Clinical Reference Systems: Pediatric Advisor 10.0
Spanish version

DESCRIPTION

• 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.)
• The coating adheres to the mouth and cannot be washed away or wiped off.
• Thrush causes mild discomfort.
• Your child is bottle-fed or breast-fed.

CAUSE

Thrush is caused by a yeast (called Candida) that grows rapidly on the lining of the mouth in areas abraded by prolonged 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 may also occur when your child has recently been on a broad-spectrum antibiotic. Thrush is not contagious because it does not invade the lining of the mouth when it is normal.

HOME CARE

1. 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 breast-feeding, apply nystatin to any irritated areas on your nipples.

2. 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.

3. Restrict pacifier use to bedtime

   While your child has thrush don't give him 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 130 degrees F (60 degrees C), which is the temperature of most hot tap water, for 15 minutes.

4. 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 four times a day.

   (See Diaper Rash. )

CALL YOUR CHILD'S PHYSICIAN 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.