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How to Identify and Treat Oral Thrush in Babies

How to Identify and Treat Oral Thrush in Babies

I remember nursing my six week old baby Ophelia, when I noticed some white spots in her mouth that didn’t seem to go away. After a bit of research, I learned that the shooting pains I had while nursing and the white spots in her mouth were both signs of thrush.

I had been battling a yeast infection throughout the last half of my pregnancy with her, and I thought I had gotten rid of it…but apparently not. It was quite an ordeal to identify and heal from this fungus, and I just wanted to share my journey of what I did and what I learned along the way that helped us to finally get rid of Ophelia’s oral thrush and my nipple thrush, which essentially saved our breastfeeding relationship.

Oral Thrush in Babies

Oral thrush occurs when there is an overgrowth of the fungus Candida Albicans in the mouth.

Oral Thrush in a Baby (Photo Credit: Wikimedia Commons, Doc James, 2010)

Oral Thrush in a Baby (Photo Credit: Wikimedia Commons, Doc James, 2010)

Candida Albicans lives in the gastrointestinal tract of most adults and children as one of the microbes that helps to break down undigested food. It is only a problem when it grows out of control. This picture below is actually of a young child who had Candidiasis after taking a round of antibiotics, and while not an infant with oral thrush, I think it gives a really nice image of what happens when Candida grows out of control.

A Child with Oral Candidiasis (Photo Credit: Wikimedia Commons, Doc James, 2010)

A Child with Oral Candidiasis (Photo Credit: Wikimedia Commons, Doc James, 2010)

Oral thrush typically presents itself in the fourth week of a baby’s life. It is very rare in the first week of life and after 6-9 months of age. As many as 39% of infants will develop thrush in the first few months of life.

Nipple Thrush in Nursing Mothers

Because breastfeeding provides a warm, moist, sugary environment, which is precisely where Candida thrives, babies can easily pass their oral thrush to the mother’s nipples, especially if they are already cracked or sore because of a bad latch. If the thrush isn’t treated, it can pass back and forth between mother and baby.

Causes of Oral Thrush

  1. Yeast Infection During Vaginal Birth: New babies are born with a clean gastrointestinal tract void of any microbes whatsoever. Within hours of birth, however, they start to build their own gut flora through exposure to the mother’s vaginal and fecal flora during a vaginal birth, breastfeeding, and exposure to the environment. If the mother has a yeast infection during a vaginal birth, however, the yeast will be one of the first microbes entering a baby’s clean and pristine gastrointestinal tract.
  2. C-Section Birth: If a mother delivers her baby by c-section (as one-third of mothers in the U.S. do), the baby will not getting any of her vaginal or fecal flora, which helps to populate the baby’s gut with healthy microbes. This new study shows how the baby’s gut flora can be disturbed for up to 6 months after a c-section birth, and this study shows how a c-section delivery leads to more pathogenic microbes (including Escherichia coli and Clostridium difficile) populating the baby’s gut. When the good microbes aren’t there first, it makes it very easy for the bad ones to take over.
  3. Antibiotics: If a mother tests positive for group B strep (which affects 25% of women), she will be given antibiotics during labor that will cross the placenta and reach the baby. Routine antibiotics are also given after a c-section (and sometimes before) to ward off infection. Antibiotics wipe out all bacteria good and bad, and when a newborn baby is having something introduced to its system that wipes out all of the bacteria before there is any, it makes it easier for something like Candida to take hold and grow out of control.
  4. Steroid Use: If a baby needed a nebulizer and inhaled corticosteroids for say, a bad case of croup, any steroids that get in the mouth can lead to oral thrush.

Signs of Oral Thrush

  1. White Patches in Baby’s Mouth: It might look like little milk spots in your baby’s mouth, but unlike milk spots, they won’t go away on their own. If you tried to scrape them off, you’ll notice that it’s actually an inflamed lesion that may bleed.
  2. Refusing to Nurse: Your baby may refuse nursing or be reluctant to nurse because its painful.
  3. Fussy Baby: Your baby may seem particularly fussy or up a lot in the night.
  4. Yeasty Diaper Rash: Sometimes a yeasty diaper rash will accompany oral thrush. Look for a diaper rash that’s red and inflamed with small blistery lesions that won’t go away with typical diaper rash treatments. I battled this with my son on and off for months. We tried the pharmacist’s recommended “magic butt paste” (which is just regular diaper rash cream mixed with Monistat) which kind of worked, but once we gave him some probiotics, the rash immediately went away and never came back again.

