Oral Thrush in Children

Babies and older adults are the people most likely to develop thrush, which is caused by Candida yeast.

Thrush is a yeast infection of the mouth and throat. Thrush can also be associated with yeast infections of the esophagus. Thrush appears as creamy white curd-like patches on the tongue and inside of the mouth and back of the throat. As mentioned above, in individuals with impaired immune systems, yeast infections are more common. For example, in a non-infant population, thrush may be a sign of an underlying HIV infection. The child may not have any symptoms from the condition or may refuse to eat or swallow because of pain or an unusual feeling in the mouth. Sometimes older children complain of a cottony feeling in the mouth.

Another form of oral yeast infection is angular cheilitis, which is the development of painful fissures at the corners of the mouth. Yeast infection can also involve the tongue and lead to flattening (erosion) of the papillae of the surface of the tongue, along with pain and reddening of the tongue (acute atrophic candidiasis).

What are commonly known as "yeast" infections are caused by various species of a yeast-like fungus called Candida, particularly the species Candida albicans. Yeast organisms are some of the germs (including bacteria) that normally reside on various parts of the body and that ordinarily cause no symptoms or signs.

Certain conditions, such as antibiotic use, may upset the balance of microbes in the body (particularly between the bacteria and fungi) and allow an overgrowth of Candida. Yeast also can thrive in chronically moist folds of skin, such as in the groin.

Yeast infections may flare up and then heal in most people. However, in newborns or individuals with impaired immune systems, yeast can cause more serious or chronic infections.

Many infants acquire Candida infections from their mothers during the process of birth. Yeast exists naturally in the mother's vagina. The baby comes in direct contact with the yeast during delivery through the birth canal.

Many babies who escape this infection at birth soon acquire Candida from close contact with other family members.

Most common oral thrush symptoms include:

• Thrush is characterized by a white coating or white patches on the tongue, mouth, inner cheeks, and the back of the throat. 
• The tissue under the white patches is often red, raw, and sore. Lesions can be painful and even bleed when scraped. 
• Oral thrush often looks like cottage cheese or milk curds.
• Bad breath
• Cheilosis (Cracking at the outer edges of the lips)
• Feeling of food stuck in the throat or sore throat
• Strange or unpleasant taste in the mouth
• Burning mouth syndrome: Symptoms of a painful burning sensation, mouth dryness, soreness, tingling, or numbness throughout the mouth and tongue. Symptoms can be associated with an abnormal bitter or metallic taste in the mouth.
• In severe cases of thrush, the esophagus (food pipe), which leads down to the stomach, may also be involved. This will cause pain with swallowing, fever, shaking or chills, or difficulty swallowing.

Outbreaks of thrush in childcare settings may be the result of an increased use of antibiotics and growth of the yeast normally present in the mouth, rather than newly acquired Candida infections. In children (and adults) taking antibiotics or steroids (such as cortisone-related asthma medications), the balance of the normal microbes in the mouth can be disturbed. This may cause an overgrowth of Candida, which in turn results in oral thrush.

Candida may infect an infant's diaper area and worsen a diaper rash. This is because yeast can grow very readily on irritated, moist skin. The infected skin is usually fiery red with areas that may have a raised red border and is usually intensely itchy (pruritic).

Children who suck their thumbs or other fingers may occasionally develop Candida around their fingernails. This causes redness at the edges of the nails.

Nursing mothers are at risk for developing Candida infections on their breasts (this is called mastitis) and can be treated with the same medication that is used for infants.

Health care professionals usually treat oral thrush and yeast infections, such as Candida diaper rash, with antifungal medicines; these include nystatin (Mycostatin), clotrimazole (Lotrimin), or miconazole (Monistat) either by mouth or in a topical cream. Luckily, most Candida are very sensitive to nystatin, and resistance is rare. There are many topical antifungals available as over-the-counter brands. Oral thrush requires an oral medication that is available by prescription only.

The following tips can help care for children with diaper rash:

• Caregivers should change the child's diapers frequently and gently cleanse the child's skin with water and a mild soap and pat it dry.
• It is important to minimize skin contact with urine and stool.
• Allowing periods of exposure to dry air without wearing a diaper can also be helpful.
• Barrier creams or ointments, such as Desitin or A&D, are helpful. While cornstarch may help mild diaper rash, it should not be used for children with significantly inflamed skin.
• High-absorbency disposable diapers may help keep the skin dry.
• A baby's bottom is very sensitive, so staying dry is very important. Avoid plastic pants that do not allow air to circulate over the diaper area. The diapering system should be able to hold urine or liquid feces.

There are some situations when a child may need a different medication to clear a yeast infection. A health care provider may prescribe another type of antifungal cream or oral preparation that may include ketoconazole (Nizoral, Extina, Xolegel, Kuric), fluconazole (Diflucan), or itraconazole (Sporanox).

There is no need to remove a child with yeast infection from childcare. Since most healthy people already harbor Candida, children with thrush and Candida diaper rash do not have to be excluded from child care (as long they are able to participate comfortably).

Childcare providers should follow good hygiene, including careful hand washing and disposal of nasal and oral secretions of children with thrush, in order to avoid transmitting the infection to children who may not already be infected.

Health care professionals refer to a yeast infection as candidiasis because Candida causes the infection. Thrush is another name for oral candidiasis. The old name for Candida was Monilia. The infection is still sometimes called moniliasis, and thrush is still at times known as oral moniliasis.