Thrush is a yeast infection in the mouth caused by the yeast Candida albicans. Thrush can also be called an oral fungal infection. Although oral thrush can happen to anyone, it’s most common in babies, older adults, and people with suppressed immune systems. Babies’ immune systems are still developing and learning to fight unwanted germs, but oral thrush is easily treatable for healthy babies.2 In this article, we’ll explain the symptoms, risk factors, diagnosis, treatment, and more for baby thrush. We’ll also explain what nipple thrush is and what it looks like. Let’s dive in!
Oral thrush is a yeast infection of the mouth that grows white or creamy-looking patches on the inner cheeks, gums, tongue, and roof of the mouth. Sometimes, it can even spread to the tonsils and back of the throat. The Candida yeast that causes thrush lives in everyone’s mouth as a normal organism, but certain situations can lead the yeast to flourish or overgrow, causing a thrush infection. You can tell the difference between a white coating on the tongue from milk/formula residue (also called “milk tongue”) and a thrush infection by gently scraping the tongue with gauze or a clean fingernail. Milk/formula residue will come off the tongue, but thrush won’t. If you suspect that your baby has thrush, call your provider for advice.1,2,3
Thrush can develop in several ways since, as mentioned, the Candida yeast that causes thrush lives on the skin and in the mouth of humans. It can develop when:3,4
- A breastfeeding mom or a baby takes antibiotics (antibiotics can kill our bodies’ good, everyday germs, leading to the Candida yeast growing out of control)
- A baby uses a pacifier or bottle nipple that has grown yeast on it
- A baby has been born premature or has a very low birth weight, which usually coincides with an underdeveloped immune system
- A baby is delivered through a birth canal that has an active yeast infection
- A mother is breastfeeding and has a Candida infection on the nipple area
Thrush causes velvety-looking white or yellow patches in the mouth and on the tongue. Cottage cheese-type lesions are another way to describe it. Some babies find it uncomfortable and will experience pain in the mouth when feeding or swallowing. Most babies, however, seem not to feel any pain with thrush and act completely normal. Some common thrush symptoms include:2,5
- Creamy white or yellow bumps on the tongue, inner cheeks, gums, roof of the mouth, and/or tonsils and throat area
- Lips show a white film that doesn’t easily wipe off
- Redness or bleeding in the mouth
- Tingling sensations, a burning feeling, or pain in the mouth
- Redness, soreness, and cracking of the lips at the corners of the mouth
- Mood changes with increased fussiness, especially during feedings, or even refusing to eat or nurse at all
- Bright red diaper rash with red dots along creases
Technically, thrush is considered contagious because it can be passed from baby to mom and from mom to baby during breastfeeding. It’s more typically an opportunistic infection, meaning it can cause an infection in the right conditions. Typically, this would be someone with a weakened immune system, such as a baby. It’s most common for babies ages 1-6 months. After that, their immune system is usually strong enough to keep the yeast at bay.6,7,11
Most babies and children with healthy immune systems can get rid of thrush without treatment. But there are some risk factors to keep in mind:6,8
- Premature babies and low birth weight babies (they’re more susceptible due to an immature immune system)
- Babies exposed to an active yeast infection in the vaginal canal during birth
- Recent use of antibiotics in a baby or nursing mother
- Using pacifiers for too long without cleaning them
- Using breast pump parts or baby bottles that aren’t adequately cleaned
- Active untreated thrush infection on a nursing mother’s nipples
- Known immune system deficiency in nursing mother or baby (whether breast- or bottle-fed)
A medical provider usually diagnoses oral thrush by looking in the mouth and asking questions about the baby’s medical history and symptoms. It has a very distinct and recognizable pattern. Your doctor might also take a sample of the thrush by lightly scraping the tongue or inner cheeks to send a sample to the lab, but this isn’t always necessary.1,4
Treatment for thrush can vary according to the age of the child and their overall health condition. Some children won’t require any treatment. Older children may be given the medication in pill form. But the treatment for baby thrush is very simple. Your provider will prescribe a liquid or gel antifungal medication such as nystatin, clotrimazole, or miconazole. Since the medications are liquid or gels, it’s easy to “paint” or coat the inside of the mouth. Helpful items to use for applying the medicine are sponge applicators (or a new makeup sponge), gauze, or a cotton-tipped swab.1,3,6,8
You’ll need to apply the medicine to all affected areas inside the mouth. If you lay baby on their back and turn their head to one side, it’s easier to see where you’re putting the medication. Then, turn their head to the other side and repeat. Don’t forget the roof of the mouth, under the tongue, and the gums. It’s safe for baby to swallow the medicine. Always apply the medication after feeding and wait 30 minutes before putting anything else in the mouth. Thrush will usually go away in four to five days with treatment, but sometimes it takes up to two weeks.1,3,6,8
If the diaper area is affected, you can use an over-the-counter antifungal cream as long as you discuss this oral thrush treatment with your provider. Apply the antifungal cream directly to the diaper rash in a thin layer.6 You should only apply the antifungal cream. If the area seems itchy or irritated, you can also apply a small amount of 1% hydrocortisone ointment.12 Some babies do well with diaper-free time (with a puppy pad underneath them to catch urine and stool), which helps the area dry out as well. Change wet diapers often to prevent having a moist environment.
