Oral Thrush in Infants and Young Children

What is oral thrush?

Oral thrush is an oral infection caused by a yeast fungus (candida albicans). It occurs in the mucous membranes of the mouth. Most people have Candida in the mouth but it does not usually cause problems. This is because the fungus is kept in check by other beneficial bacterial.

However, infants have a high chance of acquiring oral thrush because their immune system isn’t fully developed at birth. Furthermore, they come into contact with Candida yeast during the process of childbirth because candida is naturally present in the mother’s vagina at delivery.

In infants, oral thrush may occur in areas where the lining of the mouth is extremely moist because of too much sucking. This scenario usually occurs when a baby sleeps with a bottle or pacifier, which induces saliva production. In addition, a large pacifier or nipple can injure the lining of the babies’ mouth too. Hence, the situation can be an entry point for yeast.

However, thrush in children may be due to an increased used of antibiotics for asthma). The medications will disturb the balance of bacteria in the mouth. As a result, an overgrowth of candida occurs therefore causing oral thrush.

Signs and Symptoms

The symptoms of oral thrush are creamy white or yellow lesions on the tongue or inner cheeks. The lesions are slightly raised and may appear similar to cottage cheese. In addition, oral thrush can cause pain or fever if the infection has spread beyond the esophagus. Besides, it can cause an uncomfortable burning sensation in the mouth and throat, and difficulty in swallowing because food may get stuck in the throat or mid chest area.

Mothers sometimes mistake the white patches inside the mouth for milk curds. The distinguishing feature of the white patches due to yeast infection is that the patches cannot be easily removed from the mouth. If the spots are scraped away, they leave a sore and reddened wound, which may sometimes bleed slightly. Moreover, infants with thrush infection may have difficulty in feeding. They may become more fussy or annoyed, especially during feeding.

Treatment Timescale

Oral thrush responds quickly to treatment. However, if the signs and symptoms have not subsided within a week, patients should consult their doctor as soon as possible.

Management

Restrict pacifier use during bedtime for the infant or child who has thrush. It is advisable to use a smaller and regular type of pacifier instead of using an orthodontic-type pacifier. All nipples should be soaked in water at 130°F (60°C – hot water temperature) for 15 minutes to disinfect it. Furthermore, reducing sucking time during feeding to 20 minutes may help to avoid the infection from getting worse. If symptoms relapse and the child is bottle-fed, it is suggested to change to a nipple of a different shape, one that is made from silicone.

When an infant has both oral thrush and nappy rash, both should be treated at the same time. The yeast (Candida) may exacerbate the nappy rash because it will grow faster and readily on damaged and moist skin. Therefore, topical anti-fungal creams containing colorimetric and miconazole can be used for the nappy area.

If thrush develops due to a course of antibiotics, it is recommended that unsweetened yogurt be introduced to the toddler or child’s diet. Yogurt contains zinc, which helps to maintain the immune system and retain vitamin C that helps to fight infection. In addition, yogurt helps to restore the natural balance of bacteria in the bowel. If the toddler or child is experiencing difficulty eating due to a sore mouth, plenty of liquids should be given to help prevent dehydration. Drinking fluids such as milk, which contain a lot of vitamins, minerals and energy, will help to enhance the immune system.

Once the condition that caused oral thrush has been controlled and treated, it will hasten the thrush resolution, or perhaps no medication may be needed to heal the infection. Generally, the effective treatment for oral thrush is the appropriate anti-fungal application, such as miconazole gel.

This is an oral gel, but is restricted to prescription only status. It is advisable not to swallow the gel immediately after applying it, but retain the gel in the mouth for as long as possible. It’s suggested to scrape off the plaques in the mouth when applying the gel, and hence, the effectiveness of the treatment will be enhanced. Although the thrush will clear with medication, treatment should be continued for 2 days. This is to ensure all infections have subsided.

If the symptoms have not been eradicated after one week, consult your doctor immediately.