Thrush in babies and children: how to treat candida infections

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Does your child have candida? Here’s how to treat fungal infections in babies and children.

By Dr Louise Wiseman MBBS, BSc (Hons), DRCOG, MRCGP

If your baby is unexpectedly fussy during feedings or you notice white patches in their mouth or an uncomfortable rash in their nappy, they might have thrush. Thrush is a common yeast infection that is usually harmless, but it can be uncomfortable.

Dr Louise Wiseman shares her expert tips on thrush in babies and children including common symptoms and treatment options:

What is thrush?

Thrush (also called Candida) is a common yeast infection often caused by a fungal organism called candida albicans (although there are others). This is a bug that naturally lives on the body, usually without causing any problems. But when the environment of your body is put under certain conditions, overgrowth of the candida occurs and then it can cause symptoms.

Thrush loves a warm moist environment which is why the most common sites affected are the vagina, penis, armpits and groin. In adults this can be triggered by stress, clothes rubbing and a course of antibiotics but in babies and children there may not always be an obvious cause. It is thought about two thirds of babies have oral thrush at some point during their first three months of life.

How do babies and children get thrush?

Thrush is more common in people with an immature or reduced immune system. This is why babies and infants can be vulnerable as their immune system is only just developing. The following factors can causes thrush in babies:

  • Pregnancy and labour

A baby may have come into contact with thrush via the mother either during pregnancy or during labour as they come down the birth canal.

  • Breastfeeding

If the mother’s nipple or the skin around it is affected by thrush (which is quite common as this has a tendency to be a moist warm area) the baby can become infected from latching on and feeding. Transmission can also occur if the mother has candida in the milk ducts within the breast. These are not reasons to stop feeding as treatment is straightforward Ask your GP or midwife for help if you are concerned.

  • Antibiotics

Sometimes children or babies can develop thrush after a course of antibiotics. Antibiotics can tip the balance so there are slightly less good bacteria in the gut that would normally keep candida in check. This then means the candida can overgrow.

  • Steroid inhalers

Children using steroid inhalers for asthma can develop thrush in their mouths. The steroids can alter the natural environment of the mouth. Good asthma care includes rinsing the mouth with water after using inhalers and also using a device called a spacer attached to the puffer. This reduces the steroid deposit in the oral cavity and hence reduces the chance of candida.

  • Health conditions

Much less commonly, if a child has a compromised immunity (through illness or medical treatment) they will be more vulnerable to candida that can then potentially infect the bloodstream and this becomes more serious. In these cases a child will already be under the care of an experienced Paediatric team who are used to treating candida within the body. Examples of scenarios causing reduced immunity include:

  • Certain nutritional deficiencies such as very low iron.
  • Very low birth weight babies.
  • Having a long-term urinary catheter.
  • Having a long-term drip site or ‘central line’ in a vein for medical treatment.
  • Diabetes.
  • Medical treatment directly lowering immunity, eg chemotherapy.

Where do babies and children typically get thrush?

Candida commonly affects the nappy area in babies and infants – wherever there are folds of skin and a damp, warm environment. Thrush is not usually the cause of a nappy rash, but it can make an existing irritation a lot worse. The nappy rash develops and then this creates the perfect environment for candida.

The mouth can be affected and this can include the tongue, palate and inside walls of the mouth and throat.

If a baby has eczema patches it is possible for candida to affect these.

Thrush symptoms in babies and children

Look out for the following signs and symptoms of thrush in babies and children:

  • Nappy area rash

If candida is affecting the nappy area there will be a bright red rash and there may be ‘satellite’ or scattered red spots around the main area. These might be small red dots or very large areas. Sometimes these spots can have a classic raised red border. They can be very sore and itchy and may sting if in contact with urine or poo is left in the nappy or when actually weeing. Candida tends to affect both sides of the nappy area at once and more commonly at the front. You may notice that the rash does not clear up with simple nappy creams.

  • White or yellow patches in the mouth

In a baby’s mouth candida can be white or yellow patches on the tongue, gums, palate, or inner cheeks. Some areas of the mouth may have smaller white spots. The lips may have a white film. White patches on the tongue will not wipe off easily. These can all be painful for the baby and may cause problems with latching on or feeding. They may drool saliva more than normal or be generally irritable.

