About oral thrush

Oral thrush is a fungal infection of the throat, tongue or the lining of the mouth. In bad cases, it can spread down the food pipe.

Oral thrush is mostly caused by a fungal yeast called Candida albicans. We all have this yeast in our bodies, and our immune systems keep it in balance with the other bacteria and fungi that live in our bodies. If the balance is upset, the yeast can multiply and produce an infection.

Things that can upset the balance include:

• medicines like corticosteroids and antibiotics
• a weakened immune system because of a medical condition or medical treatment
• poorly controlled type 1-diabetes and type-2 diabetes.

Some babies pick up oral thrush when they pass through their mothers’ vaginas during birth. This is because the vagina often has small amounts of Candida naturally.

Babies might also develop oral thrush if they suck on objects already infected with thrush, like nipples, teats or dummies.

Oral thrush is very common in the first 2 years of life. It doesn’t easily spread among children.

Symptoms of oral thrush

If your child has oral thrush, you might notice that they have white spots and patches that look like cottage cheese on their tongue, inner cheeks, lips, gums or roof of their mouth. These patches don’t rub off with gentle pressure. If the patches are removed, they leave inflamed areas that can bleed.

A child with oral thrush might also have cracking and inflammation at the corners of their mouth. They might not be able to taste things as well as usual.

Oral thrush generally doesn’t irritate babies and young children. But it might cause irritation if the areas get very inflamed. In this case, your child might not want to feed or eat. They might also drool. And if the infection spreads to your child’s food pipe, it can be painful and make it hard for them to swallow.

If a baby is breastfeeding, they can pass on thrush, which can cause a nipple infection. This kind of infection causes inflamed, sensitive and cracked nipples. Your breast might hurt during feeding, and you might have a stabbing pain deep in your breast.

Medical help: when to get it for children with oral thrush

You should take your child to the GP if your child:

• has white patches on the inside of their mouth
• suffers from thrush infections that keep coming back, even though you’re using treatment recommended by a health professional
• has difficulty or pain swallowing.

Oral thrush treatment

If your child has oral thrush and is otherwise well, your GP might not need to treat the oral thrush. It will go away on its own.

But if your baby is having difficulty feeding or is irritable, your GP will probably prescribe antifungal drops or oral gel, which you use after each feed or meal for 1-2 weeks. You might need to continue this treatment for at least 7 days after symptoms go away.

Sometimes oral thrush goes along with thrush in the nappy area, which will need treatment at the same time.

If there are signs of thrush spreading to your child’s food pipe, your GP might refer your child to a specialist.

You can still breastfeed if your child has oral thrush. Your doctor might advise you to put some antifungal cream on your nipples as well, but you should wipe this off before feeding.

Prevention of oral thrush

There are several things you can do to prevent oral thrush:

• If you’re bottle-feeding your baby, sterilise teats and bottles after each use.
• If you’re breastfeeding, clean your nipples gently between feeds.
• Sterilise dummies and teething rings regularly.
• If your baby gets nappy rash, make sure you treat it properly.
• Use antibiotics only when necessary and prescribed by a doctor for your child.
• If your child has asthma, make sure they wash their mouth with water after asthma preventer medications.
• If your child has diabetes, try to keep their blood sugar level within its target range.
• Wash clothing at 60°C to kill fungus.
• Help your child to brush their teeth regularly.