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Thrush—Child

(Oral Candidiasis)

Definition

Thrush is a fungal infection of the mouth. It usually begins on the tongue and inside of the cheeks, and may spread to the palate, gums, tonsils, and throat.
Severe, untreated thrush can spread to the:
Thrush
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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:
Factors that may increase your child's chance of getting thrush include:

Symptoms

Thrush may cause the following in infants:
Thrush may cause the following in children:

Diagnosis

The doctor will ask 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. The doctor may take a sample of cells 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:

Medications

In infants, antifungal medications may be a gel or a rinses that are swished around your baby's mouth. Systemic medications may be used if:
  • Your baby is at risk for developing a systemic infection
  • Your baby can't tolerate other treatments
  • Your baby doesn't respond to other treatments
Breastfeeding mothers of babies with thrush can use a topical antifungal medication on their nipples to reduce the baby's infection.
Antifungal medications for children may include oral tablets, rinses, or lozenges that dissolve in the mouth.

Proper Oral Hygiene

Oral hygiene practices that may aid in healing include:
  • Clean your baby's mouth with a clean, moist gauze pad as soon as baby teeth appear.
  • Have your child rinse their mouth with warm salt water
  • Gently scrape patches off your child's mouth with a toothbrush
  • Gently brush any newly appearing teeth with a child-size toothbrush and water.
  • Start to clean your baby’s teeth regularly as soon as they come in. Use an amount of fluoride toothpaste that is about the size of a grain of rice. Progress to an amount that is about the size of a pea by the time your child is three years of age. This will reduce the risk of the child swallowing it.
  • If your child has two teeth that touch, you can start to use dental floss.

Prevention

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

RESOURCES

Centers for Disease Control and Prevention http://www.cdc.gov

National Foundation for Infectious Diseases http://www.nfid.org

CANADIAN RESOURCES

Canadian Dental Association http://www.cda-adc.ca

Public Health Agency of Canada http://www.phac-aspc.gc.ca

References

Babies and kids healthy habits. American Dental Association Mouth Healthy website. Available at: http://www.mouthhealthy.org/en/babies-and-kids/healthy-habits. Accessed December 9, 2013.

Greenspan D, Greenspan JS. HIV-related oral disease. Lancet. 1996;358:9029).729-733.

Oral candidiasis. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/fungal/Candidiasis/thrush. Updated May 6, 2013. Accessed December 9, 2013.

Oral candidiasis in children and adults. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated October 1, 2013. Accessed December 9, 2013.

Oral candidiasis in infants. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated September 26, 2013. Accessed December 9, 2013.

A prospective, randomized, double-blind, placebo-controlled trial evaluating the effects of nystatin on the development of oral irritation in patients receiving high-dose intravenous interleukin-2. J Immunother. 2001;24(2):188-192.

2/17/2014 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: American Dental Association Council on Scientific Affairs. Fluoride toothpaste use for young children. J Am Dent Assoc. 2014 Feb;145(2):190-191.

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