Oral Thrush in Babies in Brampton: What Parents Should Look For

During a feed, you notice white patches on the inside of your baby’s cheeks. At first you assume it is milk, but when you gently try to wipe it away with a soft cloth, it does not budge, or the skin underneath looks red. Your baby has been fussier than usual at feeds too. This may be oral thrush, one of the most common infections in young babies.

Thrush is caused by a yeast called Candida, which normally lives in the mouth and gut without causing problems. In young babies, whose immune systems are still developing, the yeast can sometimes overgrow and cause an infection. Thrush is usually mild and treatable, but it can make feeding uncomfortable and may pass between a baby and a breastfeeding parent.

In Ontario, pharmacists can assess oral thrush as part of their minor ailment services. At Pharmasave BramNorth, 25 & 26 - 2 Dewside Drive, you can learn more on our oral thrush page and ask whether an assessment suits your baby’s age and situation.

Why babies are prone to thrush

Several factors make thrush more common in babies:

• Developing immune systems. Young babies are still building their defences against germs, including yeast.
• Warm, moist environment. The mouth is an ideal place for yeast to grow.
• Antibiotics. If a baby, or a breastfeeding parent, has recently taken antibiotics, the normal balance of microorganisms may be disrupted, allowing yeast to overgrow.
• Pacifiers and bottle nipples. These can harbour yeast if not cleaned well.
• Passing between parent and baby. Yeast can move back and forth between a baby’s mouth and a breastfeeding parent’s nipples.

Thrush is most common in babies under six months, but it can occur at any age. It is not a sign of poor hygiene.

Recognising the signs

Common signs of oral thrush in babies include:

• White or creamy patches on the tongue, inner cheeks, gums, roof of the mouth or lips.
• Patches that look like cottage cheese and do not wipe away easily.
• Red or raw areas underneath the patches if they are wiped off, sometimes with slight bleeding.
• Fussiness during feeds, pulling off the breast or bottle, or refusing to feed, which may suggest discomfort.
• A yeast diaper rash, which is bright red with small red spots around the edges, since the same yeast passes through the gut.

Some babies with thrush show no discomfort at all, and parents only notice the patches.

Thrush or milk residue?

Many parents worry about thrush when they see a white coating on their baby’s tongue. Often it is simply milk residue, which is very common in breastfed and formula-fed babies. Here is how to tell the difference:

• Milk residue usually appears only on the tongue and wipes away easily with a damp, soft cloth, leaving normal pink skin.
• Thrush patches often appear in other areas of the mouth, such as the cheeks and gums, and do not wipe away easily. If they do come off, the area beneath may look red or raw.

If you are not sure, have it checked by a pharmacist or doctor rather than trying to scrape the patches off.

How thrush is treated

Mild thrush sometimes clears on its own, but treatment is often recommended, especially if it is affecting feeding. Treatment usually involves an antifungal medicine applied to the inside of the mouth, given for a set period.

A pharmacist can assess your baby, ask about their age, feeding, any recent antibiotic use and whether the breastfeeding parent has symptoms, and recommend or, where appropriate, prescribe treatment. In some cases, such as very young babies, babies who are not feeding well or babies with other health concerns, the pharmacist will refer you to a doctor.

When applying an oral antifungal:

1. Wash your hands.
2. Use the applicator or method recommended by the pharmacist, such as a dropper, syringe or clean swab.
3. Apply the medicine to the affected areas inside the mouth, as directed.
4. Give it after feeds if instructed, so it stays in contact with the mouth longer.
5. Continue for the full length of time recommended, even if the patches disappear sooner.

Our pharmacists can show you the best way to apply the treatment.

Applying medicine inside a wriggly baby’s mouth takes practice. It often helps to do it when your baby is calm and slightly drowsy, rather than when they are hungry and upset. Gently paint or drip the medicine onto the patches rather than squirting a large amount at once, which can make your baby gag or swallow it all before it has a chance to work. Ask the pharmacist whether your baby should avoid feeding for a short time after each application.

