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Thrush - An Oral Yeast Infection

Pediatric Basics

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Updated May 16, 2014

Thrush is a common infection that affects many newborns and younger children. It is caused by the Candida albicans yeast or fungus, which can also cause vaginal infections and diaper rashes. When it infects a child's mouth, it is called oropharyngeal Candidiasis, or more simply - thrush.

Symptoms of Thrush

Thrush is one of those infections that looks and sounds much worse than it is. Although sometimes painful, the most common symptom is for an infant to have white patches coating the inside his mouth. You may see these patches on the insides of his cheeks, on his tongue, on the roof of his mouth, and on his lips and gums as it spreads.

These white patches, unlike breastmilk or formula, can not easily be wiped away. However, if you do try to wipe them away, the area may bleed and leave behind a painful ulcer.

Diagnosis

Thrush is usually diagnosed by the pattern of symptoms and no culture or testing is typically required. If your child is very fussy and refuses to eat, your Pediatrician may do more to investigate if your child has another condition in addition to thrush that is causing these symptoms.

Thrush Treatments

Thrush is usually treated with a prescription medicine called Nystatin which is given four times a day. The dosage is 0.5ml to each side of the child's mouth if they are under 30 days old, and 1 ml to each side of their mouth for older infants and toddlers. Treatment is continued for about 7 to 10 days and at least 3 days after you no longer see any signs of thrush. If your child's infection isn't quickly improving after a few days, you may want to use a gauze to directly rub the medication on the white patches. Although your child will likely swallow the dose of Nystatin, since it isn't absorbed, it is the direct contact with the yeast that combats the infection.

Fluconazole (Diflucan) is another prescription medication that can be used as an alternative to Nystatin. It has the benefit of once a day dosing, but it is more expensive than Nystatin and is usually used as a second line treatment, when Nystatin doesn't work. Keep in mind that in one small study, Comparison of fluconazole and nystatin oral suspensions for treatment of oral candidiasis in infants, "fluconazole was shown to be superior to nystatin suspension for the treatment of oral thrush in otherwise healthy infants."1

Another alternative is Gentian Violet, an older treatment that doesn't require a prescription. Keep in mind that it is rather messy and can turn your baby's lips and clothing purple, so it is not as popular as other treatments.

What You Need To Know About Thrush

  • Breastfeeding mothers who have a baby with thrush may get a yeast infection on their breasts and nipples, causing pain while breastfeeding. In addition to getting treatment for their baby, these mothers also need to be treated by their doctor.

  • Children get thrush because the Candida albicans yeast is ubiquitous or everywhere, so no matter how carefully you clean and sterilize pacifiers, bottles, toys, etc., your baby will likely still be exposed to this yeast. Still, you should carefully clean any objects that go into your child's mouth.

  • If your baby gets thrush over and over, be sure that he isn't overusing a pacifier or bottle, which may be causing the insides of his mouth to be overly moist and cracking, which provides the perfect environment for yeast to grow. You might also get rid of and buy new nipples and pacifiers once the infection clears up.

  • In older children, especially if they haven't recently been on antibiotics or steroids, thrush can be a sign of uncontrolled diabetes mellitus or an immune system disorder.

  • Infants with thrush that doesn't go away or keeps coming back can also be associated with immune system problems, especially if your infant isn't gaining weight well or has other infections and medical problems.

References:

1Comparison of fluconazole and nystatin oral suspensions for treatment of oral candidiasis in infants. Goins RA - Pediatr Infect Dis J - 01-DEC-2002; 21(12): 1165-7

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