necessary if there are indications that include a burdened obstetric and gynecological history of the mother, prematurity and intrauterine malformations of the child, respiratory disorders, birth injuries of newborns, CNS pathologies. Newborns included in this group, the first 7 days of life, microscopy and bacteriology of samples of mucous membranes and feces are performed.

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