Keep a simple record of each application, especially if several people care for your baby. Thrush treatments usually need to be given several times a day, and it is easy to lose track during sleepless nights.

Breastfeeding and thrush

Thrush can pass between a baby’s mouth and a breastfeeding parent’s nipples. Signs in the breastfeeding parent may include nipple pain, particularly burning or shooting pain during or after feeds, cracked or shiny nipples, or itching. If both baby and parent have symptoms, both usually need treatment at the same time to prevent passing it back and forth.

Continue breastfeeding during treatment unless your healthcare provider advises otherwise. If feeding is painful, speak with a pharmacist, doctor or lactation consultant for support. A breastfeeding parent should also be assessed by a healthcare provider for treatment that is appropriate for them.

Cleaning bottles, pacifiers and pump parts

Yeast can survive on items that go in a baby’s mouth or contact the breast, which can lead to reinfection. During treatment and for a little while afterward:

• Wash bottles, nipples, pacifiers, teethers and breast pump parts in hot, soapy water after each use, and rinse well.
• Sterilise items daily if possible, following the manufacturer’s instructions.
• Replace pacifiers and bottle nipples if thrush keeps returning.
• Wash bras, breast pads and towels in hot water, and change breast pads frequently.
• Wash your hands before and after feeds, diaper changes and applying treatment.

Treating the diaper area too

Because the yeast passes through the gut, babies with oral thrush often develop a yeast diaper rash. If you notice a bright red rash with small red spots around the edges, mention it to the pharmacist. A separate antifungal cream may be recommended for the diaper area, and our pharmacists can assess diaper rash at the same visit where appropriate. Our article on diaper rash care explains more about diaper rashes and how to protect the skin.

When to see a doctor

Contact your doctor if:

• Your baby is a newborn or only a few weeks old.
• Your baby is not feeding well, has fewer wet diapers or shows signs of dehydration.
• Thrush does not improve after a few days of treatment, or keeps coming back.
• Your baby has a fever or seems unwell.
• Patches spread to the throat or your baby seems to have difficulty swallowing.
• Your baby has other health conditions.
• Thrush appears in an older child without an obvious reason, such as recent antibiotics or inhaled steroids.

Seek prompt care if your baby shows signs of dehydration, such as a dry mouth, sunken soft spot, few wet diapers or unusual sleepiness.

Thrush in older children

Older children can also get thrush, although it is less common. Risk factors include recent antibiotic use, use of inhaled steroid medicines for asthma, and certain health conditions. Children who use inhaled steroids can reduce their risk by rinsing their mouth with water and spitting after each use, as advised by their healthcare provider or pharmacist.

If an older child gets thrush repeatedly without a clear reason, mention it to your doctor, who may want to look for an underlying cause.

Preventing thrush from coming back

After treatment, a few habits can help prevent recurrence:

• Keep bottles, pacifiers and pump parts clean.
• Let breasts air-dry after feeds if possible.
• Use antibiotics only when needed, and ask about thrush prevention if your baby or the breastfeeding parent needs them.
• Watch for early signs so you can act quickly.

Remember that a single episode of thrush is common and not a reflection of your care. Some babies simply get it once or twice during the early months and never again. If it does return, it is worth reviewing cleaning routines, checking whether the breastfeeding parent needs treatment, and speaking with a pharmacist or doctor about whether anything else could be contributing.

Talk to our pharmacists about thrush

If you think your baby may have thrush, or you are breastfeeding and experiencing nipple pain, our pharmacists can help you understand your options and work out whether pharmacy care or a doctor’s visit is the right next step. We will also explain how to apply treatment and keep feeding equipment clean.

You can find us at Pharmasave BramNorth, 25 & 26 - 2 Dewside Drive, Brampton, ON L6R 3Y5. Call (905) 792-7333, see our contact page for store details, or arrange a consultation through our booking page. Bring your baby if you can, so the pharmacist can take a look.

Please read this as general information about oral thrush. It does not replace an assessment by a pharmacist, doctor or other healthcare provider who can examine your baby.