Ask the Pediatrician: Dr. Molly

Category: Infections

Thrush a bother for babies, moms but can be treated, prevented

Tongues are funny things. Sometimes they will look like they have patches of the top layer of skin removed (geographic tongue); other times they will look like a ripe strawberry with a very red, somewhat swollen background and the papillae of the tongue looking like the seeds (as seen in strep infection), and one of the most common appearances in infancy is a tongue with a white fur-like coating.

Not all white tongues are problematic. Sometimes, whether the infant is breast or bottle fed, the white coating on the tongue is just residue from the milk. Other times, though, the white coating on the tongue is paired with a whitish film on the inner lips or the insides of the cheeks and when this is the combo, the diagnosis is most likely thrush.

Thrush is a yeast infection of the mouth and occurs frequently in infants who aren't yet colonized with the "good" bacteria that keep yeast at bay. Older children can also get thrush, but usually only if their immune systems are compromised or if using an inhaled steroid to control their asthma, which acts as a local immune suppressant in the mouth and allows yeast to grow.

The symptoms of thrush vary from no symptoms at all to extreme pain and fussiness in infants. If a mother is breastfeeding she, too, may have pain and redness of her nipples.

Treating thrush depends on the severity of the symptoms and if the mother is breastfeeding. If the infant is bottle feeding and asymptomatic, pharmaceutical treatment may not be needed. Instead, wash the bottle nipples in hot water, dry them thoroughly (including pacifiers) and give the baby bifidus to help colonize her with the "good" bacteria that can naturally combat the yeast and get them back under control.

We all have some yeast in our systems and this is normal. It is only a problem if the balance of yeast and bacteria gets out of whack that problems ensue. By giving the bifidus, the balance can be reset.

Sometimes, though, the thrush is uncomfortable and requires treatment. Some natural remedies beyond probiotics include tea tree oil or grapefruit seed oil mixed with water and used on the diaper area and sparingly in the mouth. The downside to this one is that if you use a mixture that is too concentrated you run the risk of causing ulcers in the mouth. Using just a few drops of tea tree or grapefruit seed oil in 1/2 cup of water is all you need. Then you use a cloth soaked with the treated water and rub the inside areas of the mouth and diaper area, too, if needed. Make a new dilution each time.

Another over-the-counter product is gentian violet. This purple dye is a powerful antifungal and with as little as a single application oral thrush in infants can be eliminated. It is important to use this product very sparingly because ingestion of too much has potentially serious side effects. Breastfeeding moms can also apply this to their nipples to treat topical yeast with the same caveats about how much to use.

The other downside is that it stains. It turns the inside of the baby's mouth purple and even his drool will be purple for a couple of days. This is not the time to put on the holiday clothes!

If all else fails, there are medications by prescription that can be used including Nystatin and Diflucan. Both are effective, with diflucan being somewhat more effective, but are not without their own issues. Nystatin needs to be applied directly to the areas in the mouth four times a day and may cause some mild stomach upset. Diflucan is given just once a day but has a rare side effect of liver damage.

Thrush is a hassle and can be uncomfortable for kids and moms alike. Preventing it by using bifidus regularly in infants may well be a good idea. If that fails, talk to your doctor about the treatment options because none is without side effects.