Thrush in Healthy Infants - Symptoms and Treatment

How to Identify and Manage Thrush in Your Baby

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Thrush is a common infection that affects many newborns and younger children. It is caused by the Candida albicans yeast or fungus, which can also cause vaginal yeast infections and yeast diaper rashes. When it infects a child's mouth, it is called oropharyngeal Candidiasis, or more simply - thrush.

Symptoms of Thrush

Thrush is one of those infections that looks and sounds much worse than it is. Although sometimes painful, the most common symptom is for an infant to have white patches coating the inside his mouth.

You may see these patches on the insides of his cheeks, on his tongue, on the roof of his mouth, and on his lips and gums as it spreads.

These white patches, unlike breastmilk or formula, can not easily be wiped away. However, if you do try to wipe them away, the area may bleed and leave behind a painful ulcer.


Thrush is usually diagnosed by the pattern of symptoms and no culture or testing is typically required. If your child is very fussy and refuses to eat, your pediatrician may do more to investigate whether your child has another condition, in addition to thrush, that is causing these symptoms.

Thrush Treatments

There are a few options available for treating thrush infections.

Nystatin is a prescription medication which is given four times a day., and is the most commonly used treatment. The dosage is 0.5ml to each side of the child's mouth if they are under 30 days old, and 1 ml to each side of their mouth for older infants and toddlers.

Treatment is continued for about 7 to 10 days and at least 3 days after you no longer see any signs of thrush. If your child's infection isn't quickly improving after a few days, you may want to use a gauze to directly rub the medication on the white patches. It is the direct contact of the Nystatin with the yeast that combats the infection.

Diflucan (fluconazole) is another prescription medication that can be used as an alternative to Nystatin. It has the benefit of once a day dosing, but it is more expensive than Nystatin and is usually used as a second line treatment, when Nystatin doesn't work. In one small study it was found that Diflucan was superior to Nystatin for treating thrush, and may also be better if your child has frequent recurrences of thrush.  It is, however, more difficult to give than Nystatin.

Gentian violet is an older treatment that doesn't require a prescription. Keep in mind that it is rather messy and can turn your baby's lips and clothing purple, so it is not as popular as other treatments.

Microbiologists are currently evaluating the use of probiotics and prebiotics in the treatment of thrush, but more research needs to be done to see if these are effective.

Thrush and Breastfeeding Mothers

Breastfeeding mothers who have a baby with thrush may get a yeast infection on their breasts and nipples, causing pain while breastfeeding.

In addition to getting treatment for their baby, these mothers also need to be treated by their doctor.

Recurrent Thrush

Infants with thrush that doesn't go away or keeps coming back may have underlying immune system problems, especially if your infant isn't gaining weight well or has other infections and medical problems.

Preventing Thrush

Children get thrush because the Candida albicans yeast is ubiquitous or everywhere, so no matter how carefully you clean and sterilize pacifiers, bottles, toys, etc., your baby will likely still be exposed to this yeast. Still, you should carefully clean any objects that go into your child's mouth.

If your baby gets thrush over and over, be sure that he isn't overusing a pacifier or bottle, which may be causing the insides of his mouth to be overly moist and cracking, which provides the perfect environment for yeast to grow. You might also get rid of and buy new nipples and pacifiers once the infection clears up.

Thrush in Older Children

In older children, thrush is less common, but may occur after they have been on antibiotics (due to overgrowth of the fungus.)  Thrush may also occur in children who use steroid inhalers for allergies or asthma.

If your older child has recurrent thrush, especially if he hasn't recently been on antibiotics or steroids, thrush can be a sign of uncontrolled diabetes mellitus or an immune system disorder.


Egunsola, O., Adefurin, A., Fakis, A. et al. Safety of fluconazole in paediatrics: a systematic review. European Journal of Clinical Pharmacology. 2013. 69(6):1211-21.

Goins, R., Ascher, D., Waecker, N. et al. Comparison of fluconazole and nystatin oral suspensions for treatment of oral candidiasis in infants. Pediatric Infectious Disease Journal. 2001. 21(12):1165-7.

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