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Treatment & Prevention of Oral Thrush in Newborns

Reviewed by James Brann, M.D.

Oral Thrush is Rarely Serious and can be Treated Relatively Easily

This article is about how to prevent and treat oral thrush of the newborns

Newborns are susceptible to a number of ailments, one of the more common of which is oral thrush. Oral thrush is caused by a yeast, also known as Candida Albicans, and typically invades the insides of newborn's mouth and tongue.

How will you know if your newborn comes down with oral thrush? Most babies will have a cottage cheese like or milky white substance that coats the side, roof of and even the tongue of the baby's mouth.

It is most common in newborns two months of age and younger but can also occur in older babies. Your newborn baby can acquire the infection at birth as they pass through the birth canal or later in life with the treatment of antibiotics. A newborn baby can also get thrush from breastfeeding if you have a yeast infection on your nipples.

Most oral thrush infections do not cause any symptoms for your baby and in most cases spontaneously resolves without treatment. Other babies with oral thrush will be uncomfortable while feeding and will need treatment.

How is Oral Thrush Treated?

The successful treatment of oral thrush in babies includes topical antifungal medicines and measures to prevent reinfection, including sterilization of things that are placed in your baby’s mouth. Make sure to boil bottle nipples and pacifiers before reusing.

The current treatment of choice for oral thrush in the newborn baby is to use a prescription mouth rinse that has medicine in it to kill the yeast. The most commonly used mouth rinse is a nystatin suspension and is to be used four times a day for seven to fourteen days. The normal nystatin suspension dose is 100,000 unit which is divided as 50,000 units to each side of the mouth. The mouth rinse should be squirted into your baby’s mouth or can also be applied with a cotton swab. The mouth rinse should be used for two to three days after you do not see any more white patches. This will usually take two weeks. If the oral thrust infection does not resolve in the two week time frame this may be related to re-exposure form pacifiers or bottle nipples.

You can also use fluconazole oral rinse as an alternative to nystatin. Oral fluconazole works faster to clear up the infection, but regardless nystatin is still the initial recommended treatment.Oral fluconazole is used only when the infection does not resolve with nystatin.

If you're breastfeeding an infant who has oral thrush, you and your baby will benefit if both are treated. Otherwise, you're likely to pass the infection back and forth. Signs that your nipples are infected with thrush include a cracked, itchy, red, and burning nipples. You may also have shooting pains after breastfeeding.

Topical miconazole or clotrimazole creams are used to treat breastfeeding moms that show evidence of yeast infection. These two medications work better than the older nystatin cream preparations. Theses medications should not be of a concern for your baby during breastfeeding, however they should be washed off prior to feeding and reapplied afterward.

Suggestions to Help Prevent Oral Thrush

Tips that may help prevent oral thrush include:

  • Giving baby sterilized water to drink after breastfeeding to rinse any milky residue away.

  • Be sure to clean and sterilize bottles and pacifiers thoroughly and allow to dry.

  • Let your nipples air dry between feedings.

  • Consider supplementing if you know you have taken or need to take a course of antibiotics.

The good news is that oral thrush is rarely serious and can be treated relatively easily when it is discovered. If you think you or your newborn might be suffering from an oral thrush infection, be sure to contact your healthcare provider for an accurate diagnosis before attempting any treatment methods.

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