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Thrush is a common infection of the mouth found in babies and young toddlers, as well as on the nipples of nursing mothers. Thrush appears as sticky white patches that line the mouth, inner lips, and gums. In nursing moms, thrush may appear as cracked, bleeding nipples. Thrush occurs in both breast- and bottle-fed babies. It can recur as the organism that causes it, Candida albicans, can be found on bottles, nipples, toys, and pacifiers in addition to the mouth. Treatment of thrush involves a quick visit to the doctor to obtain a liquid medicine called Nystatin.  The medicine is applied to the child’s mouth several times a day as well as onto the mother’s nipples for breastfed babies.

In most babies and toddlers, thrush does not indicate a serious infection. Thrush is caused by common yeast present in the human digestive tract that grows easily in warm wet environments. In young infants, frequent feeding further supports yeast growth with the nutrients in breast milk. As infants age, thrush is often associated with use of antibiotics. Antibiotics, while beneficial for killing harmful bacteria, also kill the helpful bacteria that normally prevent yeast growth. Unopposed, the yeast grows quickly.  Babies with chronic infections or suppressed immune systems, such as those with cancer, often battle thrush chronically.

Nystatin works well to eliminate the yeast in the mouth and on the mother’s breast, but the rest of the environment has to be cleaned as well. All bottles, nipples, pacifiers, and toys that a baby puts in the mouth should be cleaned daily during treatment of thrush. Boiling these objects eliminates the yeast and decreases the chance for reinfection. You can also run them through the sanitation cycle on your dishwasher if your bottles are labeled dishwasher safe.  Rinsing them with a white vinegar and water solution after washing then letting them air dry further prevents yeast growth.

As yeast is common to the entire GI tract, babies with thrush often have its cousin, yeast diaper rash. A yeast diaper rash looks like little pink papules over the diaper area and often spreads quickly. A cream formulation of Nystatin treats the yeast in the diaper area. In addition, keeping the diaper area clean and dry helps speed along resolution of the rash.

Thrush often is not bothersome to infants. However, left unchecked it can cause pain in the mouth and then difficulty feeding. It can also cause significant pain to the nursing mother. Treating it early helps avoid unnecessary suffering of both mother and child.

Takeaways

  • Thrush is a common infection and happens in both breast- and bottle-fed babies.
  • In babies, thrush looks like cottage cheese stuck to the inside of the mouth.
  • In nursing mothers, thrush can look like cracked and bleeding nipples.
  • When treating thrush, removing the yeast from all objects as well as the nipples of the breast is key in eliminating the infection.

References

  1. Nelson Essentials of Pediatrics 4th Ed.; pp. 488-489

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