Thrush in Infants: Causes, Symptoms, and Treatment Tips

Oral thrush (3)

Dear Dr.
Pei,
I would like to ask you a few questions.
(1) My child has not yet recovered from oral thrush and has returned for a second consultation (at a different hospital).
The second pediatrician believes that the reason for the persistent condition may be that the medication is only applied over the milk residue (as the milk residue on the tongue seems quite thick).
Therefore, I was advised to clean the oral cavity before applying the medication.
After returning home, I used gauze to clean my child's mouth, and to my surprise, the white spots on the inner sides of the upper and lower lips, the inner cheeks, and the hard palate could be wiped away.
However, after drinking milk two or three times, they reappeared.
This situation has been repeating (I have been applying the medication on schedule, but there has been no improvement).
I would like to ask the doctor...
Is it possible that this is just milk residue? (2) Is milk residue only found on the tongue (hence the term "coated tongue")? Can milk residue also be present on the inner sides of the lips, inner cheeks, and hard palate? If so, how can we differentiate between milk residue and oral thrush?
Thank you for taking the time to respond.

Xiao Fen, 30~39 year old female. Ask Date: 2007/12/26

Dr. Pei Rensheng reply Pediatrics

Dear Xiaofen,
Hello!
(1) Oral thrush is a type of candidiasis infection.
Infants and young children with normal or compromised health, those who have used antibiotics or corticosteroids, and individuals with congenital or acquired immunodeficiency are all at risk for developing oral thrush.

(2) Milk residue refers to leftover food particles.

(3) Tongue coating occurs due to the growth of filiform papillae on the tongue's mucosa, mixed with food, mucus, shed cells, and bacteria.
The following factors may contribute to the thickening of tongue coating: psychological stress, gastrointestinal diseases (such as constipation), smoking, poor oral hygiene, oral inflammation, and mouth breathing.

(4) Oral thrush and milk residue can be found throughout the oral cavity, while tongue coating is only present on the tongue.

(5) Milk residue and tongue coating can be removed with a toothbrush or spoon, whereas forcibly removing oral thrush may cause bleeding.

Wishing you health and happiness!
Sincerely,
Dr.
Pei Rensheng
Director of Pediatrics, Taoyuan Hospital, Department of Health

Reply Date: 2007/12/26

More Info

Understanding thrush in infants, also known as oral candidiasis, is essential for parents dealing with this common condition. Thrush is caused by an overgrowth of the Candida fungus, which is naturally present in the mouth. While it can occur in anyone, it is particularly common in infants due to their developing immune systems and the presence of milk in their diets.

Causes of Thrush
1. Immature Immune System: Infants have not yet developed a fully functional immune system, making them more susceptible to infections, including fungal infections like thrush.

2. Antibiotic Use: If the infant has been treated with antibiotics, this can disrupt the balance of bacteria in the mouth, allowing Candida to flourish.

3. Diabetes: In some cases, underlying conditions such as diabetes can predispose individuals to thrush due to higher sugar levels in saliva.

4. Poor Oral Hygiene: Milk residue can create an environment conducive to the growth of Candida. If milk is not properly cleaned from the mouth, it can lead to thrush.

Symptoms of Thrush
The symptoms of thrush in infants typically include:
- White patches on the tongue, gums, inner cheeks, and sometimes the roof of the mouth. These patches can resemble milk curds but do not wipe away easily.

- Redness and soreness in the mouth, which may cause discomfort during feeding.

- Difficulty feeding due to pain or discomfort.

Treatment Tips
1. Oral Hygiene: As you mentioned, maintaining good oral hygiene is crucial. Gently cleaning the infant's mouth with a soft cloth or gauze after feedings can help remove milk residue and reduce the risk of thrush. It’s important to do this carefully to avoid causing any irritation.

2. Medication: Antifungal medications, such as nystatin or fluconazole, are commonly prescribed to treat thrush. It’s important to apply the medication directly to the affected areas of the mouth, and parents should ensure that the medication is not just being applied over milk residue.

3. Follow-Up: If symptoms persist despite treatment, it is essential to follow up with a healthcare provider. They may need to reassess the situation to ensure that the diagnosis is correct and that the treatment is effective.

4. Avoiding Irritants: Ensure that any pacifiers, bottles, or toys that come into contact with the infant's mouth are regularly cleaned and sterilized to prevent reinfection.

Differentiating Between Milk Residue and Thrush
It can be challenging for parents to distinguish between milk residue (often referred to as "milk tongue") and thrush. Here are some tips:
- Milk Residue: Typically appears as a thin, white coating on the tongue and can be wiped away easily. It usually does not cause redness or soreness in the mouth.

- Thrush: The white patches associated with thrush are thicker, do not wipe away easily, and are often accompanied by redness and soreness. If the patches bleed when wiped, this is a strong indicator of thrush.

In your case, if the white patches are easily removed but reappear after feeding, it may indicate milk residue rather than thrush. However, if the patches persist and are not easily wiped away, it is likely thrush.

Conclusion
In summary, thrush is a common condition in infants that can be managed effectively with proper oral hygiene and medication. If you notice persistent symptoms or have concerns about your child's oral health, it is crucial to consult with a pediatrician or a pediatric dentist for further evaluation and treatment. Regular follow-ups and maintaining good oral hygiene practices will help ensure your infant's mouth remains healthy and free from infections.

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