Have you ever noticed that some babies have tongues that appear to be white?
In this blog we will review what is normal versus what is cause for concern.
What is it?
Thrush is a condition caused by the overgrowth of yeast in the mouth. Yeast is a type of fungus, most 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 the digestive 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 a baby’s immature immune system. At birth, an infant’s immune system is under-developed and therefore not as well equipped at maintaining the sensitive balance between yeast and bacteria in the body.
When infants are given antibiotics by mouth for the treatment of bacterial infections, such as ear infections, the antibiotics destroy some of the body’s beneficial bacteria along with the unwanted kind. This then allows for the overgrowth of yeast. Something similar may also occur when a breastfeeding mother takes antibiotics. That is because small amounts of the antibiotic can still cross over to the baby through mom’s breast milk.
Signs and Symptoms of Thrush
Thrush typically appears as 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.
Mothers of breastfeeding infants can also develop yeast infections on their breasts. The breasts may appear swollen, red or have peeling leading to burning pain and even deep shooting pains during breastfeeding sessions.
A harmless condition, milk tongue, is often mistaken for thrush by parents and even some health professionals. 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. If you attempt to wipe away the tongue 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, painful or red nipples for mom or the 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.
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, may improve thrush by helping to restore the healthy balance between the beneficial bacteria and the yeast. Yogurt should only be given to infants above 4 months old who have shown they are developmentally ready for solid foods. To try, 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 the treatment of thrush is 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 visible in the mouth. Most often, Nystatin treats thrush successfully. In the few cases where thrush does not improve after treatment with Nystatin, a stronger medication called Fluconazole may be prescribed.
For any questions, please contact our office to get more information from some of your favorite Board Certified Pediatricians in Oviedo.
Andrea D. Burns, M.D.