Thrush

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.

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