Hey there its Dr. Andrea your board Certified Pediatrician and newborn expert. Have you ever noticed that some babies have tongues that appear white? In this blog I review what is normal or cause for concern.
What is it?
Thrush is an overgrowth of yeast in the mouth. Yeast is a type of fungus, commonly Candida Albicans, which occurs naturally throughout the human digestive system and is usually kept in balance by the healthy bacteria that also lives there. Certain conditions may cause this environment to become imbalanced allowing overgrowth of the yeast, which leads to thrush.
Common Causes in Infants
The most common reason for thrush in young infants is thought to be related to the fact their immune systems are immature or under-developed, and not as well equipped at maintaining the sensitive balance needed between yeast and bacteria in the body.
When infants are given antibiotics by mouth for the treatment of bacterial infections, such an ear infection, the antibiotics destroy some good bacteria along with the unwanted ones, which then allows the yeast to thrive. This may also occur when a breastfeeding mother takes antibiotics because small amounts of the medicine can cross over to the infant in mom’s milk.
Signs and Symptoms of Thrush
Thick white spots on the tongue, gums and inside of the lips or cheeks resembling cottage cheese or curdled milk. The spots can cause pain and discomfort, especially during eating, or they may not bother your baby at all.
Moms of breastfeeding infants can also develop yeast infections on their breasts, which can present as swollen, red or peeling nipples and can lead to burning pain and even deep shooting pains during breastfeeding sessions.
Look-A-Likes
A harmless condition, milk tongue, is often mistaken by parents and even some health professionals as thrush. Milk tongue is the white staining of the small bumps of the tongue, papillae, by milk or formula. So how can you tell the difference between milk tongue and thrush? Milk tongue typically presents as a thinner white coating on the tongue and does not affect other areas of the mouth (gums, cheeks, lips) like thrush. Milk tongue is not painful and if you attempt to wipe away the coating it usually comes off easily revealing a clean pink tongue underneath. Milk tongue also tends to come and go whereas thrush usually does not. White spots from thrush do not wipe off easily and if wiped off forcefully the underlying tongue will likely be red and may even bleed. Other things that may suggest you are dealing with thrush and not milk tongue include associated pain or discomfort for baby during feeds, recent use of antibiotics before the spots appeared, painful or red nipples for mom or a presence of a persistent red diaper rash which can also be due to yeast. If you are unsure, it is best to err on the side of caution and see your child’s doctor.
Treatment
Milder cases of thrush will sometimes resolve on their own. Giving products like commercial infant Probiotics, a supplement containing ‘healthy’ bacteria, or plain greek yogurt which also contains these good bacteria, may treat thrush more naturally by helping to restore a healthy balance with the yeast. Yogurt should only be given to infants above 4 months old who have shown they are developmentally ready for solid foods. First place a small amount of the yogurt on a clean finger and gently rub a small amount onto areas where white spots are noted then feed the yogurt to your baby as usual. The most common prescription medicine that doctors prescribe for thrush is a medication called Nystatin. It is typically given to an infant 3-4 times daily until all white patches resolve. I generally recommend to families to treat for 2 additional days after spots are no longer seen in the mouth. Most often, Nystatin treats thrush successfully but in the few cases where thrush is not resolving, a stronger medication called Fluconazole may be prescribed.
Andrea D. Burns, M.D.