A common question from parents is, “How do I get rid of oral thrush in my baby? Aren’t there more natural ways to treat thrush instead of using medication in infants?” The answer is that there are no home remedies currently recommended for the treatment of oral or nipple thrush. The only “natural” recommendation is to decrease sugar intake and ensure you eat a healthy variety of foods to have normal amounts of vitamins and minerals. It’s also helpful to ensure any risk factors are treated appropriately, such as diabetes and immune system disorders.11
Several other home remedies for thrush may be available on the internet but aren’t well-studied and cannot yet be recommended. Most of these home remedies also aren’t appropriate for infants, as the instructions may include “do not swallow” or “swish and spit.” You may also be instructed to make a mouthwash for oral thrush, but again, this isn’t something to be swallowed.
If your child has a mild oral thrush, it may resolve on its own in three to five days. But if it doesn’t go away or seems to be getting worse, or your baby is becoming fussier and more irritated with feedings, call your provider. They can guide you through the next steps to resolve the issue.4
A thrush infection of the mother’s nipples can be a pain — literally. As we already know, nipples are a very sensitive area. A breastfeeding mom can miss a thrush infection for a while if the nipples are already a little sore and irritated from other issues, such as a shallow latch or pump trauma, which can also increase the chances of infection. The symptoms of nipple thrush are:2,6,8
- Dry, flaky, or shiny skin around the nipple area
- Bright red skin or cracked skin in the nipple area
- A burning or itching feeling around the nipple area
- A burning, throbbing, or shooting pain sensation during or in between feedings
- Deep, stabbing pains within the breast
- Baby has thrush in their mouth, and mom has nipple symptoms
- Mom has a vaginal yeast infection along with nipple symptoms
You can continue to breastfeed if you and/or baby have thrush. If you both have symptoms, you should treat both at the same time to prevent the infection from passing back and forth and lasting longer than it should.6,8
You may not be able to prevent baby thrush, as it’s primarily due to baby’s immature immune system. But once your baby has thrush, here are some helpful hints to help keep it from coming back:3,4,10
- Sterilize any pacifiers, bottles, bottle nipples, or pumping/feeding equipment after each use. Boil items in water for five to 10 minutes to sterilize or per package instructions.
- Sterilize any toys your baby puts in their mouth using the same boiling water method.
- Wash your hands and baby’s hands with warm water and soap often. Be sure to wash your hands before and after feedings.
- If you’re breastfeeding or pumping and have symptoms of nipple thrush, ask your doctor for evaluation and possible treatment.
- Wear a clean bra or breast pads every day.
- Wash bras, breast pads, mom’s and baby’s bath towels, and baby clothes in hot water cycles while thrush is present.
- Use disposable breast/nursing pads while thrush is present, and change them after every feeding.
Oral thrush is a well-known, easily treatable yeast infection in infants. Many babies can clear the infection on their own, while others need a little help from medication. It usually clears up within five days but can take up to two weeks.6,12 Breastfeeding mothers may also need treatment if they have symptoms of nipple thrush or seem to be passing thrush back and forth.
Thrush is a common concern that you can be sure your provider will treat if necessary, and they’ll reassure you if it’s simply “milk tongue.” If you’re concerned about thrush, contact your healthcare provider for further evaluation and management. It’s better to trust your parental intuition and have your baby checked out. Your provider won’t mind, and it’s always a bonus for them to see an adorable baby! 😉
