Oral thrush in babies

What is oral thrush?

Thrush is an infection caused by a yeast called candida. The mouth is a common site where candida causes infection- this is called oral thrush.

Other common sites for thrush to develop are the vagina, nappy area, and nail folds. See the separate leaflets called Vaginal thrush, Yeast infection and Nappy rash for more details about other types of thrush.

Small numbers of candida organisms normally live on all our healthy skins and in our healthy mouths. They are usually harmless and can be useful in protecting us from other infections. However, an overgrowth of candida can occur in the mouth and this can cause oral thrush.

This overgrowth may happen more commonly in babies because the baby's immune system is still quite immature and so it is less good at controlling the candida levels.

Another cause for oral thrush in babies is following a recent course of antibiotic medication. This is because the antibiotics kill off some of the healthy bacteria that live in your baby's mouth. These good bacteria normally help to control the levels of candida in your baby's mouth. If there are fewer healthy bacteria around, more candida can multiply.

If you are breast-feeding and you have recently been on antibiotics yourself, the levels of your healthy bacteria can be affected. This can make you, or your baby, more likely to develop thrush.

About 1 in 7 babies develop a bout of oral thrush at some point. It is most common in babies younger than 10 weeks, but it can occur in some older babies too. Oral thrush in babies is not usually due to poor hygiene and it does not usually mean that your baby is ill in any other way. Some babies have recurring bouts of oral thrush.

White patches usually develop in your baby's mouth and on their tongue. These patches may join together to form larger spots called plaques. They may become yellow or grey and look slightly like cottage cheese. Your baby may not be bothered by the infection. However, sometimes his or her mouth may become sore. Some babies may drool saliva, or refuse to feed properly because of soreness.

Note: if you are breast-feeding, it is possible that your baby can pass on thrush infection from their mouth to your nipples. This can be very painful for you. Your nipples can become cracked and sore, or sometimes red and shiny. See your doctor if you think that you may have thrush infection of your nipples. Your doctor may suggest some cream to apply to your nipples to clear up the infection.

In some babies, no treatment is needed. Many mild cases of oral thrush in babies only last for a short time - just a few days or so - and clear without any treatment.

If treatment is started, there are two main options.

The first-line treatment for oral thrush in babies is drops which contain an anti-thrush medicine called nystatin. You use a dropper which comes with the drops to place the liquid on to affected areas within your baby's mouth.

If this does not work or is unavailable, your baby may be prescribed a gel that contains an anti-thrush medicine called miconazole. You smear this gel on to the affected areas in your baby's mouth, using a clean finger, as often as prescribed by your doctor. Follow the instructions carefully. Use the gel after a feed. To avoid the very small risk of choking, apply a little at a time and not to the back of the throat. The medicine works by killing the candida within the inside of your baby's mouth.

Strictly speaking, neither of these treatments is licensed to be used in babies under 4 months old. However, many doctors are happy to recommend their use in babies of all ages.

Alternative treatments

You should continue with the treatment that your doctor prescribes, for two days after the thrush has cleared. See your doctor if the thrush has not cleared within seven days of starting treatment.

Most bouts of oral thrush in babies occur for no apparent reason. However, the following tips may help to prevent some bouts:

• Regularly sterilise all dummies and other mouth toys used by your baby.

• If you bottle-feed, regularly sterilise all feeding equipment, especially teats.