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What is Oral Thrush in Children and Babies?

Oral thrush is a common yeast infection also called oral Candidiasis. Parents may notice a white “cottage cheese” like substance in the corners of the child’s mouth that can’t be easily wiped away. When peering into the mouth, the tongue and the insides of the cheeks can be coated with this substance as well. It can affect both inside the mouth and around the outside of the mouth by irritating the tissues. The good news is this common yeast infection can be easily treated and prevented!

Causes

Thrush is caused by an overgrowth of a type of yeast (a type of fungus) called Candida Albicans. Everyone has this yeast in their mouths, but it is usually kept under control by “good” bacteria and a healthy immune system. Since babies do not have fully developed immune systems, they may be susceptible to Candida overgrowth. Because this yeast affects the entrance to the digestive system of a child, it may affect the diaper area on its way out of the body. So, the baby can have oral thrush and a diaper rash at the same time from this yeast infection (1).

A child taking antibiotics to treat an infection of another nature is also susceptible to oral Candidiasis. As the prescribed antibiotics are being taken to cure the other illness, they can also kill off “good” bacteria in the mouth and create an environment more conducive to the overgrowth of Candida. Corticosteroids used to decrease inflammation are also medications that can allow the yeast to flourish in the mouth. Children with asthma may regularly take steroids in an aerosol form in nebulizer treatments or inhalers and it is a good idea to rinse their mouths after each use (2).

Symptoms

You may not know that your child has oral thrush. Older children can sometimes complain of the following symptoms, and this may alert you to the development of the infection:

  • White, slightly raised lesions on their tongue, inner cheeks, or on the roof of their mouth.
  • Redness or soreness that can sometimes be severe enough that your child does not want to swallow liquids or eat foods
  • Mild bleeding if the lesions are scraped
  • Cracking at the corners of their mouths or redness and irritation
  • “Cottony” feeling in their mouths
  • Lack of taste when trying to eat

Breastfeeding babies may be irritable and fussy or have trouble feeding. This may be the first indication of oral thrush, and you may then investigate the mouth and find the white spots. This yeast infection can pass back and forth from the baby to the mother as the baby latches on to the mother’s breast (3). Breastfeeding mothers may also experience signs and symptoms related to Candidiasis.

Prevention

You can do many things as a parent that can minimize the risk of oral thrush. For babies, prevention can be as easy as thoroughly cleaning bottle nipples, breast pump parts, and pacifiers in a hot water solution or the dishwasher. Be aware of any cracks or defects in the nipples or pacifiers and throw damaged ones away as these are excellent places for yeast (fungi) to grow (3).

The sugars in breast milk provide excellent food for yeast. So, if you are breastfeeding, it is a good idea to wash your breasts before nursing to prevent the passing of any infection to the baby and after nursing to cleanse off any residual milk that may encourage the growth of yeast. Store any prepared bottles in the refrigerator, whether breast milk or formula, for the same reason. Wipe out your baby’s mouth with a soft cloth to remove excess milk from their mouth after every feeding. This same prevention method should be done after the baby is older and eats food and drinks juices as these are also sugary. Never put a baby to bed with a bottle as “bad” bacteria or yeast can develop on the bottle or in your child’s mouth (1, 3).

Breastfeeding moms should wear a clean bra every day. Nursing pads can prevent any infection from spreading to your clothes. You want to look for those without a plastic barrier which may encourage Candida growth. Change these when they become soiled (3).

Finally, practice good oral hygiene with your baby or young child. A clean, soft cloth can be used to wipe out a baby’s mouth after nursing or drinking a bottle. Once teeth are formed, parents should brush a child’s teeth twice daily then begin flossing once your child has two teeth next to each other. Please don’t use fluoride toothpaste until our dental staff recommends it. Let them watch you brush and floss, so they know that this is an essential part of their self-care regimen and emphasize the necessity of keeping their teeth healthy. Our Jungle Roots staff can recommend dental rinses, when appropriate, that will not kill off all of the “good” bacteria but will keep the hard-to-reach areas in your child’s mouth clean and clear of “bad” bacteria and oral thrush. Limit the amount of sugar and yeasty food and drinks that will encourage Candida growth. Visit our office regularly to allow our professionals to spot any signs of problems (1, 2, 3).

Treatment

Thrush usually starts suddenly and sometimes can go away on its own. However, Candidiasis can generally be diagnosed by our dental staff just by looking at the mouth (2).

The goal of the treatment of oral thrush is to stop its spread and the underlying causes must be eliminated to prevent reoccurrence. Treatment is non-invasive and easy to do with proper instructions (3).

Healthy children may be prescribed an oral antifungal medication that is taken for 7 to 14 days. These medications can come in many forms, so there are different delivery options. Our dentists may recommend a liquid swish and swallow that is sometimes easier for a child to take. There are lozenges to melt in your mouth or tablets to take for those older children not likely to choke (3). Your health care provider will have a specific treatment regimen depending on the child’s age and the cause of the infection. Common prescription medications include clotrimazole, miconazole, or nystatin (2).

Nursing mothers may need an antifungal cream to treat their breasts so as not to pass the thrush back and forth between them and their baby and should be treated simultaneously with their child (2, 3).

If the non-invasive antifungal oral medications do not seem to be working and the infection becomes more severe, a more aggressive medication called fluconazole might be given. This treatment is uncommon in healthy children with no other immune deficiencies (1).

What have we learned?

As with any other mouth illness, oral thrush can almost always be prevented with good oral hygiene. If your baby or child does develop this common yeast infection, our dental staff at Jungle Roots can provide treatment to eliminate the problem. We are happy to provide guidance and support regarding all of your oral care needs. We can’t wait to see you at your child’s next appointment!

At Jungle Roots Children’s Dentistry & Orthodontics, we strive to provide the highest comprehensive pediatric and orthodontic dental care in a unique, fun-filled environment staffed by a team of caring, energetic professionals. We believe the establishment of a “dental home” at an early age is the key to a lifetime of positive visits to the dentist.

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Sources:

  1. Candida Infections of the Mouth, Throat, and Esophagus. (2021, February 25). Centers for Disease Control and Prevention. Retrieved January 28, 2022, from https://www.cdc.gov/fungal/diseases/candidiasis/thrush/index.html
  2. Thrush. (2019, October 22). Cleveland Clinic. Retrieved January 28, 2022, from https://my.clevelandclinic.org/health/diseases/10956-thrush
  3. Oral Thrush. (2021, April 23). Mayo Clinic. Retrieved January 28, 2022, from https://www.mayoclinic.org/diseases-conditions/oral-thrush/symptoms-causes/syc-20353533
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