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Thrush is a yeast infection that
causes white patches in the mouth and on the tongue. Thrush is most common in
babies and older adults, but it can occur at any age. Thrush in babies is usually not
thrush when a yeast called Candida, normally found on the body, grows out of control.
In babies, Candida causes thrush because
immune systems are not yet strong enough to control
the growth of the yeast. Older people get thrush because their immune systems
can weaken with age.
Some people get thrush when they take certain
medicines, such as
inhaled corticosteroids. People who have certain health
problems, such as
HIV, are also more likely to get thrush.
The most common symptoms of
thrush are white patches that stick to the inside of the mouth and tongue.
In babies, it is easy to mistake
thrush for milk or formula. It looks like cottage cheese or milk curds. Don't
try to wipe away these patches, because you can make them red and sore. Some
babies with thrush can be cranky and do not want to eat.
Talk to your doctor if you think you or your child has thrush.
In most cases, doctors
can diagnose thrush just by looking at the white patches. Your doctor will also
ask you questions about your health. If your doctor thinks that another health
problem, such as
diabetes, may be related to your thrush, you may also be
tested for that condition.
Thrush is usually treated with prescribed antifungal medicine such as nystatin liquid.
In most cases, you will put the medicine directly on the white patches. When a
baby has thrush, the yeast can cause a diaper rash at the same time as thrush.
Your doctor may prescribe nystatin cream or ointment for his or her diaper
To treat thrush in adults, at first you will probably use
medicine that goes directly on the white patches, such as a liquid or a
lozenge. If these medicines don't work, your doctor may prescribe an antifungal
If your baby has
thrush, it may help to:
If you wear dentures and have thrush, be sure to clean
your mouth and dentures every night. You can soak them overnight in a denture
cleaner that you buy at the store. Rinse your dentures well after soaking
Learning about thrush:
Candida, the yeast that causes
thrush, is normally present in small amounts in the
mouth and on other
mucous membranes. It usually causes no harm. But when
conditions are present that let the yeast grow uncontrolled, the yeast invades
surrounding tissues and becomes an infection.
Thrush is most
commonly caused by the yeast Candida albicans. Less
frequently, other forms of Candida can lead to thrush.
There are many types of bacteria in your mouth that normally control the
growth of Candida. Sometimes a new type of bacteria gets
into your mouth and disrupts the balance of the organisms already there,
allowing Candida to overgrow. Health conditions and
other things may also be involved.
yeast that causes thrush can pass from one person to another in different
Thrush can be a
mild infection that causes no symptoms. If symptoms develop, they may include
Symptoms of thrush in an infant may
Symptoms of thrush in an adult may
A breast-feeding mother may get a yeast infection of her
nipples if her baby has thrush. This can cause sore, red nipples. She may also
have a severe burning pain in the nipples during and after breast-feeding.
Most cases of
thrush are mild and clear up with the use of an
antifungal mouth rinse or lozenges. Very mild cases of thrush may clear up
without medical treatment. It usually takes about 14 days of treatment with an
oral antifungal medicine to cure more severe thrush infections. In some cases,
thrush may last several weeks even with treatment.
If thrush goes
untreated and does not go away by itself, it can spread to other parts of the
Thrush is more likely to recur in:
Complications related to thrush are
rare in healthy people but may include:
There are several things
that can increase your risk for getting
Medicines that can let the thrush
yeast grow uncontrolled include:
Exposure over time to certain
environmental chemicals, such as benzene and some pesticides, can weaken the body's
immune system, increasing your risk for infections, including
If you think you may have
thrush but it has not been diagnosed, see the topic
Mouth Problems, Noninjury to evaluate your
Call your doctor today if you or your child has been
diagnosed with thrush and:
Thrush in an infant's mouth can spread to the breast of the
nursing mother. This can cause nipple redness and pain. Contact your doctor if
you have redness and pain in the nipples in spite of home treatment or if you
have burning pain in the nipple area when you nurse. Your doctor will likely examine your baby's mouth to find out whether thrush is causing your symptoms.
