Thrush is an infection caused by a fungus called Candida (CAN-did-ah). Thrush in the mouth begins as tiny flat white spots. These spots come together and form "cheesy" white patches that may cover the tongue, the gums or sides and roof of the mouth. These spots are often mistaken for "milk patches." You will not be able to remove these patches with a soft cloth or a cotton tipped swab. If there are very many of these patches, your child may have pain while sucking and will not drink as much formula and other liquids as usual.
If your child has thrush, the doctor will prescribe a medicine. Some medicines work directly in the mouth, Nystatin (nie-STAT-in). Others work only after the medication is swallowed, Fluconazole (flu-CON-a-zol).
How to Give Nystatin
Give the Nystatin by mouth. Give it right after you feed your baby, so the medicine stays in the mouth for a while. It will not hurt your child to swallow the medicine. To give the medicine:
- Wash your hands well.
- For an infant or young child, place him on his back and turn the cheek with the white patches down toward the bed (Picture 1).
- Gently open your child's mouth and drop half of the medicine onto the white patches inside the cheek. Turn your child's head to the other side and drop the other half of the medicine on the inside of that cheek.
- Using a cotton-tipped swab, "paint" the medicine onto your baby's tongue and gums.
- For an older child, have him or her swish the medicine in the mouth for 30 seconds, then swallow.
- Wait 30 minutes before giving your child anything to eat or drink.
How to Give Fluconazole
Give the medicine to your child by mouth following the prescribed dose for the suggested number of days.
- Always wash your hands well after touching your child's mouth so you don’t pass the infection to others.
- Be sure your child drinks plenty of formula or other liquids so that he does not get dehydrated (lose too much fluid).
- Sterilize baby bottle nipples after each use. Do this by placing the nipples in boiling water for 10 minutes. Let the nipples cool before using them.
- If your baby uses a pacifier, buy several extras that can be sterilized between uses. Sterilize pacifiers the same way as the bottle nipples. Change your baby's pacifier several times a day.
- Do not let other children use your child's pacifier or drink from your child's bottle or cup. Thrush is contagious (“catching”) and other children could get thrush. Adults can get thrush too; do not put your child’s pacifier in your mouth.
- If you are breast-feeding, clean each breast with water and air-dry after each feeding. If your breasts show any signs of infection, such as soreness or redness, call your doctor. Your breasts may need to be treated at the same time.
- Limit sucking time to 20 minutes per feeding. Limit pacifier use to bedtime. Prolonged sucking may increase irritation.
Candida Infection in the Diaper Area
Candida can also infect the diaper area. It can cause a red, "scalded-looking" rash with tiny blisters.
If your baby has a Candida diaper rash, the doctor will prescribe an ointment or cream to be applied to the diaper area. Please follow these steps in caring for the diaper area:
- With each diaper change, clean the diaper area with warm water and mild soap. Always wipe from front to back. Pat dry.
- Do not use baby wipes or baby oil until the rash is gone. Most wipes have baby oil in them. Instead, use a clean cloth with each diaper change.
- Apply the ointment as directed by the doctor.
- Always wash your hands well after each diaper change.
- Take the diaper off for a few minutes several times a day (Picture 2). Air helps heal the rash.
When to Call the Doctor
- Thrush usually starts to clear up in 4 to 5 days with treatment but use all the medicine (for at least 7 days).
- Call your child’s doctor if thrush gets worse after 3 days of treatment or if it lasts more than 10 days.
If you have any questions, be sure to ask your doctor or nurse.
HH-I-117 6/90, Revised 12/15 Copyright 1990, Nationwide Children's Hospital