Is your baby irritable? Are they crying and fussing during a typical feeding session? Your baby may have thrush, an infection in their mouth. Your first instinct as a mother is to worry and panic. However, thrush is pretty common and very treatable.
Thrush is an infection in the mouth1 from a fungus called candida. Candida is a normal inhabitant of the human body. It’s usually present in small amounts, but its overgrowth can cause infection. This is a common infection in young babies.
Thrush Symptoms and Remedies
What are the signs of thrush in babies?
Thrush looks like white patches inside a baby’s mouth. Babies can also have normal white patches from breastmilk or formula in their mouths. The critical difference between these white patches and those of thrush is the ability to wipe them away. Breastmilk or formula can be easily wiped away with a soft cloth, whereas the patches from thrush cannot be.
Sometimes thrush causes no symptoms at all. Other times, it can cause some discomfort in babies, especially during feeding when something is touching these patches, often referred to as plaques or lesions. These white patches can be on the tongue, inside the cheeks, on the roof of the mouth, or the gums. Sometimes they are red around the base, but not always.
What causes thrush in babies?
Candida2 is a fungus, and fungi thrive in dark, moist environments of an immunocompromised host. Newborns, by definition, have a weakened immune system. So their dark and moist mouths are a great environment for thrush to thrive. Similarly, the nipples of a breastfeeding mother are also a great environment for the overgrowth of candida.
How do you treat thrush in babies?
Infants with thrush who are at home and otherwise healthy are generally at low risk for developing a more serious candidal infection in their bodies. Therefore, these babies can often be treated with topical antifungal therapy.
Here are some treatments for oral thrush in babies:
- Nystatin is a commonly prescribed topical antifungal agent. It is not absorbed into the baby’s gastrointestinal system, so it is very safe. It is usually given in liquid form with instructions to squirt into the baby’s mouth or rub on with a cotton cloth or clean finger. Nystatin needs to be applied inside the baby’s mouth four times a day between feeds for anywhere from 5 to 14 days.
- Oral miconazole gel, which is not available in the United States, is a very effective topical treatment. This can be absorbed into the baby’s body, though, so some side effects have been reported.
- Gentian violet is also an effective topical treatment. However, it is associated with an increased risk of cancer, may cause irritation, and stain the infant’s lips and clothing.
- Oral fluconazole is a systemic treatment, so not just a topical treatment. This is often given to babies who didn’t get better after topical nystatin.
Premature babies admitted to the neonatal intensive care unit (NICU) are at increased risk for developing a more serious candidal infection that can invade their urine, blood, or nervous system. So more intense treatments are often required.
What about any home remedies for thrush in babies?
Always check with your baby’s doctor on this.
- Some prefer to treat all babies with thrush. This is recommended by the Infectious Diseases Society of America and endorsed by the AAP (American Academy of Pediatrics).
- Others may closely observe the baby without treatment if the baby is healthy, full-term, feeding and growing well, and showing no symptoms. And also, if breastfeeding, the mother must also show no signs of candida infection in the breast or nipple. These are the recommendations of the National Institute for Health and Care Excellence guidelines.
Is there anything else to know about thrush in babies who are breastfeeding?
Yes! Breastfeeding women can get candida infection of their breasts.
This can present as:
- Deep, sharp, shooting, and/or burning pains in the breasts
- Breast pain out of proportion to physical findings
- Shiny or flaky skin of the nipple
- Nipple and/or areolar rash
If you are experiencing any of these, you should check with your doctor. If you’re diagnosed with a candida infection of your breasts, you should check with your baby’s doctor.
How can I prevent thrush?
Since a dark, moist environment is a perfect place for candida to grow, you can help prevent that by keeping things clean and dry.
- Adequately clean and dry your baby’s bottles, nipples, pacifiers, and toys.
- Adequately clean and dry your pumping equipment and nipple shields.
- Wash and dry your hands thoroughly after changing your baby’s diaper and before feeding your baby.
- Allow your nipples to dry completely between feedings.
- Change nipple pads often.
- Use cotton bras and tanks; keep them clean and dry.
If your baby has already been diagnosed with thrush, sterilizing things that go into the baby’s mouth (such as bottle nipples, pacifiers, and toys) between uses can also help prevent re-infection.
But sometimes, even if you’ve done all of the above, you and/or your baby will get thrush! This doesn’t mean you did anything wrong! It is very common and, with the proper treatments, eventually goes away.