If you have previously been diagnosed with
thrush and you believe you may have another thrush
infection, home treatment may help. Very mild cases of thrush may clear up
without medical treatment. Talk to your doctor if:
The following health professionals can diagnose and treat
Other specialists may be required if other organs become
infected or other conditions develop. The type of specialist depends on the
organs affected and may include the following:
To prepare for your appointment, see the topic Making the Most of Your Appointment.
A visual exam is
usually all that is needed to diagnose thrush. In addition to looking in your
mouth, your doctor will ask you questions about your
In rare cases, your
doctor may order a
KOH test in which one of the white patches is scraped and examined. A
KOH test is used only in cases when thrush is not clearly evident by
A fungal culture may be done when a diagnosed case of thrush is not responding to
Thrush is a
yeast infection that can develop in the mouth and throat and on the tongue.
Thrush is most common in newborns, infants, and older adults, but it can occur
at any age. In healthy newborns and infants, thrush is usually not a serious
problem and is easily treated and cured.
Except for the mildest
cases, you should treat
thrush to keep the infection from spreading.
Prescribed antifungal medicines, which slow down the growth of yeast, are the standard
treatment for thrush. Thrush is most commonly treated with medicines that are
either applied directly to the affected area (topical) or swallowed
In adults, mild cases of thrush may
clear up with simple treatment that can be done at home. This treatment usually
involves using an antifungal mouth rinse or lozenges. Treatment usually lasts
about 14 days.
Mild thrush in infants is usually treated with
topical medicines until at least 48 hours after the symptoms have gone
More severe thrush
infections that have spread to the esophagus are treated with an oral
antifungal medicine. A topical antifungal medicine may also be used.
For some severe infections, a treatment period longer than 14 days may be
Oral antifungal medicines are almost never used during
pregnancy, because the
fetus may be harmed. But if a pregnant woman has a
rare, severe thrush infection, oral antifungal
medicines may be used. In this case, the risk of harm to the mother and fetus
from the severe thrush infection may be greater than the risk posed by the use
of antifungal medicines.
recurrent cases of thrush may:
weakened immune systems can take an antifungal
medicine on a continuous basis to prevent thrush infections.
very important to get rid of any sources of infection, or thrush will continue
to come back. Do this by cleaning toys, pacifiers, bottles, and other items a
child may put in his or her mouth or share with another child.
important to treat conditions that make you more likely to get thrush, such as
diabetes, human immunodeficiency virus (HIV), or cancer. For more information, see Prevention.
To reduce the risk of spreading thrush to infants:
If your baby is taking antibiotic medicine for a different
infection, such as an ear infection, rinse his or her mouth out with water
after each dose. Antibiotic medicines can disrupt the balance of bacteria in
the mouth and allow growth of the yeast that causes thrush. Rinsing the mouth
with water after taking an antibiotic can prevent disrupting the normal
environment in the mouth.
If your baby needs medicine to treat
thrush, don't put the medicine dropper in the baby's mouth. Drop the medicine
on a cotton swab and swab it on the affected area. Throw away the swab, and
don't put anything back into the medicine bottle that could be contaminated
with the yeast.
If your child has mild
thrush, you may only need to clean bottle nipples and
pacifiers regularly and massage the inside of your child's mouth with a clean
moist cloth. If you breast-feed, dry your
nipples after breast-feeding. And apply lanolin lotion, which may help relieve
nipple soreness. Your doctor may also prescribe an antifungal medicine that you can put on your nipples.
If you develop thrush and have false teeth
(dentures), it is important to clean your mouth and dentures every night.
Gentian violet (1%) sometimes works as treatment for thrush. It is a dye that kills
bacteria and fungi, and it is available
without a prescription. Talk to
your doctor before using gentian violet.
