Oral thrush in babies

This is for anyone looking after a baby with oral thrush.

What is oral thrush in babies?

Oral thrush in babies is a fungal infection in the mouth. It is usually harmless and easily treatable. Mild cases of oral thrush only last a few days and do not need treatment.

About 1 in every 7 babies develops oral thrush at some point. It is more common in babies younger than 10 weeks, but older babies can also get it. Some babies have repeat episodes of it.

Oral thrush is rarely due to poor hygiene. It is unlikely to mean that your baby is ill in any other way.

What causes it?

Oral thrush in the mouth is caused by a yeast germ called Candida. Healthy people have this in their mouth naturally and most of the time it doesn’t cause a problem.

A baby can have too much Candida in their mouth because their still-developing immune system is less able to resist infection. This can also happen if your baby has recently been treated with antibiotics.

If you are breastfeeding your baby and you have recently had antibiotics, this can affect your own healthy bacteria. This makes you more at risk of getting oral thrush yourself.  You can pass this infection on to your baby during breastfeeding.

What are the signs of oral thrush?

• Creamy white spots or patches on the tongue, gums, roof of the mouth or inside of the cheeks.  If you gently wipe these patches they won’t come off. (If these patches rub off easily, they are likely to be milk coating your baby’s tongue, not oral thrush).
• Your baby may be unsettled when feeding.
• They may have a white film on their lips.
• Some babies also have nappy rash which won’t clear up. This is caused by the same yeast infection as oral thrush.

Is it uncomfortable for my baby?

Oral thrush is a mild infection, but it can be uncomfortable and painful for your baby.

What if I am breastfeeding?

• Breastfeeding babies who have thrush can sometimes pass their infection on to you, via your nipples.  This can make your nipples cracked and painful, or make your breasts red and shiny. There is unlikely to be discharge from the nipples (apart from milk).
• If you have any infection in your breasts and you are breastfeeding, you may find it painful to feed or express milk. You may have burning or shooting nipple pain in both breasts which does not go away, even after careful re-positioning of your baby. 

What can I do to help my baby at home?

To help your baby, you can do the following.

• Take time to wash your baby’s hands, toys and pacifiers (dummies).
• Wash towels, clothing, and bras that may have come into contact with your nipples. Use a hot wash cycle.
• If you are pumping your milk, keep it refrigerated. Take it out of the fridge just before you use it.
• Sterilise your breast pump and the parts that come with it.
• Sterilise any bottles that you use.
• Make sure your breasts are dry after every feeding,
• Avoid using disposable nursing pads with a plastic backing. Change your nursing pads when they get wet.

When do I talk to my GP?

Talk to your GP if:

• Your baby is distressed and their oral thrush is getting worse. They will need treatment.
• You are breast feeding and your baby has oral thrush.  You will need to take an anti-fungal treatment yourself (usually by mouth). This will stop you and your baby re-infecting each other.
• You have already had treatment for your own symptoms and you are not improving after 48 hours.

What treatment is available?

If you or your baby needs treatment, your GP may prescribe the following.

• Treatment with an anti-fungal gel or liquid which goes in the mouth. This is safe for your baby.
• Treatment with an anti-fungal cream for your baby’s nappy area.
• An anti-fungal treatment if you are breastfeeding your baby.  This is usually a tablet to be taken by mouth.
• Wash your hands carefully with soap and warm water before and after treating your baby. 

How long does thrush last?

Once treatment has started, symptoms usually improve within 2 to 3 days. It takes around 7 days for the infection to completely clear.

When do I make an urgent GP appointment or call NHS 111?

Make an urgent GP appointment or call NHS 111 if: Your baby is not feeding well (less than half their usual feeds). Or Your baby has not passed urine at least 3 times in 24 hours.

More information

NHS information on breastfeeding and oral thrush www.nhs.uk/conditions/baby/breastfeeding-and-bottle-feeding/breastfeeding-problems/thrush/
Information from National Breastfeeding Helpline www.nationalbreastfeedinghelpline.org.uk	0300 100 0212 Seven days a week, 9.30 am to 9.30 pm
Kingston Hospital information on infant feeding www.kingstonhospital.nhs.uk/following-birth/infant-feeding/
Kingston Hospital information on breastfeeding www.kingstonhospital.nhs.uk/following-birth/infant-feeding/breastfeeding/

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Contacts

Your GP
Paediatrics Admin Team, Monday to Friday, 9 am to 5 pm	020 8934 6403 khft@paediatricadmin@nhs.net