INFANT THRUSH

What is thrush?
Thrush in baby’s mouth
Thrush diaper (nappy) rash
Nipple/breast thrush
Treatment
Antifungal medications
Natural remedies
When thrush doesn’t get better

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What is thrush?

Thrush is the term used to describe an overgrowth of a strain of yeast fungus called candida albicans. Everyone carries this yeast in his or her body. For most of us, it lives quite happily in moist areas such as our bowels, mouth, skin folds, vagina, and groin and we usually don't have any trouble from it.

However… certain conditions can allow the yeast population to explode and cause an infection, such taking antibiotics or steroids, oral contraceptives, getting inadequate rest, eating lots of sugary foods, stress, allergies or an injury to nipples from poor latch-on during breast feeding.

Babies are more pone to a thrush infection than adults because their immune system is immature. This means they are unable to fight infections as effectively as adults can. That’s why it’s necessary to be even more careful with hygiene when caring for a young baby.

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Thrush in baby’s mouth

If a baby has thrush in his mouth, there’s a chance that he’ll also has a yeast infection on his little bottom, because the yeast can pass from his mouth through his gastro-intestinal tract.

Signs of oral thrush

• White or cream colored patches like milk curds can be seen on the roof of his mouth, inside his cheeks and on his tongue. There may be red areas around these patches. Or his entire tongue may have a solid white coating.
• One of the first signs your baby may have oral thrush could be fussy, unsettled behavior during feeding, because his mouth may be sore. However, this is rare and generally only occurs if the infection is severe.
• If your baby sucks his thumb or fingers, he may also develop a yeast infection around his fingernails.
Milk residue left after feeding can sometimes be mistaken for thrush. Milk residue is usually only found on the tongue. It’s thin and wipes or rinses out of the mouth easily.
Treating oral thrush
• Boil pacifiers, feeding equipment and teething rings etc. for 5 to 7 minutes after each use, while the infection is present.
• Toys your baby (or other children) may chew on should be washed in hot soapy water and either bleached regularly or dried in the sun.
• Rinse your baby’s mouth out after a feeding. A few mouthfuls of water from a medicine cup will help remove the milk from his mouth. (Milk residue encourages the growth of the yeast).
• Wash his hands frequently with soap and warm water.
• Use a natural remedy or antifungal medication as described in ‘Treatment’ below. Where a medication is used, wash the medicine dropper with hot, soapy water after each use.
If your baby has oral thrush, you will need to extra take care to avoid a thrush diaper rash occurring. If your baby is breast fed baby, you will also need to treat your nipples at the same time, in order to prevent an infection occurring in your nipples or breast.

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Thrush diaper (nappy) rash

The yeast fungus (candida albicans) that causes thrush, flourishes in warm, moist environments. This makes your baby’s diaper area a likely place for a thrush infection to occur. Thrush can cause a rash on your baby’s thighs, buttocks or genitals.

Signs of thrush in the diaper area

• A yeast diaper rash is bright pink or red with small red spots near the edge. A skin rash with thrush does not have white spots like thrush in the mouth.
Preventing and treating a thrush diaper rash
• Change diapers as soon as you know they’re wet or dirty.
• Wash your hands with soap before and after changing diapers.
• Take care that you don’t spread the yeast, that could come in contact with your hands (as you change your baby’s diaper), back into diaper rash creams.
• While a rash is present avoid the use of diaper wipes (which can sting).
• After a wet diaper, gently clean his skin using a water and vinegar or baking soda solution (described in Natural Remedies). Always clean a baby girl’s diaper area from front to back.
• After a poop, first clean off the poop and then soak his bottom in a small bath with a little baking soda (described in natural remedies).
• Pat dry his skin (avoid rubbing).
• Allow his bottom to air much as possible by providing diaper fee time 3 or 4 times a day.
• Avoid using corn starch or petroleum jelly on his bottom as these can provide a food source for yeast to thrive on.
• If you use cloth diapers, the yeast can be passed through the laundry. Carefully follow the instructions for pre-wash diaper soaking solutions (available at the supermarket). Wash cloth diapers in the hottest possible water. Add a cup of vinegar to the final rinse and dry in the sun. If sun drying is not possible, use the hottest setting on the clothes drier.
• Diaper rash with thrush may not clear up with the usual diaper rash treatments and you may need to use a natural remedy or antifungal medication on his diaper rash, as described in ‘Treatment’ below.

