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My baby has white patches in her mouth. What could this be?
It could be the common and sometimes painful oral yeast infection known as thrush. Thrush causes creamy white or yellow patches to develop on the sides, roof, gums, lips, and tongue of a baby's mouth. It also can spread to the throat, tonsils, or esophagus. Thrush is most common in infants and toddlers.
What causes thrush in babies?
Yeast is normally present in everyone's digestive system, but an infection can set in if there's an imbalance.
Some infants first come in contact with yeast in the birth canal. After your baby is born, antibiotics can trigger a case of thrush, whether you are taking the medication (if you're breastfeeding) or your baby is. That's because antibiotics kill off "good" bacteria that keep yeast in check.
Some moms and babies pass the infection back and forth: Your baby can spread thrush to you if you're breastfeeding, resulting in a painful yeast infection on your nipples that will require treatment. And you can give your baby a case of thrush if you're breastfeeding and develop a yeast infection on your nipples from taking antibiotics.
On the other hand, it's possible for you to remain symptom-free, even if you're breastfeeding a baby who has thrush. Similarly, your breastfed baby may not be affected by your yeast infection.
Some people think thrush can also be caused by sucking on a bottle or pacifier for an extended period of time. Others think unclean bottle nipples are to blame. But infants who breastfeed exclusively and don't use pacifiers can still get thrush, so it's hard to pinpoint one single cause. Some babies (and moms) are simply more susceptible to yeast infections than others.
What are the symptoms of thrush?
If you notice a white coating only on your baby's tongue, it's probably just milk residue (especially if you can wipe it off). But call your baby's provider if you see any of the following signs:
- White or yellow patches on your baby's lips, tongue, roof of the mouth, or inside of the cheeks, gums, or throat. Patches of thrush look like cottage cheese and aren't easily washed off.
- Crying when nursing or sucking on a pacifier or bottle. The white or yellow patches may be painful and make feeding uncomfortable if the infection is severe. (Note: Some babies with thrush don't feel any pain or discomfort and are able to feed normally.)
- Some babies with thrush also develop a yeast diaper rash – a raised, patchy, or bright or dark red rash with distinct borders. Small, red spots frequently appear around the edges of the main rash. The affected area is red and may be tender or painful, and the rash can creep into the folds of skin around your child's genitals and legs. It almost never appears on the buttocks.
How can I treat thrush?
If your baby's provider diagnoses thrush, she may prescribe an oral antifungal medication (often nystatin) and recommend giving your baby acetaminophen for the pain. It may take about two weeks to clear up the infection.
For a diaper rash, your provider may also prescribe nystatin ointment to use in the diaper area.
If you're breastfeeding a baby with thrush, many providers recommend that you apply nystatin or clotrimazole to your nipples so that you and your baby won't pass the infection back and forth.
Check in with your provider if the infection still doesn't seem to clear up – recurrences are fairly common.
Can I prevent my baby from getting thrush?
Not always. Some people are naturally more prone to yeast infections, but you can take the following steps to lower the chances of your baby getting thrush. (These measures can also help you avoid reinfection if you and your baby are being treated for thrush.)
- Don't give your baby antibiotics unless it's absolutely necessary. (Antibiotics don't help against viral infections.) Thrush is often triggered by taking antibiotics.
- Clean and sterilize pacifiers after every use, and disinfect any toys that go into your baby's mouth.
- Let your nipples air dry between feedings.
- If you bottle-feed, thoroughly clean all equipment – including nipples – after every use by washing it with hot, soapy water or running it through the dishwasher.
- Wash your hands frequently, especially after feedings and diaper changes.
You may also want to change your baby's diaper frequently to keep the yeast from causing a diaper rash.
Is thrush dangerous?
No. But if your baby is very fussy and uncomfortable, thrush could interfere with feeding. It can be very distressing when a hungry baby finds it painful to eat.
Give your baby all the comfort he needs, and follow your provider's instructions for pain relief and medication. And remember that this infection, too, shall pass.
What about home remedies? Can I use gentian violet to treat my baby's thrush?
If you want to try an alternative therapy, ask your baby's provider about gentian violet. This is a dye that can also be an effective antifungal treatment, but it will stain anything it comes in contact with. And if gentian violet is used for too long or in a concentration that's too high, it can cause sores in your baby's mouth, so be sure to talk to your child's provider before using it.
If you'd like to try this method and you've discussed it with your baby's provider, you can ask your local compounding pharmacist to prepare the gentian violet solution for you. If you want to prepare it yourself instead:
- Buy a 1 percent gentian violet solution. You can find it at many drugstores or order it from the pharmacy. A 1-ounce bottle should cost around $5.
- To prevent side effects, such as mouth sores, dilute this solution to create a gentian violet concentration of 0.25 percent or less. (Mix one part gentian violet solution with two parts water.)
Before applying the gentian violet, undress your baby from the waist up so you don't stain his clothes. Then put down a towel (that you don't mind getting stained) to protect the surface underneath him.
To apply the solution:
- First apply a thin layer of petroleum jelly to your baby's lips and cheeks to prevent staining.
- Use a cotton swab to "paint" the diluted solution inside your baby's mouth. Have someone help you by holding your baby's head and hands while you swab the insides of his lips, cheeks, and tongue.
- Do this once a day for no more than seven days.
When you nurse your baby, some dye may get on your nipples – this is perfectly safe.