To help reduce
the discomfort of thrush in children and adults (but not newborns):
Prescription medicines that inhibit the growth of yeast (antifungals) are
used to treat thrush.
infants, treatment is continued for at least 48 hours after the symptoms have
gone away. Most adults need treatment for 14 days. In more severe or persistent
infections, treatment may be continued beyond the normal treatment
Antifungal medicines are either applied directly to the
affected area (topical) so the medicine affects only that area, or swallowed
(oral) so the medicine affects the entire body. In rare cases, an antifungal medicine will need to be
injected into a vein (intravenous, or IV).
medicines are applied to the affected area and are available in several forms, such as rinses and lozenges.
Topical antifungal medicines
need to be in contact with the affected area long enough to stop the growth of
the yeast. Lozenges are preferred because they take longer to dissolve. Because
the lozenges need moisture to dissolve, sipping water while using them may
help them work better.
Because several of the topical
antifungal medicines contain sugar, there is an increased risk of
cavities when the medicines are used for long periods
of time. Using a topical fluoride rinse or gel (if you are not already
obtaining fluoride through other means) during treatment may help prevent
cavities. Talk to your doctor or dentist before you give your child fluoride products. Too much fluoride may be toxic and can stain a child's teeth.
antifungal medicines, oral antifungal medicines affect the whole body. Oral
medicines are used alone to treat mild thrush infections. But oral medicines also may be
combined with topical antifungal medicines to treat more severe thrush
Oral antifungal medicines are used to prevent thrush
in certain people with conditions that weaken the body's
Oral antifungal medicines
should not be used during pregnancy because the
fetus may be harmed. But oral antifungal medicines may
be used in pregnant women who have a rare, severe infection.
This American Academy of Pediatrics website has information for parents about childhood issues, from before the child is born to young adulthood. You'll find information on child growth and development, immunizations, safety, health issues, behavior, and much more.
The American Dental Association (ADA), the professional
membership organization of practicing dentists, provides information about oral
health care for children and adults. The ADA can also help you find a dentist
in your area.
This website is sponsored by the Nemours Foundation. It
has a wide range of information about children's health—from allergies and
diseases to normal growth and development (birth to adolescence). This website
offers separate areas for kids, teens, and parents, each providing
age-appropriate information that the child or parent can understand. You can
sign up to get weekly emails about your area of interest.
La Leche League International (LLLI) offers information and
encouragement—mainly through personal help—to all mothers who want to
breast-feed their babies. It also offers support and information about
breast-feeding babies with various disabilities, such as cleft lip or cleft
palate. Call for information about a chapter in your area.
CitationsKnapp KM, Flynn PM (2009). Candidiasis. In RD Feigin et al., eds., Feigin and Cherry's Textbook of Pediatric Infectious Diseases, 6th ed., vol. 2, pp. 2741–2751. Philadelphia: Saunders Elsevier.Other Works ConsultedAmerican Academy of Pediatrics (2009). Candidiasis (moniliasis, thrush). In LK Pickering et al., eds., Red Book: 2009 Report of the Committee on Infectious Diseases, 28th ed., pp. 245–249. Elk Grove Village, IL: American Academy of Pediatrics.American Public Health Association (2008). Candidiasis. In DL Heymann, ed., Control of Communicable Diseases Manual, 19th ed., pp. 98–101. Washington, DC: American Public Health Association.Dominguez SR, Levin MJ (2011). Candidiasis section of
Infections: Parasitic and mycotic. In WW Hay Jr et al., eds., Current Diagnosis and Treatment: Pediatrics, 20th ed., pp. 1251–1254. New York: McGraw-Hill.Edwards JE (2010). Candida species. In GL Mandell et al., eds., Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases, 7th ed., vol. 2, pp. 3225–3240. Philadelphia: Churchill Livingstone Elsevier.
July 25, 2011
Susan C. Kim, MD - Pediatrics & Thomas Emmett Francoeur, MD, MDCM, CSPQ, FRCPC - Pediatrics
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