Thrush is a fungal infection caused by a yeast called Candida. In babies, thrush often occurs in areas where the lining of the mouth is cracking and moist. If your child has thrush, she will have:

• white, irregularly shaped patches coat the inside of the mouth and sometimes the tongue. (If the only symptom is a uniformly white tongue, it's due to a milk diet, not thrush.)
• white coating that sticks to the mouth and cannot be washed away or wiped off.

Thrush causes mild mouth discomfort.

What is the cause?

Most people already have Candida in their mouth and other parts of their bodies. Sometimes certain conditions, such as use of an antibiotic or too much moisture can cause the yeast to grow rapidly and cause thrush. In babies, thrush often occurs in areas where the lining of the mouth is cracking and moist from too much sucking (as when a baby sleeps with a bottle or pacifier). A large pacifier or nipple can also injure the lining of the mouth. Thrush is generally not spread to others under normal conditions. However, if you are breastfeeding and your baby has thrush, the yeast could flare up and cause thrush on your breasts.

How can you take care of your child?

• Nystatin oral medicine

  The drug for clearing this up is nystatin oral suspension. It requires a prescription.

  Give 1 ml of nystatin four times a day after meals or at least 30 minutes before you feed your baby. Place the nystatin in the front of the mouth on each side (it doesn't do any good once it's swallowed). If the patches of thrush in the mouth don't start improving in 2 days, rub the nystatin directly on the patches. Use a cotton swab or a gauze wrapped on your finger. Keep this up for at least 7 days, or until all the thrush has been gone for 3 days.

  If you are breastfeeding, apply nystatin to any irritated areas on your nipples.

• Decrease sucking time during feeding
  If sucking on a nipple is painful for your child, temporarily use a cup and spoon. In any case, while your child has thrush, reduce sucking time to 20 minutes or less per feeding.

  If the thrush comes back after treatment and your child is bottle-fed, switch to a nipple with a different shape and made from silicone.

• Restrict pacifier use to bedtime

  While your child has thrush don't give her a pacifier, except when it's really needed for going to sleep. If your infant is using an orthodontic-type pacifier, switch to a smaller, regular one. Soak all nipples in water at 60° C (130°F), which is the temperature of most hot tap water, for 15 minutes.

• Diaper rash associated with thrush

  If your child has a diaper rash as well as thrush, assume the rash is caused by yeast. Ask for a prescription for nystatin cream and put it on your baby's bottom 4 times a day.

Call during office hours if:

• your child refuses to drink
• the thrush gets worse during treatment
• the thrush lasts beyond 10 days
• you have other concerns or questions