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Oral thrush is a common condition seen in infants and young children. It is often harmless and self-limiting but can sometimes be indicative of an underlying problem as well. Here is everything you need to know about oral thrush in children.

Oral thrush is usually a mild yeast infection caused by a fungus called Candida albicans. It is also known as Candidiasis, Oropharyngeal Candidiasis or thrush. It most commonly occurs in infants, however, adults with a compromised immune system can develop oral thrush as well. Oral thrush occurs in the mouth, but a yeast infection can occur in other parts of the body too.

Candida albicans is considered a "bad" micro-organism. It exists in our body even in a healthy state but its numbers are kept in check by the "good" micro-organisms. An overgrowth in the numbers of Candida albicans causes Candidiasis.

Causes of oral thrush in children

  • A reduction in the number of good bacteria due to excessive intake of medication like antibiotics, corticosteroids, and other immune suppressant drugs.
  • Poor oral hygiene and inadequate cleaning of feeding bottle nipples, pacifiers, and breast pump tubing may lead to these tools being an excellent breeding ground for the fungus.
  • Kissing a child or adult suffering from oral thrush may result in your child developing oral thrush as well.
  • The presence of yeast infection in the mother may transfer it to the child. In case the mother has a vaginal yeast infection, this can be transferred to the child during a vaginal delivery. Additionally, if the mother has a yeast infection around her nipple, this can be transferred to the child during breastfeeding.
  • Diseases such as HIV or leukemia cause suppression of the body’s natural immunity and hence oral thrush may result as an opportunistic infection due to an uncontrolled rise in the numbers of Candida albicans.
  • Treatment of cancer also causes a suppression of natural immunity, leading to an imbalance in the numbers of the good bacteria and Candida albicans.
  • Patients suffering from uncontrolled diabetes have high blood sugar which provides favorable conditions for Oral Thrush to occur.

Symptoms of oral thrush

  • Characteristically, oral thrush presents as white or yellow patches on the tongue or on the inner lining of the cheeks. These will not get wiped away and may bleed if scraped. They are usually painless but in some cases may be sore and lead to a reduction in food intake of your child.
  • Dry and cracked skin at the corners of the mouth.
  • A foul odor emanating from the mouth.
  • Fever may be present rarely.
  • The infection may spread to the throat, leading to pain on swallowing. Rarely, the infection may spread to other parts of the body via the bloodstream. Widespread yeast infections will only occur in severely immune-compromised individuals and can lead to dangerous complications.

Diagnosis of oral thrush

Oral thrush is diagnosed due to the presence of the typical whitish-yellow bumps around the mouth which cannot be wiped away. The diagnosis can be confirmed through a biopsy, where the dentist will take a small swab from the mouth and have it checked for the presence of Candida albicans.

In case the child complains of pain on swallowing, the dentist may suspect the spread of the infection to the throat or esophagus. In this case, a throat swab may be taken or an endoscope may be used for confirmation.

Treatment of oral thrush

Oral thrush may disappear on its own, however, it is better to treat it, as it is contagious and can be spread by kissing, breastfeeding, etc. Antifungal drugs are the treatment of choice. They come in the form of lozenges, mouthwashes, ointments, and pills. Some commonly prescribed drugs include fluconazole, clotrimazole, nystatin, itraconazole and amphotericin B.

Increasing intake of probiotics such as yogurt rich in lactobacilli may be recommended. This will increase the number of good bacteria in the mouth and hence work to restore the balance in favor of the good bacteria.

In case of a breastfeeding child, it is always better to treat both mother and child for a yeast infection to prevent them from infecting each other. In case you are applying an antifungal ointment on your breast, make sure to wipe it clean before breastfeeding your child. Treatment may be required for up to two weeks for complete recovery. Oral Thrush may also recur during the first year of the child’s life. The child’s toothbrush, pacifier and feeding bottle nipples should be changed after an episode of Oral Thrush.

Prevention of oral thrush

Maintenance of good oral hygiene, brushing twice a day, along with flossing and gargling post meals goes a long way in preventing any oral diseases. Sterilizing of pacifiers, bottle nipples, and breast pump tubing is of great benefit as well.

Providing your child with a nutritious diet with low sugar content helps keep the numbers of good bacteria up, hence preventing a rise in numbers of Candida albicans.

Conclusion

Oral thrush is usually a mild infection and can be easily treated. It looks worse to the parent than it feels to the child. In case you feel your child is suffering from oral thrush, make an appointment with your dentist for confirmatory diagnosis and treatment. Definite risk factors for oral thrush are medical conditions such as HIV, leukemia, diabetes, and cancer treatment. Frequently repeated episodes of oral thrush may arouse suspicion of the presence of some other underlying condition, which should be investigated.

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