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Nipple/breast Thrush

Because your baby may have the yeast that causes thrush (candida albicans) in his mouth and gastro-intestinal tract without showing any symptoms, any damage to your nipples from breast feeding, such as a graze or small crack, will increase the chance of a yeast infection developing on your nipples or in the milk ducts of your breasts. Although, it can be painful, thrush on your nipples or in your breast shouldn't affect your ability to breast feed your baby.

Signs of nipple thrush

• Unusually pink or red nipples.
• Skin can be flaky (but not always).
• Cracked or bleeding nipples.
• Itching or burning nipples.
• A shooting pain deep within the breast.

Symptoms can occur during feeding or may start 10 to 15 minute after the feed has finished.

Treating thrush on nipples

• Your baby will need to be treated for oral thrush, even if he doesn’t have symptoms, to avoid infections going back and forth.
• Wash your hands carefully, before and after feeding breast feeding and after apply cream to your nipples.
• Ensure he latches on correctly, to avoid further damage to your nipples.
• Try to keep your nipples as dry as possible, because moisture encourages the yeast to grow. Leave breast exposed to the air for as long as possible.
• Expose your nipples to sunlight, up to 10 minutes twice daily.
• Put on a clean bra every day or more often.
• Change breast pads after every feed.
• Bras and reusable breast pads should be soaked in bleach solution prior to washing in hot water and dried in the sun or on a hot setting in the dryer.
• Breast milk pumped during an active yeast infection of the breasts should be either used within 24 hours or discarded. Because freezing does not kill the yeast, using breast milk at a later time could result in a re-infection.
• Sterilize pumping equipment (that comes into direct contact with your breast or your milk) by boiling or bleaching.
• Treat vaginal infection if necessary.
• Use a natural remedy or antifungal medication as described in ‘Treatment’ below. Before breast feeding, gently rinse off any residue of medicine on your nipples.

If breast pads stick to your nipples, dampen them before removing them to avoid further damage to your nipples. If your nipples are so painful that it hurts to wear clothing, breast shells (available from a chemist or drug store) may provide some comfort.

If antifungal treatment fails to relieve your symptoms within a few days, see your doctor. Burning breast pain can also be due to a bacterial infection and you may need antibiotics.

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Treatment

Do not rely on medications alone to control your baby’s yeast infection. If the source of infection is not corrected, either the infection will not clear or thrush is likely to return as soon as antifungal medication has been completed.

Because young babies have immature immune systems, a small number of babies can experience severe thrush infections. Along with medications, additional care needs to be taken to decrease your baby’s exposure until his immune system eventually matures enough to control the yeast. At which time a thrush infection is less likely to occur. (While he’s in diapers, he will still be at risk or a thrush diaper rash).

Because candida albicans will eventually become an inhabitant in his body (the same as it is for the rest of the human population), where a yeast infection is mild this means his immune system is working to control the infection and antifungal medications are not always necessary. Often using a natural remedy to make the environment (mouth or skin) less favorable for the growth of the yeast will prove helpful.

Whether you use a treatment (antifungal medication or natural remedy) or not, it’s important to try to control the source of your baby’s infection. Because you can’t always see the yeast that causes thrush, it can easily be carried on your hands, feeding equipment, diapers or clothing. To help you to get rid of yeast that’s not always visible, you will find basic recommendations under each section above and more extreme recommendations for ‘when thrush doesn’t get better’ below.

If you are unsure whether yours or your baby’s thrush needs medication or not, see your doctor and he/she will advise you if treatment is necessary.

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Antifungal Medications

Many antifungal medications can be purchased over-the-counter, while some more potent forms require a doctor’s prescription. Antifungal medications come in drops or gel for treating oral thrush in infants and creams for treating thrush on the skin i.e. nipples and bottoms.

If you use an over-the-counter medication and the thrush is not getting better after a week of treatment, see your doctor.

IMPORTANT: It’s normally recommended to continue treatment for a period of up to 1 week after the infection appears to have cleared to reduce the risk of reoccurrence.

Nystatin (Mycostatin, Nilstat)

Nystatin is the most commonly used treatment for yeast infections. Although nystatin is one of the least toxic known drugs, it’s over 80% effective in treating thrush infections.

Unlike other medicines that work when swallowed, nystatin only works on surfaces it can touch. Therefore, it’s very important that nystatin is applied directly to the areas with thrush, rather than simply tipped into the baby’s mouth.

