Thrush

Pediatric HouseCalls Online

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.

See More Appropriate Topic (instead of this one) If

• It doesn't look like thrush, see MOUTH ULCERS.

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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).

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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.