Thrush

You are laughing and playing with your baby. She is laughing back at you, her mouth open wide. You notice a white patch on the inside of her cheek that wasn't there before. You explore her mouth further and find the white patches on the tongue and under the lips. Could it be milk? Or is it thrush that you've heard so much about.

Thrush is the term we use to describe an overgrowth of yeast in a baby's mouth. This yeast, called candida, normally lives within our mouth, intestines, and genital area. It thrives in moist, warm environments. Occasionally this yeast is allowed to overgrow so much it becomes visible as white patches.

• Location – thrush is usually visible on the inside of the cheeks and lips, on the gums, and on the tongue. If present, it will usually spread to 3 or 4 of these places inside the mouth. A thin coating on the tongue only may simply be milk. However, a thick white coating on the tongue is probably thrush.
• Does not come and go – thrush will usually hang around for weeks. Milk patches inside the cheeks and lips, on the other hand, will come and go with feedings. A milk coating on the tongue, however, can be more stubborn, often staying there for weeks as well.
• Does not easily wipe off – use your finger and try to wipe away the white patch. If it comes off easily, it's probably milk. Thrush is harder to scrape away, and can even bleed slightly when removed.
• Associated factors – if either baby or a breastfeeding mom has recently taken antibiotics, or your baby has a stubborn, raised, red diaper rash with outlying red spots (yeast diaper rash), then any suspicious white patches in baby's mouth are much more likely to be thrush.

Thrush is not passed from baby to baby. It is an overgrowth of your baby's own yeast.

• No cause – there is usually no identifiable cause for thrush. It just happens.
• Antibiotics – the normal bacteria that live in the mouth usually keep the yeast from overgrowing. They compete for space. Since antibiotics kills these normal bacteria, the yeast is allowed to overgrow unchecked.

No, thrush is not harmful. It is more of a nuisance than a medical problem. It can, however, irritate baby's mouth during feeding, and when severe, can be painful.

• Acidophilus – this is a powder form of the normal bacteria that live in our mouth and intestines. Click on it to learn how to apply it in baby's mouth.
• Nystatin – this is a prescription antifungal liquid that you either squirt or paint with a Q-tip in baby's mouth four times a day. Continue this for five days after the thrush has cleared since it can be quite stubborn. It is common for thrush to recur, and more than one course of nystatin is often needed. One good aspect of nystatin is that it is not absorbed from baby's intestines into the bloodstream. Rather, it goes right through baby and out in the stool.
• Sterilize bottle nipples or pacifiers – boil them for 20 minutes each day to kill the yeast that may be residing on them.
• Wash toys that baby frequently chews on in hot, soapy water every day.
• Don't forget to treat mom if breastfeeding – see below.
• If the candida is resistant to the standard treatments described above, in consultation with your healthcare provider, try a 0.25 - 0.5 percent solution of gentian violet applied to your nipples twice a day for three days. Gentian violet is effective, but messy. Also, apply a small amount once a day to baby's mouth, but be aware that overuse of gentian violet may irritate the sensitive oral mucus membranes of baby's mouth. Apply Vaseline to baby's lips before using the gentian violet to avoid purple stains.
  Warning - gentian violet has been used for many years to treat thrush. A recent study done in Australia has linked gentian violet to cancer of the mouth. However, many other professionals around the world believe that it is safe, and continue to recommend it. For this reason, we suggest you use this remedy sparingly, and for as little time as possible.

The yeast can be passed back and forth between mom's nipples and baby's mouth. The yeast can begin to infect the skin around the nipples. While this is usually mild, it can turn into a chronic, painful, itchy problem that is very difficult to eradicate. Symptoms of nipple yeast infection:

• sore nipples
• red or pink nipples
• itchy or burning nipples, even when not feeding baby
• puffy, dry, or flaky nipples
• deep, shooting breast pain during or after feedings

Because of the possible severity of chronic yeast infections in the breasts, we suggest mom's nipples be treated along with baby's treatment. This will usually prevent the yeast from taking hold on mom. See below.

If you feel that you have chronic yeast infection of the nipples and/or breasts, here are some steps you can take to eradicate it:

• Treat baby – as above, even if baby's thrush has resolved.
• Acidophilus – this is a very important natural remedy for any yeast infection. Click on it to learn how to take it.
• After each nursing, follow these 5 steps:
  • Breastmilk – massage a bit into the nipples after nursing, then let air-dry.
  • White vinegar – mix a solution of one tablespoon white vinegar in one cup of water. Keep the bottle next to your nursing chair. Dab a bit onto each nipple and let air dry after each nursing.
  • Nystatin anti-fungal cream – available by prescription. Apply 2 to 3 times a day to each nipple after nursing.
  • Clortrimazole anti-fungal cream – you can use this over-the-counter cream in place of Nystatin. Do not use both!
  • Hydrocortisone ointment 2.5% - available by prescription and if recommended by your doctor for severely swollen painful nipples. Apply 2 to 3 times a day when not applying nystatin.
• Diflucan – this is a very strong prescription anti-fungal pill. It can be used under supervision by your OB/GYN or baby's pediatrician to treat very severe and stubborn infections.

Occasionally, yeast can become very stubborn,persistent or recur despite the above treatments. Here are some steps you can take to eradicate the yeast from you and your baby. Some of these steps are extremely time-consuming. Take the steps that you feel are most appropriate for you.

• Hot water over 122º F will kill yeast, either in the laundry, dishwasher, sink, or on your skin (not infants – too hot!).
• Microwaving your undergarments on high for 5 minutes will kill yeast (make sure there’s no metal in the bra).
• Sunlight kills yeast. Hang infected clothing outside to dry in the sun.
• Freezing does not kill yeast.
• Stored breastmilk pumped during an active yeast infection of the breasts should be dumped (this will make pumping moms cringe, but should be done if necessary).
• Dishwashers – use the hot water setting when washing infected items.
• For infected items that you choose to hand wash (such as pump parts, bottles, artificial nipples, pacifiers, and teethers) dip these into a 10% bleach solution before thoroughly rinsing. Wear rubber gloves for this.
• Disinfect daily any item that comes in contact with mom’s breasts, baby’s bottom or mouth. This includes breast shells, breast pads, bras, spit-up rags, pump parts, artificial nipples, pacifiers, teethers, toothbrushes, toys, clothing, underwear and cloth diapers.
• Towels and washcloths can harbor yeast so they should be used once and then washed in very hot water and sun-dried.
• If needed, use disposable items such as paper towels, napkins, cups and plastic utensils for extreme family cases.
• White vinegar added to baths or washing machines can help kill yeast.

As you can see, some of these measures are extremely inconvenient. Only do these if you have a very resistant case of thrush effecting you or baby.

For another discussion on this problem, click here