What is thrush?
Thrush is a yeast infection that causes white lesions to form on the inside of the mouth, tongue and throat. The medical term for thrush is oral candidiasis. It is caused by an overgrowth of the Candida fungus, which normally lives in small amounts in the mouth and digestive tract. When the growth of Candida becomes uncontrolled, thrush can develop.
Thrush is common in young children but can affect anyone. Factors that increase the risk of thrush in kids include:
- Age – Thrush is most common in infants under 6 months old and toddlers between 1-3 years old. Their developing immune systems makes them more prone to infection.
- Antibiotics – Antibiotics kill off good bacteria along with harmful bacteria, which can allow Candida to multiply.
- Illness – Conditions that weaken the immune system, like diabetes and cancer, increase susceptibility to fungal infections.
- Oral hygiene – Kids who wear dentures or orthodontic appliances or don’t brush regularly are at higher risk.
- Medications – Inhaled corticosteroids used to treat asthma can alter oral flora.
- Formula feeding – Bottle-fed infants are more likely to get thrush than breastfed infants.
Thrush is usually not considered contagious. It can occasionally spread through contact with an infected person’s saliva, but this is uncommon. Thrush is also not considered a sexually-transmitted infection.
What are the symptoms of thrush?
The most common symptoms of oral thrush in children are:
- White lesions or patches on the tongue, inner cheeks, gums, palate or throat
- Redness or soreness in or around the mouth
- Difficulty feeding or eating
- Fussiness and refusal to eat in infants
- Cracked skin at the corners of the mouth (angular cheilitis)
- Loss of taste
- Cottony sensation in the mouth
- Pain when swallowing (odynophagia)
The lesions can look like milk curds or cottage cheese. They may be painless or cause mild discomfort. Thrush lesions often start as small white spots that can multiply and cover larger areas inside the mouth.
In babies, symptoms may also include:
- Fussiness or irritability
- Excessive crying
- Reflux or vomiting
- Refusal to eat
- Trouble sleeping
Because thrush can make eating uncomfortable, infants may start feeding less and become dehydrated or undernourished.
How do kids get thrush?
There are several ways children can develop thrush:
Weakened immunity
Anything that compromises the immune system makes children more prone to fungal overgrowth and thrush. Illnesses like HIV or diabetes, medications like steroids or cancer drugs, or conditions requiring antibiotics can all increase risk. Malnutrition also impairs immunity.
Oral bacteria imbalance
Using antibiotics, especially for a prolonged time, can kill off healthy bacteria in addition to bad bacteria. This allows Candida yeasts to proliferate. Steroids like asthma inhalers also change the oral microbiome.
Unsanitary objects
Putting contaminated objects in the mouth increases exposure to Candida. This includes sharing utensils, cups, toothbrushes, or toys with someone who has thrush. Pacifiers can also harbor yeast if not cleaned properly.
Breastfeeding
An infant can develop thrush by exposure to a breastfeeding mother with a yeast infection on her nipples or milk ducts. Thrush can then pass back and forth between mother and baby. Proper hygiene is important.
Birth and delivery
Babies are exposed to yeast during vaginal delivery. Infants born via C-section have a lower risk of thrush than vaginally-delivered babies. Premature infants are also more susceptible due to underdeveloped immunity.
Oral appliances
Dentures, retainers, mouthguards and orthodontics like braces provide surfaces for Candida to adhere to. Food particles can also get trapped under these appliances.
When to see a doctor
Mild thrush often clears up on its own without treatment. But see a pediatrician or family doctor if:
- Symptoms last more than 2 weeks
- Thrush returns frequently
- Lesions are widespread
- Your child has trouble eating or sleeping
- Your baby becomes dehydrated
- You suspect a nursing mother may be infected
Prompt medical care is also needed if the infection spreads beyond the mouth to the esophagus. This can cause pain or trouble swallowing. Babies under 6 weeks old with thrush should be evaluated to rule out underlying conditions.
How is thrush diagnosed?
Doctors can usually diagnose thrush simply by examining the distinctive lesions in the mouth. In ambiguous cases, a swab of the lesions may be sent to a lab to confirm Candida overgrowth under a microscope. Blood tests can help identify any related illnesses like diabetes.
Thrush treatment
Mild thrush often goes away on its own after a week or two. For moderate or severe infections, antifungal medications may be prescribed. Common antifungal drugs used for kids include:
- Nystatin suspension or pastilles – Applying nystatin directly to lesions several times a day clears infection in most cases.
- Fluconazole – This antifungal medication is taken by mouth.
- Gentian Violet – This purple liquid dye has antifungal properties and can be swabbed on lesions once a day.
In severe cases, fluconazole is taken for 2-3 weeks along with nystatin swish and swallow treatment. Gentian violet is not used long-term due to potential toxicity.
For breastfeeding mothers, nystatin cream may be applied to the skin and antifungal medication taken by mouth. Proper hygiene is also critical – all objects coming into contact with infant’s mouth must be thoroughly cleaned. Pacifiers should be replaced frequently. Breast pumps and bottle parts must be sterilized.
In addition to medication, good oral hygiene helps clear thrush lesions. Gently brushing the tongue and roof of the mouth prevents adherence and overgrowth of Candida fungi. Dentures and orthodontics should be properly cleaned and removed at night. Probiotic supplements containing healthy bacteria can also prevent fungal overgrowth after antibiotics. A healthy diet limits sugary foods that yeast thrive on.
