Persistent Oral Thrush in Infants: Causes and Treatment Options

Side effects

My baby is already 3 months old.
A few weeks ago, he developed oral thrush, and it has been almost a month now.
I took him to see a doctor and received Mycostatin to apply, but there hasn't been much improvement.
Therefore, I took him to see the doctor for a second time.
The doctor said to continue using Mycostatin, but it still seems to be ineffective.
Why is this happening? Does prolonged use of Mycostatin have any implications? (P.S.
I have boiled and sterilized all the bottles, and I have replaced the nipples twice.
I am currently using a steam sterilizer available on the market, and I have been giving him a vitamin drop for about two weeks.)

Youyou's Mom, 20~29 year old female. Ask Date: 2005/01/24

Dr. Lin Huizhen reply Pediatrics

Dear Yuyou's mother,
Dr.
Lin Huizhen from the Pediatric Department of Tainan Hospital, Ministry of Health and Welfare, would like to address your concerns: Oral thrush can occur in children under one year old or in patients who have been on long-term antibiotics, steroids, or those with acquired immunodeficiency.
In infants, oral thrush is usually temporary due to their immature immune system and may recur, but it often resolves on its own.
Treatment can include antifungal medications such as Mycostatin, which is generally effective when applied topically.
The dosage prescribed by the physician for topical application is quite low, significantly less than that used for treating systemic candidiasis, thus the risk of side effects is minimal.
However, in some infants, oral thrush may be triggered by other factors, such as the use of antibiotics or steroids, and it is essential to eliminate these triggering factors for easier resolution.
Sometimes, recurrent oral thrush in children may indicate an underlying immunodeficiency.
In such cases, these children may also present with skin inflammation, recurrent diarrhea, or poor weight gain.
If your child exhibits any of these symptoms, it is advisable to take them to the hospital for a thorough examination for peace of mind.
Wishing you good health and all the best from Tainan Hospital!

Reply Date: 2005/01/24

More Info

Persistent oral thrush, or candidiasis, in infants can be a challenging condition for both the child and the parents. It is caused by an overgrowth of the fungus Candida, which is normally present in small amounts in the mouth and digestive tract. In infants, especially those under six months, the immune system is still developing, making them more susceptible to infections like thrush.

In your case, it seems that your baby has been dealing with oral thrush for almost a month, despite treatment with Mycostatin (nystatin). There are several reasons why the thrush may not be improving:
1. Inadequate Treatment: Sometimes, the antifungal treatment may not be sufficient to eradicate the infection. The dosage or frequency of application might need to be adjusted. It's essential to follow the doctor's instructions carefully and ensure that the medication is applied correctly, covering all affected areas in the mouth.

2. Underlying Conditions: If your baby has any underlying health issues, such as a weakened immune system or other medical conditions, these could contribute to the persistence of thrush. Conditions like diabetes in older children or certain genetic disorders can predispose to recurrent infections.

3. Reinfection: Even with proper treatment, reinfection can occur. This can happen if the environment (like bottles, nipples, or pacifiers) is not adequately sterilized. You mentioned that you have been sterilizing bottles and changing nipples, which is excellent. However, ensure that all feeding items are thoroughly cleaned and sterilized regularly.

4. Dietary Factors: If your baby is on antibiotics for any reason, this could disrupt the normal flora in the mouth and lead to an overgrowth of Candida. Additionally, if your baby is consuming any sugary liquids or foods, this could also promote fungal growth.

5. Duration of Treatment: Sometimes, antifungal treatments need to be continued for a longer duration than initially expected. If your baby has been on Mycostatin for a short period, it might be necessary to continue treatment for a few more weeks.

Regarding the safety of prolonged use of Mycostatin, it is generally considered safe for infants when used as directed. However, prolonged use of any medication should be monitored by a healthcare professional to avoid potential side effects or complications. Always consult your pediatrician if you have concerns about the duration of treatment or if you notice any side effects.

If your baby's thrush does not improve after a reasonable period of treatment, or if it worsens, it is crucial to follow up with your pediatrician or a pediatric infectious disease specialist. They may consider alternative antifungal medications or investigate other potential causes for the persistent thrush.

In summary, persistent oral thrush in infants can be due to various factors, including inadequate treatment, underlying health issues, reinfection, dietary factors, and the duration of treatment. It's essential to maintain open communication with your healthcare provider, follow their recommendations closely, and seek further evaluation if the condition does not improve.

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