Oral thrush

What is oral thrush?

Oral thrush is an infection of the mouth.

Signs and symptoms of thrush

The main symptoms of oral thrush are:

• white lesions that look like cottage cheese may appear on a child’s tongue, inner cheeks, gums or on the roof of the mouth.
• occasionally babies and children may experience pain and difficulty feeding due to thrush

Breast-feeding individuals of babies with oral thrush may have:

• red, sensitive or itchy nipples
• flaky or shiny skin on the areola
• pain during nursing
• sharp pains deep within the breast

Causes of thrush

Oral thrush is caused by a species of yeast, or fungus, called Candida. The yeast occurs naturally in the mouth. The infection occurs when there is more yeast in the mouth than normal. 

The infection occurs most often in healthy babies in the first year of life. Older children who have had a recent course of antibiotics, corticosteroids or chemotherapy may also develop oral thrush. Children of any age who have problems with their immune system (immunodeficiency) may develop recurrent or difficult to treat oral thrush.

Diagnosing thrush

Thrush is diagnosed most often by examining the mouth for the typical white lesions. Sometimes a health-care provider will try to scrape one off using a tongue depressor or wipe it off with a cloth. White lesions from milk easily wipe or scrape off, while lesions caused by thrush do not.

Treating thrush

Treatment of oral thrush depends on the age and underlying health of the child. There are several antifungal treatments, including drops, gel and oral medications (e.g., nystatin and fluconazole). Breastfeeding individuals of babies with oral thrush often also need treatment with an antifungal ointment applied to their nipples.

Preventing thrush

Prevention of thrush depends on the age of the child. For instance, in order to prevent another infection in babies, thoroughly clean nipples, baby bottles and pacifiers. 

For children who use inhaled corticosteroids, taking a sip of water after each dose helps reduce the likelihood of developing thrush.

Complications

Oral thrush is rarely a severe problem for healthy babies. Usually, it does not hurt or affect feeding. If your child has a weak immune system, thrush can be more serious. In such cases, the infection can spread to other parts of the body or may require longer courses of treatment. 

When to seek medical assistance

Once you notice creamy yellow or white spots on the tongue, gums or lining of the mouth, see the doctor. This is very important if your baby seems unwell or is feeding poorly.