When treating with nystatin oral suspension, it’s important to shake the bottle well before use. Put a small amount (one milliliter) into a small cup. Use a cotton swab to apply nystatin to all surfaces inside your baby's mouth, between his cheeks and gums, on his tongue, under his tongue, on the roof of his mouth and between his lips and gums. Gently tip any remaining nystatin into his mouth.

When using nystatin cream on your nipples, rinse the cream off before nursing, because it tastes awful.

Miconazole (Daktarin, Fungo)

In Australia and Europe, miconazole antifungal cream and oral gels are available for use in a baby's mouth and on a mother's nipple. Use a cotton swab to gently apply the gel to all areas of your baby’s mouth.

If nystatin (or micronazole) is not effective initially, or the yeast becomes chronic or invades the ducts of the breast (resulting in breast pain) other antifungal medications are available. You will need to see your doctor for advice and/or a prescription for these.

Clotrimazole (Lotrimin, Mycelex, Canesten)

Although available over-the-counter, clotrimazole is a potent antifungal treatment. Creams should only be used on your nipples or your baby’s bottoms if advised to do so by your doctor.

Fluconazole (Diflucan)

A new and now commonly prescribed vaginal yeast medication, Diflucan (fluconazole), given as an oral table to mothers is being used to treat breast yeast. This is a very strong prescription anti-fungal treatment. Although fluconazole can be used to treat thrush in infants, its use is generally reserved for severe or stubborn infections and should only be used on your baby under your doctor’s advice.

Ketoconazole (Nizoral, DaktaGOLD) or Itraconzazole (Sporanox)

Neither of these commonly used antifungal medications is recommended for use in children or lactating women.

Gentian violet

Gentian Violet, a traditional remedy for yeast and other infections, has been available long before most modern antifungals and antibiotics. Although it’s effective in the treatment of thrush, there’s a risk of burning your baby’s mouth using this treatment. This form of treatment should only be considered if recommended by your baby’s doctor.

WARNING: Although still available in many countries, Gentian Violet has been removed from the market in Australia and many European countries because it contains a material reasonably suspected of being carcinogenic.

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Natural remedies

Acidophilus

Eating natural yogurt or taking acidophilus capsules will help to colonize your body with lactobacillus acidophilus (good bacteria that will help to control the yeast in your digestive system).

Since an infant's digestive system is more sensitive, bifidus is recommended rather than acidophilus for children less than a year old, because bifidum occur naturally in the intestinal flora of humans, including infants.

Grapefruit Seed Extract (not grape seed extract)

Also known as grapefruit seed oil, grapefruit seed extract is a broad-spectrum anti-microbial compound made from the seeds and pulp of grapefruit.

Make up a solution by adding 5 drops of grapefruit extract to 4 ounces of cooled boiled water. This can be separated into two containers. One to wipe over your baby’s mouth after feeding, using a cotton swab (it can also be used on your nipples after breastfeeding). The other portion can used as a wash for your baby's bottom, as part of each diaper change. Use this solution at least three or four times each day and make up fresh solution each day.

WARNING: DO NOT use grapefruit extract in a concentrated form.

Tea Tree oil

Tea tree oil is an essential oil, which is well known for its antiseptic, antiviral and antibacterial properties. It’s also good for combating fungal infections. For yeast diaper rash, rinse your baby's bottom with diluted tea tree oil - 5 drops to 4 ounces of cooled boiled water. This can be used on your nipples and wiped off before feeding.

WARNING: Tea tree oil can be very irritating and should NOT be used as a mouthwash or on the diaper area unless diluted. Concentrated tea tree oil can be very dangerous if swallowed.

Vinegar

Other natural remedies include the use of vinegar or baking soda to alter the acidity of the environment, making it difficult for the yeast to grow.

Make up a solution of 1 tablespoon of white vinegar to one cup of water. (Pour the solution into separate containers if you plan to use this for your baby’s mouth and bottom). Use a cotton swab to wipe solution onto your baby’s mouth after feeding (this can also be used on your nipples following breastfeeding). A separate portion of this solution can be used as a wash at diaper changes. WARNING this can sting if thrush is severe.

In the laundry: Pour one cup of white vinegar to the final rinse.

