Thrush and infants

Definition
Thrush is a yeast infection of the mouth.

Causes/associated factors
Thrush is typically caused by the fungus Candida albicans, a type of yeast that thrives on milk and in humid environments. A newborn's immune system is not as well developed as that of an older child. As a result, a newborn is more likely to develop an infection after exposure to common germs. Premature infants have even less developed immune systems, which puts them at even greater risk. Because Candida albicans is normally found in the vagina, newborns are often exposed to the yeast while passing through the birth canal. If even a tiny break in the lining of the baby's mouth develops (often due to prolonged sucking or using a large pacifier), an overgrowth of Candida albicans can easily develop.

Transmission
Thrush can spread through contact with infected secretions from the mouth, vagina or skin. Sharing infected toys or pacifiers in child care settings often contributes to its spread. Transmission from mother to baby during childbirth is especially likely if the mother has a vaginal yeast infection, a common condition during the third trimester of pregnancy. Thrush may develop within hours or can take up to seven days after birth to appear.
Sometimes, the infection spreads from the baby's mouth to the mother's nipples during breastfeeding. Because antibiotics may upset the balance of organisms in the mouth, thrush may also develop after a child has taken antibiotics.


Signs/symptoms
Patches that are slightly raised and white to creamy-yellow in color will appear in the baby's mouth. The patches resemble milk curds, but they don't wipe off easily. Although the patches cause little or no discomfort, they leave small raw areas that may bleed slightly if they're rubbed off. They may also make feedings painful.

Diagnosis
The doctor will ask questions about your baby's medical history and do a physical exam. In some cases, the doctor may also take a sample of one of the patches for lab analysis.

Treatment
In healthy newborns, thrush often clears up on its own. If necessary, the doctor may prescribe an oral antifungal medication, such as nystatin oral suspension, oral ketoconazole or gentian violet. Keep the following tips in mind when using the medication:
Place the medication in the front and sides of the baby's mouth, as well as any other areas where patches are visible. The medication must directly contact the patches and is ineffective if swallowed.

Don't feed the baby anything for 30 minutes after applying the medication.

Do not allow prolonged sucking, which can erode the lining of the mouth, cause irritation and predispose the baby to developing thrush. Don't put the baby to sleep with a bottle or pacifier. You may want to limit pacifier use to bedtime.

If eating or sucking is extremely painful for the baby, give fluids using a spoon or cup.

Soak all bottle and pacifier nipples in hot tap water (130°F) for 15 minutes, or if the items are diswasher-safe, use the dishwasher. Be sure to let them cool before using. Do not boil rubber nipples or pacifiers, however. This will create cracks in the rubber. Fungus may collect in the cracks and cause reinfection. Throw away any rubber nipples or pacifiers that have been boiled or have visible cracks.

If you don't notice improvement within two days, apply the medication to the patches in the baby's mouth with a cotton swab.

Continue the regime for at least seven days or until the patches have been gone for three days. Ask your doctor for details.
If you're breastfeeding, it's not necessary to stop when the baby has thrush. If your nipples become red and sore, leave them open to the air for at least five minutes after each feeding. Do not wash your nipples with soap and water, alcohol or antiseptic. These steps are unnecessary and can dry out your nipples, causing more pain.

Don't use breast shields, and if you're wearing bra pads, change them as soon as they become wet. Yeast thrives in warm, dark, moist environments. If it's too painful to breastfeed, pump your breasts during each feeding time to maintain your milk supply. Ask your doctor for other suggestions to make breastfeeding more comfortable.


Complications
If the baby refuses to eat or drink because of the pain caused by the thrush, he or she may become dehydrated. Thrush may also interfere with breastfeeding if you're in pain or worried about communicability. Rarely, severe cases of thrush may spread down the eosophagus (the tube that connects the throat and stomach).

Prevention
To minimize the risk of thrush, practice good hygiene. Remember to wash your hands carefully, particularly after handling your child's oral secretions.