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Definition

  • An infection of the mouth in young babies
  • White patches in the front of the mouth
  • Caused by yeast

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

Call Doctor Now or Go to ER

  • Dehydration suspected. (No urine in over 8 hours, dark urine, very dry mouth and no tears)
  • Age under 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

Call 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

Call 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

Care Advice

  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.

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