Definition

Thrush is a fungal infection of the mouth. It usually begins on the tongue and inside of the cheeks. It may also spread to the palate, gums, tonsils, and throat.

Severe, untreated thrush can spread to the:

• Esophagus
• Urinary tract
• Whole body—systemic infection causes multiple organ failure and death

Causes

Thrush is caused by a fungus. There are many microorganisms that normally live in the mouth. When these organisms become imbalanced, the fungus can grow and cause thrush. The imbalance of organisms may be caused by a medical condition or medication.

Risk Factors

Factors that may increase your baby's chance of getting thrush include:

• Contamination from caregivers
• Contamination during breastfeeding
• Birth complications, such as preterm birth, premature rupture of membranes, or perinatal asphyxia
• Very low birth weight babies admitted to neonatal intensive care
• Vaginal yeast infection in the mother at the time of birth

Factors that may increase your child's chance of getting thrush include:

• Use of antibiotics
• Health conditions that suppress the immune system, such as:
  • HIV infection
  • Cancer or medical treatments for cancer, such as chemotherapy
  • Congenital immune deficiencies
• Prolonged illness
• Conditions that cause a dry mouth
• Use of medications that treat psychiatric conditions

Symptoms

Thrush may cause the following in infants:

• Irritability
• Decreased interest in feeding
• White, lacy patches on the inside of the cheeks or tongue that don't come off when rubbed

Thrush may cause the following in children:

• Sore mouth and throat
• Difficulty swallowing
• Differences in taste
• White or red patches on the inside of the cheeks or tongue that may or may not come off when rubbed
• Fissures or cracks in the mouth

Diagnosis

You will be asked about your child's symptoms and medical history. A physical exam will be done, including an inspection of the mouth. Diagnosis can usually be done after physical exam. A sample of cells may be taken from the affected area. The sample will be examined under a microscope to confirm thrush or look for other infections.

Treatment

The goal of treatment is to restore the normal balance of bacteria and yeast in the mouth. If any underlying conditions contribute to thrush, they will also be treated.

Treatments include:

Prevention

To help reduce your child's chance of getting thrush, take these steps:

• Maintain proper oral hygiene after treatment.
• Thoroughly clean your baby's pacifier and toothbrush.
• If your baby is prone to thrush and drinks from a bottle, use disposable nipples.
• Avoid mouthwashes and mouth sprays. These can upset the normal balance of yeast and bacteria in the mouth.
• If your child uses a corticosteroid inhaler, make sure they rinse their mouth thoroughly after each use.
• If your child is at risk, ask your child's doctor about antifungal medication.