Thrush in Babies: Tips for Managing and Preventing It

What is Thrush?

Thrush in babies, also known as oral thrush or oropharyngeal candidiasis, is a common fungal infection caused by an overgrowth of Candida yeast in the mouth. It primarily affects infants and young children, particularly those under the age of one. Thrush appears as white or yellowish patches on the tongue, gums, inner cheeks, and roof of the mouth. It can cause discomfort, irritability, and difficulty in feeding. Thrush is a yeast infection caused by the fungus Candida Albicans. The fungus usually is present in babies’ mouths and does not usually cause problems. However, as your baby’s immune system is still not fully developed, the yeast may overgrow and cause an infection. In the diaper area,¹Ravanfar P, Wallace JS, Pace NC. Diaper dermatitis: a review and update. Curr Opin Pediatr. 2012;24(4):472-479. doi:10.1097/MOP.0b013e32835585f2 it can cause a yeast diaper rash.

What are the Risk Factors for Thrush in Babies?

There are some risk factors that might cause thrush in babies. For example, Vaginal yeast infection from the mother may pass on to her baby during birth. Other such risk factors include:

• Babies born prematurely(early), or those less than six months of age, and babies with low birth weight.²Kelly MS, Benjamin DK Jr, Smith PB. The epidemiology and diagnosis of invasive candidiasis among premature infants. Clin Perinatol. 2015 Mar;42(1):105-17, viii-ix. doi: 10.1016/j.clp.2014.10.008. Epub 2014 Nov 28. PMID: 25677999; PMCID: PMC4328135.
• Using unsterilized human breast milk pumps.
• A less developed/ weakened immune system.
• Recent history of baby or mother using antibiotic therapy for bacterial infection.

Why Does Thrush in Babies Occur?

Too much fungus may be a challenge for your baby’s immune system to overcome. Moreover, the fungus may grow when you or your baby takes antibiotics. The reason for thrush in babies is that antibiotic therapy may also kill the good bacteria in your baby’s mouth. Antibiotics don’t affect candida; hence, it has a higher chance of growing without competition from other microbes. As the fungus thrives in moist, warm environments, your baby’s mouth and your nipple are perfect environments for the fungus. In fact, breastfed babies and their mothers can even pass the infection to each other. Furthermore, if the fungus gets in the baby’s stool, they can also get a diaper rash.

What are the Signs & Symptoms of Thrush in Babies?

Your infant may present with fussiness, irritations, and distinctive white patches³Centers for Disease Control and Prevention. (n.d.). Thrush. Retrieved from https://www.cdc.gov/fungal/diseases/candidiasis/thrush/index.html on their tongues, inner cheeks, the roof of the mouth, etc. These patches are slight, raised, and have a cottage cheese-like appearance. There may be slight bleeding when these lesions are rubbed. These may cause soreness when the baby suckles or swallows. This may lead to your baby eating or drinking less food than usual.

Diaper rashes appear as different-sized red patches of inflamed skin on the buttocks, thighs, and genitals. The skin is itchy and tender and may have pimples that ooze pus. Your baby may cry and or be fussy, especially during diaper changes.

How are Oral Thrush and Diaper Rash Treated?

Mild thrush in babies usually clears up without treatment. Antifungal medications like Nystatin, fluconazole, or itraconazole in pill or oral form may be prescribed by your physician. Fluconazole is generally recommended for oral thrush and is safe during breastfeeding.⁴Kaplan YC, Koren G, Ito S, Bozzo P. Fluconazole use during breastfeeding. Can Fam Physician. 2015;61(10):875-876. The infection should clear in 4 to 5 days.
However, diaper rashes due to Candida would require antifungal creams.⁵Benitez Ojeda AB, Mendez MD. Diaper Dermatitis. [Updated 2023 Jan 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK559067/ These creams may contain Nyastatin. If the fungal rash doesn’t improve by 1 to 3 days, then Clotrimazole, miconazole, or ketoconazole may be prescribed by your physician. You must wash your hands well before and after you use the cream. Furthermore, to help your baby’s skin heal, keep it clean and dry.

How to Prevent Oral Thrush Infections?

For oral thrush in babies, if you opt to use a pacifier or feed your baby formula, it’s important to thoroughly clean the nipples and pacifiers after every use using hot water or a dishwasher. This is to prevent the possibility of your baby getting infected by yeast if there’s any on the nipple or pacifier. Additionally, storing milk and prepared bottles in the refrigerator is advisable to inhibit yeast growth.
In the event that you breastfeed and experience redness and discomfort in your nipples, it’s possible that you and your baby could be passing a yeast infection back and forth. It’s recommended that you speak to your doctor, who might suggest using an antifungal ointment on your nipples while your baby undergoes treatment with an antifungal solution.

How to Prevent a Diaper Rash?

It’s important to maintain a clean and dry diaper area for your baby. This can be done by promptly changing diapers when wet or soiled. Disposable diapers with an absorbent gel are recommended, as they draw wetness away from the skin. During each diaper change, rinse your baby’s bottom with warm water using a sink, tub, or water bottle, and gently clean the skin with moist washcloths, cotton balls, or baby wipes. Avoid using wipes with alcohol or fragrance, and refrain from using talcum powder. You may use a mild fragrance-free soap to bathe your baby.
After cleaning and drying the skin, apply a cream, paste, or ointment to protect it from moisture. Products with a high percentage of zinc oxide or petroleum jelly effectively prevent diaper rash. However, it’s important to use products designed specifically for babies and avoid those containing toxic ingredients such as baking soda, camphor, phenol, benzocaine, salicylates, etc.

