Oral candidiasis aka oral thrush in infants

The fungal infection of the oral cavity, also known as oral thrush, is caused by the proliferation of the fungus species Candida albicans, which is present in the mouth, skin and digestive system even under normal circumstances. Patients with depleted or immature immune systems are more susceptible to the disease, with most infants likely to contract oral thrush. Causes Oral thrush is brought on by the proliferation of the fungus species Candida triggered by the depletion/immaturity of the immune system, or deficiency of vitamin B12, anaemia, diabetes and treatment by antibiotics. Infants may also contract the infection during birth, if their mother has vaginal candidiasis and if devices and objects the baby may put into their mouth such as pacifiers, toys or tableware are inadequately sterilized. Symptoms White (or sometimes grey or yellowish) patches or an extensive coating appears on the tongue and the inside of the cheek. There is no reason to panic immediately since such marks may also be left over milk. We can satisfy ourselves whether these marks are food remains or fungus by trying to wipe off the white patch. Milk can easily be wiped off, whereas a fungal infection will be resistant to wiping and the area may even bleed once the patch has been removed. The cracking of the corner of the mouth may also be suggestive of oral thrush. Babies suffering from oral thrush may evidence lack of appetite, peevishness, but we may also suspect an infection if the baby eats less than usual. According to current medical science oral thrush poses no problem to infants and no treatment is required. However, should complaints arise, treatment is in order. Consequences Untreated candidiasis causes our baby to be peevish, have a lack of appetite and refuse food for a sustained period of time due to mucosal dryness, which may even necessitate hospitalisation. Consulting a doctor in time is very much advised for a treatment to be initiated without delay. Antidote Formerly the antidote to oral thrush used to be borax and glycerine solution which is today considered outdated due to its side effects. Our doctor will, in all likelihood, prescribe a magistral formula of Nystatin solution for topical application. In order to apply the solution, we will also be required to purchase sterilised gauze pads also available at the pharmacy. Diaper rash is best treated by means of Canesten cream or some other cream prescribed by the physician to be applied on the baby’s hindquarters and the area around the baby’s genitals. Treatment Apply a few a drops of the Nystatin solution on a multi-layered sterilised gauze pad, wrap it around your forefinger, and rub the baby’s tongue and oral cavity thoroughly. No need to panic if bleeding occurs in the wake of rubbing, this is completely normal as the mucosa becomes sensitive during the process. The treatment must NOT be finished due to bleeding. On delicate, hard-to-access areas a cotton swab may also stand us in good stead. The process needs to be repeated following each feeding session. Older children are encouraged to rinse with Nystatin solution on their own. The infection generally resolves within 1 to 2 weeks of treatment but the treatment needs to be continued for 2 more days in order to prevent reinfection. Post treatment If the infection has spread to the baby’s buttocks the application of an antifungal ointment is required until the symptoms resolve. If the nipples are also infected (cf. burning itch, severe pain, inflamed or peeling breasts/nipples) this area also requires treatment. Do not fail to consult a doctor if you experience such symptoms. Pharmacists generally recommend Canesten-like creams in association with topical antibiotics (e. g. Bactroban) provided the inflammation is definitely attributable to fungus. Such creams need to be applied between the breastfeeding sessions and removed with a damp cloth prior to breastfeeding. It is important to disinfect any objects that the baby may insert into his/her mouth (such as breast suction cups, pacifiers, toys and tableware). 20 minutes’ disinfection by boiling will destroy fungi on such objects. In case of inflammation of the breast bras and bra pads are advised to be washed frequently and further disinfected by ironing or tumble drying. Please also remember to wash your hands regularly and thoroughly and to disinfect the changing table. Should the infection fail to resolve for weeks on end, consult a doctor who will probably prescribe further antifungal treatment (such as Diflucan 10mg/ml or Diflucan 40mg/ml powder for suspension).