Baking (bicarbonate) soda

Dissolve a level teaspoon of baking soda in 8 oz of water. Use a cotton swab to wipe the insides of your baby's cheeks, gums, and tongue every feed. You can dab this onto your nipples after breast feeding. Make a fresh solution every day.

Yeast diaper rash: You can use the same solution above, as a wash during diaper changes or you can add 4 tablespoons of baking powder to a couple of inches of water in a small baby bath to soak your little one’s bottom for a few minutes.

Other natural remedies used for treatment of maternal thrush include:

Garlic: One of garlic's many healing properties is its ability to kill funguses, bacteria, and other microorganisms. Use it in your cooking. Odorless garlic capsules are available from health food stores.

Lactic acid wash: Lactic acid is unfavorable to many forms of yeast and bacteria such as candida albicans. This is a relatively new product now available at chemists or drug stores. The wash, to be used externally, contains lactic acid that helps maintain the natural pH balance in the vaginal area.

Sacchromyces boulardii: Like lactobacillus, this also helps rebalance the organisms in the gut flora.

Caprylic acid: This fatty acid, derived from coconut oil, has been shown to have antifungal properties.

Olive Oil: Olive oil contains linoleic acids, which are antifungal and may cut off the yeast’s oxygen supply.

Black Walnut: The green hulls containing the walnut are processed into oil which has antimicrobial properties. Black walnut is also used to treat thrush infections and can be used internally or externally. Black Walnut should not be taken internally if you are breastfeeding because it can affect stop lactation.

Pau d'Arco tea: 2-3 cups daily. Pau d'Arco is a South American tree that resists fungus growth PAU D' ARCO (or Taheebo) tea, both believed to have natural fungicidal properties.

Goldenseal: is a natural plant antimicrobial. Goldenseal can be used on the skin as a poultice but should not be taken internally.

WARNING: Because a product is ‘natural’ this doesn’t mean it’s without side effects. Many natural remedies are not suitable for use in infants, small children or a breast feeding mothers. Read instructions carefully and ask lots of questions at the health food store. If in doubt don’t use it.

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When thrush doesn’t getting better

If thrush returns when treatment is completed, it’s likely that the yeast is still present in the household. If this is the case, all family members may need to be treated to reduce the risk of your baby becoming re-infected. Your doctor will be the best person to advise you if this is necessary.

The yeast that causes thrush (candida albicans) can survive for long periods of time in moist environments outside the body and can spread from one family member to another in this way. There are many things you can do to reduce the risk of this spread occurring.

Basic recommendations have been made under each section for oral thrush, thrush diaper rash and nipple/breast thrush above. Additional recommendations are made below. As many of these recommendations below require a lot of work, it’s not necessary to go to the following lengths unless your baby is troubled by recurring episodes of thrush.

1. Good hand washing is the most important thing you can do. Encourage adults and older children to regularly wash their hands with warm water and soap, particularly before touching or playing with your baby.

2. Wash hand before and after diaper changes, before preparing formula and before and after feeding baby.

3. Use paper towels for hand drying then discard, since yeast can live on a moist towel.

4. Avoid bathing your baby with other family members.

5. Don’t share bath towels. Use the towel only once or thoroughly dry after each use.

6. Bed linen, towels and underwear may need to be treated in order to destroy yeast spores and prevent the re-occurrence of the infection. Laundry should be washed in the hottest possible water and dried in the sun. Use an antifungal laundry detergent and add 1 cup of vinegar to the final rinse.

7. Toothbrushes can harbour yeast. Replace each family member’s toothbrush once antifungal treatment has started, and again once all symptoms disappear.

8. Toys should be washed in hot soapy water and bleached regularly. Don’t permit other children to share pacifiers, feeding nipples, or toys that will be put in their mouth.

9. Cloth diapers should be micro-waved for 5 minutes once washed and dried to kill off any remaining yeast.

10. Disinfect surfaces such as a diaper changing pad, baby furniture, and toys with a 10% bleach solution.

11. Boil pacifiers, teething rings, bottle nipples, pump parts that touch milk or breasts for 20 minutes daily until infection is gone (after each exposure to infant's mouth or breasts). After thrush is gone, discard pacifiers and buy new ones.

12. At all times avoid putting your baby’s pacifier or feeding nipple into your own mouth. (You are unlikely to get thrush in your mouth because your immune system is strong, but you may spread candida from your mouth to your baby’s).

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See also:
How we can help
Infant colic
Crying baby

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