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Oral thrush in babies and young children is a fungal infection in the mouth that's usually harmless and easily treatable.
Although babies and young children are particularly at risk, oral thrush can also affect adults. Read about:
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The main sign of oral thrush is a white coating on your baby's tongue, although there may also be white patches elsewhere in the mouth.
This coating may look like curd or cottage cheese and usually can't be rubbed off easily.
If your baby has a white coating on their tongue that does rub off easily, it's more likely to be milk coating the tongue and not thrush.
Babies may not seem bothered by the patches, but they may be reluctant to feed – or keep detaching from the breast during feeds – if they're sore.
There may also be associated nappy rash caused by the same infection that needs to be treated as well.
Oral thrush in babies isn't usually serious, but you should visit your GP if you think your child may have the condition. You can also ask your health visitor for advice or call NHS 111.
If there's any doubt about the diagnosis, your GP may take a swab from your baby's mouth and send it to a lab to be tested.
Oral thrush is caused by a yeast fungus called Candida albicans.
Healthy people have this fungus in their mouths and it doesn't normally cause problems. But it can overgrow and infect the membranes in the mouth.
Babies are at an increased risk of oral thrush because their immune systems haven't yet fully developed and are less able to resist infection. This is particularly the case with babies born prematurely (before 37 weeks of pregnancy).
Oral thrush can also affect babies if they've recently been treated with antibiotics. Antibiotics reduce the levels of healthy bacteria in your baby's mouth, which can allow fungus levels to increase.
If you're breastfeeding and have been taking antibiotics for an infection, your own levels of healthy bacteria in your body can be affected. This can also make you prone to a thrush infection that may then be passed to your baby during breastfeeding.
If your GP or health visitor feels your baby needs treatment, they'll probably prescribe an antifungal medicine. The two main antifungal medicines used to treat oral thrush in babies are:
These medications usually need to be used up to four times a day and are most effective if used after your baby has had a feed or drink.
Continue to use the medicine for two days after the infection has cleared up as this will help prevent the infection coming back. If treatment hasn't fully cleared the thrush after a week of treatment, speak to your GP or health visitor again for advice.
In most cases, miconazole will be the first treatment recommended by a GP.
It's available as a gel that you apply to the affected areas using a clean finger. It's important only to apply a little at a time and to try to avoid the back of your baby's mouth to reduce the risk of choking.
A small number of babies are sick after being treated with miconazole, but this side effect usually passes and isn't normally any cause for concern.
In some cases, your GP or health visitor may recommend an alternative medication called nystatin.
This comes as a liquid medicine (suspension) that's applied directly to the affected area using a dropper (oral dispenser) supplied with the medicine.
Nystatin doesn't usually cause any side effects and most babies have no trouble taking the medication.
If your baby has oral thrush and you're breastfeeding, it's possible for your baby to pass a thrush infection to you. This can affect your nipples or breasts and cause nipple thrush.
Symptoms of nipple thrush can include:
If you have nipple thrush, or there's a risk of your baby passing thrush on to you, you'll normally be advised to continue breastfeeding while using an antifungal cream such as miconazole to treat the infection.
You should apply the cream to your nipples after every feed, and remove any that's left before the next feed.
In severe cases of nipple thrush, antifungal tablets may be recommended.
It's not clear whether it's possible to prevent oral thrush in babies. Some doctors suggest the following advice may help:
Washing your hands thoroughly after changing your baby's nappy can also be helpful in stopping thrush spreading because the infection can be passed through their digestive system.