Oral Thrush in Infants: Treatment and Care Tips

Oral thrush

Dear Dr.
Pei,
I would like to ask you a few questions:
(1) My child is currently over one month old and has developed oral thrush.
The doctor at the hospital prescribed a five-day supply of medication (Mycostatin, to be taken three times a day, ground into powder).
Is this medication meant to be applied topically (how should the powder be applied)? Or should it be mixed with milk for oral administration?
(2) Is it advisable to buy Bifidobacterium powder to mix with milk for my child to drink, in order to enhance his gastrointestinal resistance to pathogenic bacteria?
Thank you for taking the time to answer my questions.

Xiao Fen, 30~39 year old female. Ask Date: 2007/12/22

Dr. Pei Rensheng reply Pediatrics

Dear Xiaofen,
Hello!
(1) Oral thrush is a type of Candida infection.
In healthy individuals, Candida can be present in the oral cavity and intestines.
Infants with normal health or those with compromised health, such as those using antibiotics or corticosteroids, as well as those with congenital or acquired immunodeficiency, are at risk of developing oral thrush.
In infants with oral thrush, white, curd-like lesions can be observed in their mouths, on the inner cheeks, and on the tongue.
These lesions may resemble cottage cheese, and forcibly wiping them away can cause bleeding.
Infants with oral thrush may not appear to be in pain, but they may feel uncomfortable and have a poor appetite.
The doctor has prescribed a five-day course of medication (Mycostatin, ground into powder).
This medication is applied topically; you can use a cotton swab dipped in water to apply the powder to the white spots after meals, three times a day.
It is fine if a little is swallowed, but this medication is not meant to be taken orally.
(2) You can purchase Bifidobacterium powder to mix with milk for your child to drink, which can enhance their gastrointestinal resistance to harmful bacteria.
This is acceptable, and in fact, many infant formulas now include probiotics in their formulations.
Wishing you health and happiness!
Sincerely,
Dr.
Pei Rensheng
Director of Pediatrics, Taoyuan Hospital, Ministry of Health and Welfare

Reply Date: 2007/12/22

More Info

Oral thrush, or candidiasis, is a common fungal infection in infants caused by an overgrowth of Candida yeast, typically Candida albicans. It can manifest as white patches on the tongue, gums, and inside the cheeks, and may cause discomfort or difficulty feeding. Understanding how to treat and care for an infant with oral thrush is essential for parents to ensure their child's comfort and health.

1. Treatment with Nystatin: The medication prescribed, Nystatin (Mycostatin), is an antifungal that is commonly used to treat oral thrush in infants. It is typically administered in a liquid form, and the usual method of application involves using a dropper or a cotton swab to apply the medication directly to the affected areas in the mouth. If the doctor has provided a powdered form, it may need to be mixed with a small amount of water to create a paste or suspension before application. It is important to follow the doctor's instructions carefully regarding dosage and frequency, which is usually three times a day for five days.

2. Mixing with Milk: It is generally not recommended to mix Nystatin with milk or formula, as this can reduce the effectiveness of the medication. The antifungal needs to come into direct contact with the affected areas in the mouth to work effectively. Therefore, applying it directly to the oral lesions is the best approach.

3. Probiotics: Regarding the use of probiotics, such as bifidobacterium powder, it is often considered safe for infants and can help support gut health. However, it is crucial to consult with your pediatrician before introducing any new supplements, especially in the context of an ongoing infection. Probiotics may help restore the natural balance of bacteria in the gut, which can be beneficial, but they should not replace antifungal treatment for thrush.

4. Hygiene Practices: Maintaining good hygiene is vital in managing oral thrush. Ensure that all feeding equipment, such as bottles and nipples, are thoroughly cleaned and sterilized to prevent reinfection. Additionally, if the mother is breastfeeding, she should also maintain good breast hygiene and may need to treat any yeast infections on her nipples to prevent passing the infection back to the infant.

5. Monitoring Symptoms: Keep an eye on your infant's symptoms. If the thrush does not improve after the prescribed treatment, or if your baby shows signs of increased discomfort, difficulty feeding, or if the thrush spreads, it is essential to follow up with your pediatrician. They may need to reassess the situation and consider alternative treatments.

6. Dietary Considerations: While your infant is still very young and primarily on a milk-based diet, it is important to avoid introducing any solid foods or other liquids that could irritate the mouth until the thrush is resolved.
In summary, treating oral thrush in infants involves the careful application of antifungal medication, maintaining strict hygiene practices, and monitoring the infant's condition closely. Probiotics may be beneficial but should be discussed with a healthcare provider. Always consult with your pediatrician for personalized advice and treatment options tailored to your child's specific needs.

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