What is Oral Thrush?
Both common and not usually serious, oral thrush is a type of yeast infection that typically appears in the form of white patches that coat your baby's gums and tongue along with the sides and roof of the mouth. It is characterized by white plaques on the oral mucosa similar to sour milk.
What Causes Thrush?
Thrush is caused by a yeast called Candida albicans. This is the most common and frequent fungal infection in preterm infants, affecting 2-20% of all preemies. Premature infants have very immature and underdeveloped immune systems, meaning that they are very susceptible to acquiring infections. While it's just a mild infection, thrush can be quite uncomfortable and very painful for your baby.
How Do Babies Acquire Thrush?
Oftentimes, it starts in mom’s birth canal as a yeast infection, and that's where baby picks it up as he makes his way into the world. Candida albicans is an organism that normally hangs out in the mouth or vagina and is typically dormant and kept in check by other microorganisms. However, if mom gets sick, starts using antibiotics, or experiences hormonal changes (such as in pregnancy), this balance gets disrupted, allowing Candida albicans to grow and cause the infection.
Since thrush is usually picked up at birth, it most commonly manifests in newborns. Older babies can also develop thrush if they've been taking antibiotics to fight an infection (which kills both "good" and “bad” bacteria) or have a depressed/weakened immune system. Thrush can also be acquired from mom’s breasts while nursing or from dirty bottles and/or pacifiers. It is important to regularly disinfect, sterilize, and replace anything that is put in your baby's mouth on a regular basis, since these items are the perfect environment for yeast to thrive.
What Does Oral Thrush Look Like?
Although white patches can be a sign of thrush, they can also just simply be milk residue that remained on the baby’s tongue after feeding. In order to determine if the white you’re seeing is just leftover milk or actually a fungal infection, try to wipe it off gently by using a soft, damp cloth, the edge of a tongue depressor, or a gauze-covered finger. If the white is able to be scraped off and the tongue is pink and healthy-looking after wiping, no further treatment is necessary. If the white patch doesn't come off, or it does and you find a raw, red patch underneath, this is likely thrush, and you should contact your pediatrician.
What are Some Other Signs of Oral Thrush?
Fussiness during feeding can be another indication of oral thrush. If your infant is sucking on a pacifier or nipple, then cries or turns away in pain, he or she likely has a fungal infection. Your baby may not want to bottle feed, as the pain and irritation can deter him from enjoying this experience. If left untreated, this can cause your baby to associate bottle feeding with pain and discomfort—ultimately leading to nipple aversion.
How is Oral Thrush Treated?
Although oral thrush is not serious or life threatening, it is highly contagious and acquired very easily, which means that prompt treatment is necessary. The physician may prescribe an antifungal medication (such as Nystatin), which is applied topically inside the mouth and on the tongue multiple times a day for a minimum of 10 days. The best technique is to dip the baby’s pacifier or your gloved-finger in the solution and then place it in your baby’s mouth for him to suckle on. It is important to apply the medication to ALL of the white patches in your baby's mouth. In addition to oral meds, disposing of and sanitizing all bottles and nipples is ESSENTIAL in order to eliminate external contamination. The goal is to minimize any residue that might be used as a culture medium for Candida albicans growth and to prevent the colonization of this microorganism.
ATTENTION MOMS
If you have nipple thrush, your doctor will likely recommend that you apply a prescription antifungal cream to your breasts as well. With the proper remedy, the infection should take a week or so to clear up; check in with your doctor if it doesn't.