  • Red and inflamed eczema

Candida in eczema areas may cause it to be even more red and inflamed and there may be a red round appearance to the affected areas.

⚠️ In the rare event that a child has systemic candida they may become unwell with a fever and reduced alertness. This will require urgent hospital admission and treatment, but this is usually in a child with a known medical condition.

Can young girls get vaginal yeast infections?

It is less common for young girls to have vaginal yeast infections before puberty. The more likely diagnosis is a condition called vulvovaginitis, but if there is a thick white discharge then thrush is a possibility.

Vulvovaginitis is irritation of the vagina and vulva and is very common in young girls and will often come and go without treatment. It is often mistaken for thrush or urine infections. It occurs because the area is vulnerable to irritation and may be made worse by soaps, bubble baths, dampness and not wiping front to back after using the toilet. Protection of the area with a barrier cream (bepanthen, sudocrem) is often the best treatment. This tends to naturally resolve as the hormonal changes of puberty arrive.

Thrush diagnosis in babies and children

Your doctor will discuss the history and may ask mum about antenatal history, method of delivery, and any symptoms you may have around the nipple or within the breast area.

On examination there may be obvious spots or plaques of thrush in the mouth of the baby or the typical candidal nappy area appearance.

The doctor may not need to do a swab to make a diagnosis, but a swab may be gently taken if they are unsure. If a swab is taken it can take two or three days to gain a result from the lab and treatment may be started in the interim to avoid delay.

Thrush treatment in babies and children

To treat thrush in babies and children try the following options:

  • Nappy thrush

A simple thrush cream (clotrimazole 1% or Canesten) may be all that is needed for nappy rash. The doctor will also give simple advice and review if things are not improving in seven days.

Regular nappy changes are important so nappies are not left in contact with the skin if they are wet or dirty.

Sometimes avoiding strong fruits or certain foods in weaning may be advised if they seem to cause a nappy rash in the baby and this then gets colonised by thrush. Nappy rashes are generally common from 4-15 months and this includes the time of starting solid food.

  • Oral thrush

Your GP or Health Visitor may prescribe an antifungal treatment called Nystatin oral suspension if your baby is under 4 months. Older babies are usually prescribed miconazole gel to be very carefully applied to affected areas. Nystatin comes with a dropper that you can use to apply the medicine where needed after feeds. These are usually prescribed for seven days.

  • Nipple thrush

The mother’s nipple area may need to be treated simultaneously to prevent a cycle of reinfection. This might be simple clotrimazole cream twice a day avoiding feeding time at application. In infections that are thought to be from deep within the breast (if she has pain on feeding and thought to have ductal candida) the mother may be given an oral antifungal (fluconazole) medicine to take while also using antifungal cream on the nipple.

To reduce the chance of candida overgrowing during breastfeeding:

  • Wash hands after applying any cream.
  • Make sure the breastsare clean and dry after a feed.
  • Regularly change disposable breast pads.
  • Wash reusable pads and nursing bras at 50 degrees.
  • Add a small cup of vinegar to final washing machine rinses.
  • Rigorous hygiene is essential for dummies, bottles, teats and nipple shields.

How long does it take for thrush to go away?

Most cases resolve in a few days of treatment – if it goes on for more than two weeks then a hospital referral to a Paediatrician for review is normally made to exclude any other underlying cause.

Is thrush in babies and children ever serious?

Although oral candida or mouth thrush is common in babies, it is less so in older children so NICE guidelines advise referral in case it signifies a lowered immunity. If any case of thrush within any area of the body does not resolve with simple treatment and advice, further investigation may be necessary.

Thrush in babies and children prevention tips

To prevent thrush in babies and children try the following options:

✔️ Regular nappy changes can help.

✔️ Avoid soaps and bubble baths as these may sting and also exacerbate the problem by affecting the natural skin flora.

✔️ Use barrier nappy creams (such as Sudocrem or Bepanthen) in between applications of antifungal cream as directed by your doctor or pharmacist. This will help protect the skin barrier and speed recovery.

✔️ Wear loose clothing.

✔️ Avoiding overheating.

✔️ Wear cotton underwear.

✔️ Avoid soap and shower gels that irritate and just using warm water or prescribed substitutes to wash affected areas.

✔️ Reduce refined sugar and eat a healthy balanced diet.

Net Doctor

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