If treatment is successful, thrush lesions should steadily improve and disappear within 2 weeks. The infection can return after treatment stops, so follow-up with your pediatrician may be needed. Let your doctor know if symptoms get worse or return. Recurrent thrush may indicate an immune deficiency requiring further evaluation.
Can thrush be prevented?
It can be difficult to prevent thrush altogether, but the following tips may help reduce your child’s risk:
- Practice good oral hygiene – brush regularly, especially before bed
- Clean all objects going into baby’s mouth
- Sterilize and replace pacifiers, bottles and pumps
- Avoid excessive antibiotics if possible
- Treat thrush promptly if it develops
- Ask about probiotics after antibiotics
- Limit sugary foods and drinks
- Make sure those with thrush finish treatment
- Improve immune health through diet and nutrition
Proper hygiene is the best preventative measure. But thrush is still common in young, healthy children due to developing immunity and exposure to yeasts. Seeking prompt treatment ensures thrush complications do not develop.
Thrush complications
Usually thrush resolves without issue if treated properly. But oral thrush can potentially spread to other parts of the body in severe cases. Possible complications include:
Invasive candidiasis
This serious blood infection occurs when Candida enters the bloodstream and spreads through the body. It most often affects babies in the NICU or people with compromised immune systems. Symptoms are fever and chills. Hospitalization is required for intravenous antifungal treatment.
Esophageal thrush
If thrush extends down the throat, it can cause painful inflammation and ulcerations in the esophagus. This can make it hard to swallow. Systemic antifungal treatment is required.
Malnutrition
Oral thrush can inhibit eating and lead to nutritional deficiencies, especially in infants.
Dehydration
Difficulty drinking due to mouth pain may result in dehydration. Intravenous fluids may be needed.
Candida sepsis
In very rare cases, uncontrolled candida can enter the blood and create widespread infection, organ damage and sepsis. This is life-threatening.
Key points
Here are the takeaways about thrush in children:
- Thrush is an oral yeast infection caused by Candida fungi
- It appears as white lesions in the mouth and throat
- It’s common in babies and toddlers due to developing immunity
- Risk factors include antibiotics, illness, oral appliances
- See a doctor if thrush is severe, persists, or complicates feeding
- Mild thrush often resolves on its own
- Treatment options include nystatin, fluconazole, gentian violet
- Practice good oral hygiene and hygiene of objects in mouth
- Prompt treatment prevents complications like dehydration
Thrush is a common childhood condition. While uncomfortable, it typically resolves with time and proper oral care. But medications may be needed if lesions are widespread, last a long time, or interfere with eating. Seek medical advice for any persisting thrush or signs of complications. With a doctor’s guidance, thrush can be effectively managed and treated.
Frequently Asked Questions
Is thrush contagious?
Thrush is generally not contagious, especially among healthy children. It can occasionally spread through contact with saliva or other excretions. But this is relatively rare. Simple hygiene measures are usually sufficient.
Can adults get thrush from children?
Yes, it is possible for adults to contract thrush from an infected child. This is more likely among parents, family members and caregivers who are regularly in close contact. Sharing utensils or other mouth-contacting items can transmit thrush. But again, transmission is uncommon with proper hygiene.
What does thrush look like in the mouth?
The typical appearance of thrush is white patches or lesions on the tongue, inner cheeks, gums, tonsils and back of the throat. Spots often resemble cottage cheese or milk curds. Redness and inflammation may also be present.
How long does thrush last untreated?
Without treatment, mild thrush may resolve on its own within 1-2 weeks. But more severe thrush can persist much longer, especially if an underlying condition is contributing to fungal overgrowth. Seeking medical treatment is recommended for any thrush lasting more than 2 weeks.
Can I treat thrush at home?
Home remedies like rinsing with baking soda or apple cider vinegar provide temporary relief in mild cases. But medical treatment is recommended for moderate or severe thrush, recurrent infections, or cases affecting infant feeding. Antifungal medications are needed to fully eliminate infection. Always consult your pediatrician first.
What if thrush treatment doesn’t work?
If thrush does not improve with initial treatment, the doctor may prescribe a different antifungal medication or higher dose. Culture testing can identify the specific Candida strain and best drug options. Addressing any underlying medical conditions contributing to thrush is also important. Seek medical advice if thrush persists after treatment.
Are there long-term effects of thrush?
Thrush does not cause any permanent effects by itself. However, untreated or chronic oral thrush can potentially lead to malnutrition, dehydration, orinvasive fungal infection in immunocompromised children. Seeking prompt and proper treatment prevents any lasting issues.
Can I breastfeed with thrush?
Yes, you can still breastfeed if either you or your baby have thrush. The key is treating both mother and infant simultaneously to prevent passing it back and forth. Antifungal creams, oral medication, sterilizing equipment, and proper hygiene allow continuation of breastfeeding. Consult your pediatrician.
Conclusion
Oral thrush is a common infection in infants and toddlers caused by an overgrowth of yeast in the mouth. Prompt diagnosis and treatment from a pediatrician is important, especially for moderate or severe cases that cause pain or trouble feeding. With proper care and hygiene, thrush can be effectively managed and cleared with no lasting effects. While uncomfortable, thrush rarely causes any serious complications in healthy children. However, parents should closely monitor their child’s symptoms and follow up with the doctor as needed until the infection has resolved. With vigilance and care, kids can bounce back quickly from this common childhood ailment.