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Pediatric - Thrush

Thrush

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Does this describe your child's symptoms?

Definition
  • A superficial yeast infection of the mouth of young babies
  • Causes white patches in the front of the mouth

Symptoms

  • White, irregularly shaped patches in the mouth
  • Coats the inside cheeks or inner lips
  • Sometimes coats the tongue (if the only symptom is a uniformly white tongue, it's due to a milk diet, not thrush)
  • Adherent to the mouth (cannot be washed away or wiped off easily like milk curds)
  • Occasionally causes a painful mouth, reluctance to suck and reduced milk intake
  • Mild discomfort or no symptoms in most newborns
  • The infant is bottle-fed or breast-fed

Cause

  • Caused by a yeast (called Candida)
  • Occurs on parts of the mouth involved with sucking
  • Accentuated by friction from frequent pacifier use

Return to Day Care

  • Thrush is not contagious, since it does not invade normal tissue. Your child can go to day care with thrush.

If not, see these topics

When to Call Your Doctor

Call Your Doctor Now (night or day) If
  • Your child looks or acts very sick
  • Signs of dehydration (very dry mouth, no tears and no urine in more than 8 hours)
  • Age under 1 month old and looks or acts sick in any way
Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If
  • You think your child needs to be seen
  • Fever occurs
  • Bleeding is present
  • Drinking less than normal
Call Your Doctor During Weekday Office Hours If
  • Thrush, but none of the symptoms described above (Reason: may need prescription medicine to treat it)
HOME CARE ADVICE FOR THRUSH (Pending Talking With Your Doctor)

  1. Anti-Yeast Medicine: Your doctor will probably prescribe an anti-yeast liquid medicine. Use it as follows:
    • Place 1 ml (2 ml if over age 1 month) in the front of the mouth on each side or where ever 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 responding, rub the medicine directly on the affected areas with a cotton swab.
    • Don't feed your baby anything for 30 minutes after application.
    • Keep this up for at least 7 days, or until all thrush has been gone for 3 days.
  2. Decrease Sucking Time to 20 Minutes per Feeding:  Reason: prolonged sucking (as when a baby sleeps with a bottle) can irritate the lining of the mouth and make it more prone to yeast infection.  For severe mouth pain with bottle feeding, offer fluids in a cup, spoon or syringe rather than a bottle (Reason: The nipple increases pain).
  3. Limit Pacifier Use:  
    • Again, prolonged 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 irritate the mouth more).
    • Special washing of pacifiers or bottle nipples is not necessary or helpful.
  4. Breastfeeding:  If the mother's nipples are red and sore, apply Lotrimin Cream (no prescription needed) 4 times per day AFTER feedings.
  5. Diaper Rash:  If there's a bad diaper rash, it's also probably due to yeast. Apply Lotrimin cream (no prescription needed) 4 times per day (see DIAPER RASH topic).
  6. Contagiousness: Thrush is not contagious, since it does not invade normal tissue. Your child can go to day care with thrush.
  7. Expected Course:  With treatment, thrush usually clears up in 4 to 5 days. Without treatment, it clears up in 2-8 weeks.
  8. Call Your Doctor If:
    • Drinking becomes less than normal
    • Your child becomes worse

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

Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.


Author and Senior Reviewer: Barton D. Schmitt, M.D.

Last Reviewed: 1/19/2009

Last Revised: 8/6/2007

Content Set: Pediatric HouseCalls Online

Copyright 1994-2009 Barton D. Schmitt, M.D.

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