When to Contact a Doctor?

You should see a doctor if your baby’s rash doesn’t improve after a few days of treatment. Other indications to contact your doctor include:

• A rash with a fever
• A rash that persists or gets worse (bleeds or oozes) despite treatment
• A rash that causes burning or pain when your baby urinates or defecates

Is Thrush contagious?

Yes, thrush can be transmitted between individuals. It can be passed from breastfeeding mothers to their babies and vice versa. Additionally, it is important to avoid sharing items such as nipples, pacifiers, milk bottles, and toothbrushes between children to prevent the spread of thrush.

Can thrush cause a fever?

When oral thrush extends beyond the esophagus and progresses to invasive candidiasis, it can indeed be accompanied by fever. Invasive candidiasis⁶Lass-Flörl C, Kanj SS, Govender NP, Thompson GR 3rd, Ostrosky-Zeichner L, Govrins MA. Invasive candidiasis. Nat Rev Dis Primers. 2024 Mar 21;10(1):20. doi: 10.1038/s41572-024-00503-3. PMID: 38514673. is a severe condition that has the potential to impact various body systems, including the blood, heart, brain, and other vital organs⁷Centers for Disease Control and Prevention. (n.d.). Candidiasis. Retrieved from https://www.cdc.gov/fungal/diseases/candidiasis/invasive/index.html is associated with fever.

What are some natural remedies for thrush in babies?

If your baby can eat solid foods, your doctor may prescribe unsweetened yogurt. The “good” bacterial cultures⁸Matsubara VH, Wang Y, Bandara HMHN, Mayer MPA, Samaranayake LP. Probiotic lactobacilli inhibit the early stages of Candida albicans biofilm development by reducing their growth, cell adhesion, and filamentation. Appl Microbiol Biotechnol. 2016;100(14):6415-6426. doi:10.1007/s00253-016-7527-3 in yogurt may help stop Candida growth. Vitamin C, though it has no direct known effect on the fungus, is essential for a strong immune system. A stronger immune system may help your baby fend off Candida infections.

What is the Difference between Thrush in Babies and White Tongue?

If you notice that your young baby has a white tongue after feeding, it doesn’t always mean that your baby has thrush. Typically, if the white coating is only on the tongue and not on other parts of the mouth, such as the inside of the lips or cheeks, and you can easily wipe it away, it’s generally not thrush.

In conclusion, thrush is a common fungal infection affecting babies, particularly in their mouths and diapers. Parents and caregivers must be aware of the signs and symptoms of thrush, such as white patches in the mouth, fussiness during feeding, and diaper rash. Seeking medical advice and early treatment is crucial to alleviate discomfort and prevent the spread of thrush. Additionally, maintaining good oral hygiene practices, sterilizing feeding equipment, and practicing proper diaper hygiene can help prevent thrush in babies. Parents can effectively manage and treat thrush by staying informed and taking necessary precautions, ensuring their baby’s overall health and well-being.

Refrences

• 1
  Ravanfar P, Wallace JS, Pace NC. Diaper dermatitis: a review and update. Curr Opin Pediatr. 2012;24(4):472-479. doi:10.1097/MOP.0b013e32835585f2
• 2
  Kelly MS, Benjamin DK Jr, Smith PB. The epidemiology and diagnosis of invasive candidiasis among premature infants. Clin Perinatol. 2015 Mar;42(1):105-17, viii-ix. doi: 10.1016/j.clp.2014.10.008. Epub 2014 Nov 28. PMID: 25677999; PMCID: PMC4328135.
• 3
  Centers for Disease Control and Prevention. (n.d.). Thrush. Retrieved from https://www.cdc.gov/fungal/diseases/candidiasis/thrush/index.html
• 4
  Kaplan YC, Koren G, Ito S, Bozzo P. Fluconazole use during breastfeeding. Can Fam Physician. 2015;61(10):875-876.
• 5
  Benitez Ojeda AB, Mendez MD. Diaper Dermatitis. [Updated 2023 Jan 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK559067/
• 6
  Lass-Flörl C, Kanj SS, Govender NP, Thompson GR 3rd, Ostrosky-Zeichner L, Govrins MA. Invasive candidiasis. Nat Rev Dis Primers. 2024 Mar 21;10(1):20. doi: 10.1038/s41572-024-00503-3. PMID: 38514673.
• 7
  Centers for Disease Control and Prevention. (n.d.). Candidiasis. Retrieved from https://www.cdc.gov/fungal/diseases/candidiasis/invasive/index.html
• 8
  Matsubara VH, Wang Y, Bandara HMHN, Mayer MPA, Samaranayake LP. Probiotic lactobacilli inhibit the early stages of Candida albicans biofilm development by reducing their growth, cell adhesion, and filamentation. Appl Microbiol Biotechnol. 2016;100(14):6415-6426. doi:10.1007/s00253-016-7527-3