Oral Thrush and Common Pediatric Concerns

Angular Cheilitis (2)

Dear Dr.
Pei,
I have a few questions to ask you:
(1) My child was diagnosed with oral thrush last Wednesday.
The first three packets of medication were mixed with milk for drinking, but I later realized they should be applied topically, so I switched to that method (sometimes applying before meals and sometimes after).
Currently, there is one packet of medication left, but the white spots in the mouth have not completely disappeared.
During the past few days of applying the medication, some white spots have occasionally disappeared and then reappeared.
I am concerned that after finishing the last packet, the white spots may still not be fully resolved.
If that happens, should I take my child back to see the doctor, or should I let it resolve on its own? (My child is currently eating, drinking, sleeping, and active normally.)
(2) My child is over a month old now and passes gas frequently.
Is this normal? Does it indicate any gastrointestinal issues? (Currently, my child has a bowel movement about every two days, with soft stools that are of normal quantity and color.)
(3) My child's right eye often has discharge (the left eye is fine).
I have heard that this may be due to a blocked nasolacrimal duct.
How should I address this issue?
Thank you for taking the time to answer my questions.

Xiao Fen, 30~39 year old female. Ask Date: 2007/12/24

Dr. Pei Rensheng reply Pediatrics

Dear Xiaofen,
(1) After medication, oral thrush usually disappears within about 3 days.
If the white spots have not completely cleared after finishing the last dose of medication, it is advisable to consult a pediatrician.
(2) Sources of air in the gastrointestinal tract include crying, a nipple with a hole that is too large, frequent use of a pacifier, food fermentation, or gas produced by intestinal bacteria.
If the baby is eating and sleeping normally and growing well, with no abnormalities in bowel movements, there is no need to worry too much.
(3) If the baby has had excessive eye discharge since birth, this may be due to nasolacrimal duct obstruction.
When we pull down the inner corner of the eye, we can see a small opening through which tears flow into the nasal cavity and throat.
Therefore, when applying eye drops, one may sometimes "taste" the bitter medication.
When this passage is blocked for any reason, it is referred to as "nasolacrimal duct obstruction."
(4) Nasolacrimal duct obstruction in infants is mostly congenital, with a small number caused by trauma or infection of the tissues around the eyeball.
Statistics show that about 2% to 4% of full-term newborns will experience nasolacrimal duct obstruction two weeks after birth, with excessive tearing and eye discharge being common symptoms.
(5) For nasolacrimal duct obstruction in infants, massage of the duct can be performed, or antibiotic eye drops can be administered to reduce bacterial infection.
If symptoms persist beyond six months of age, an evaluation by an ophthalmologist is necessary to consider performing a probing procedure or further treatment.
The later the medical intervention is sought, especially after the age of two, the more difficult it becomes to treat with probing, and surgical intervention may be required.
Wishing you health and happiness!
Sincerely,
Dr.
Pei Rensheng
Director of Pediatrics, Taoyuan Hospital, Department of Health

Reply Date: 2007/12/24

More Info

Understanding oral thrush, particularly in pediatric patients, is crucial for effective management and treatment. Oral thrush, or oropharyngeal candidiasis, is a fungal infection caused by the overgrowth of Candida species, most commonly Candida albicans. It presents as white patches on the oral mucosa, tongue, and sometimes the throat, which can be painful and may lead to difficulty in feeding, especially in infants and young children.

1. Management of Oral Thrush: In your case, it seems that your child has been treated with antifungal medication, which is typically effective in clearing the infection. The fact that some white patches have disappeared while others have reappeared can be concerning, but it is not uncommon for the infection to take time to resolve completely. If your child is otherwise healthy, eating, drinking, and active, it may be reasonable to continue the treatment as prescribed and monitor the situation. However, if the white patches persist after finishing the last dose of medication, or if your child shows signs of discomfort or feeding difficulties, it would be advisable to return to the pediatrician for further evaluation. Sometimes, a longer course of treatment or a different antifungal may be necessary.

2. Normal Gas Production in Infants: Regarding your second question about your child's gas production, it is quite normal for infants to pass gas frequently. Their digestive systems are still maturing, and they may swallow air while feeding or crying, leading to increased gas. As long as your child is having regular bowel movements (which you mentioned are soft and normal in color), and is not showing signs of distress or discomfort, this is typically not a cause for concern. If you notice any changes in feeding patterns, excessive crying, or signs of gastrointestinal distress, it would be wise to consult your pediatrician.

3. Eye Discharge in Infants: Concerning the eye discharge, it is common for infants to experience some degree of eye discharge, particularly if there is a blockage in the nasolacrimal duct (the duct that drains tears from the eye into the nose). This condition is known as nasolacrimal duct obstruction and is quite prevalent in newborns. To manage this, you can gently massage the area around the inner corner of the eye to help open the duct. Additionally, keeping the eye clean by wiping away discharge with a clean, damp cloth can help. If the discharge persists, becomes yellow or green, or if your child shows signs of redness or swelling around the eye, it is important to consult your pediatrician or an eye specialist for further evaluation and potential treatment.

In summary, while oral thrush and the other concerns you've raised are common in pediatric patients, monitoring your child's overall health and behavior is key. If any symptoms worsen or do not improve, seeking further medical advice is always the best course of action. Regular check-ups with your pediatrician will also help ensure that any potential issues are addressed promptly.

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