Thrush Tips from Pediatric Partners

Thrush is a common finding in newborns and can occur in older children and adults if there are certain risk factors, such as antibiotic use, diabetes, or immune dysfunction.

SYMPTOMS OF THRUSH

• White, odd shaped patches in the mouth that coat the inner cheeks or inner lips
• Sometimes the white patches also coat the tongue
• The white patches can't be washed away or wiped off easily like milk curds
• Usually thrush is painless, but sometimes it can cause pain, decreased sucking and reduced milk intake
• A diaper rash often follows thrush because the yeast is swallowed and comes out in the diaper. If the skin is broken it can cause an infection of the skin in the diaper area. Prevention with a diaper rash cream may help prevent this.

CAUSE OF THRUSH

• A yeast (Candida) overgrowth - we all have bacteria and yeast in and on our bodies, but if the yeast grow too much, it appears as an infection

WHITE TONGUE ALONE: THIS IS NOT THRUSH

• If a white tongue is the only finding, it's not due to thrush.
• A white tongue is normal.

Treatments for Thrush

1. Anti-Yeast Medicine (Prescription):
   • Prescription anti-yeast medication:
     • Pour 1-2 mL into a small cup and use a Q-tip to absorb some, then use the Q-tip to rub into affected areas of the mouth. Re-dip the Q-tip into the small cup as neded to apply to all areas. Do not put the Q-tip in the medication bottle - that will contaminate the unused medication.
     • Repeat applications 3-4 times a day until all white spots are clear for AT LEAST 48 hours, 72 hours is better. If you stop too soon the thrush comes back.
     • Don't feed your baby for 30 minutes after the medicine.
2. Limit sucking time:
   • Limit feeding time to 20 minutes per feeding in bottle and breast fed infants.
   • Limit pacifier use to falling asleep time and then remove it from the crib (if needed at all).
   • Too much sucking can irritate the lining of the mouth. This makes it more prone to a yeast infection.
   • For severe mouth pain with bottle feeding, don't use a bottle. The nipple can make pain worse. If this happens, try giving fluids in a cup, spoon or syringe instead.
3. Washing of pacifiers, bottles, and toys:
   • Pacifiers and bottle nipples can be washed the usual way with soap and water.
   • There is no need to boil or sterilize bottles or pacifiers.
4. Breastfeeding and Yeast Symptoms:
   • If the mother's nipples are red and sore, it's probably a yeast infection.
   • Use an anti-yeast cream (such as Lotrimin - available over the counter) on the nipple area.
   • Put the anti-yeast cream on the nipple 4 times per day after feedings.
   • Wash the cream off the nipples with a warm wet cloth before each breastfeeding timem but avoid soap - it dries out the skin.
   • Many mothers will need treatment with an oral anti-yeast medicine (such as Diflucan). Call your PCP or OB during office hours for advice.
5. Diaper Rash Treatment:
   • If there's a bad diaper rash, it can also be due to yeast.
   • Use an anti-yeast cream (such as Lotrimin, available over the counter) on the diaper rash.
   • Put the anti-yeast cream on 4 times per day.
   • Apply diaper rash ointment over the cream.
6. Return to Child Care:
   • Thrush cannot be spread to others. We all have yeast and it is not an infection.
   • Your child can go to child care with thrush.
7. What to Expect:
   • With treatment, thrush usually clears up in 4 to 5 days but can last longer.
   • Without treatment, it clears up in 2-8 weeks.
8. Call Your Doctor If:
   • Your child is drinking less than normal and seems dehydrated or in pain
   • You think your child needs to be seen
   • Your child becomes worse