Signs of Thrush in Momma

  1. Painful Nursing: Nursing should not be painful. If it is, it might be a sign of thrush, especially if you’ve ruled out a bad latch. I remember Nursing Ophelia (who was two weeks old at the time) in front of my sister (who was pregnant for the first time) and she looked at me in shock and horror as I all but howled in pain as Ophelia latched on. The intense pain subsided after a bit and I just thought, well, this is part of nursing. But after I treated the thrush, the intense pain went away. (With her being my third baby, you’d think I would have known better, but I have had some sort of breastfeeding problems with all of my four children!)
  2. Shooting Pains: You may feel a deep shooting pain that occurs during or after feedings because the thrush can embed itself deep within your breast tissue.
  3. Cracked Nipples: Your nipples may also be pink or red, shiny, flaky, and/or have a rash with tiny blisters.
  4. Yeast Infection: If you have thrush, there’s a pretty good chance you’ve got a yeast infection too.

How to Cure Momma’s Thrush

  1. Limit Sugar: Thrush is caused by Candida and Candida feeds on sugar. You don’t have to give up sugar forever, but if you can get limit Candida’s food source while treating thrush (especially in the form of pure sugar and processed foods), it will be much easier to get rid of.
  2. Probiotics: Probiotics, such as lactobacillus, feed on sugar too (and prebiotics, which can be found in such foods as raw onion, garlic, and asparagus…or as a supplement), and unless they are wiped out by antibiotics or a poor diet, they will keep the Candida in check. You can get them from fermented foods such as kombucha, sauerkraut, sourdough, kimchi, keifer, and yogurt. When battling thrush, however, I suggest getting them in a stronger format as well. My favorite probiotics for treating Candida are Bio Kult Candea and Custom Probiotics.
  3. Apple Cider Vinegar: Apple cider vinegar is an anti-bacterial, anti-fungal, and anti-viral miracle worker. I tried every remedy under the sun, but when I used apple cider vinegar, I was finally able to eliminate the thrush. This is what I did.
    • First, mix a solution in a peri bottle with about 2 T. of apple cider vinegar and the rest filtered water (chlorine free).
    • Then, after every breastfeeding session, squirt some onto some cotton balls and wipe your nipples, then throw those cotton balls away!
    • *If you’re pumping and/or using bottles, you have to really sterilize these components after every use. You can use apple cider vinegar, but really hot water will do the trick too.
    • In addition, wash all of your bras and anything your nipples come in contact with hot water and with apple cider vinegar added to the rinse cycle.
    • You can also mix 6 T. per gallon of water (or about 1 t. per 8 ounces) and drink throughout the day to heal from the inside out.
  4. Coconut Oil: Coconut oil is a soothing anti-fungal topical treatment. After I cleaned my nipples with apple cider vinegar, it felt really soothing and healing to dab a little coconut oil on them. You can also heal yourself from Candida from the inside out by eating it.
  5. Fresh Air: Candida can survive in oxygen, but it really thrives in dark, oxygen free areas. Going shirtless will not only feel good, but your husband/partner might get a kick out of it too! Get some sunlight on those nipples for extra measure because that also kills the fungus.
  6. *Gentian Violet: They say you can paint your nipples with Gentian Violet to get rid of thrush, but when I tried it, it caused Ophelia to go on a complete nursing strike. It was awful. I do not recommend using this on your nipples unless perhaps you plan to pump and bottle feed.
  7. *Grapefruit Seed Extract: I’ve read that you can mix Grapefruit Seed Extract with equal parts water and clean your nipples with it, much the same way that I did with the apple cider vinegar. I did not try this method, but it seems like it might work. (Read more here.)

How to Cure Baby’s Thrush

  1. Coconut Oil: If you leave some coconut oil on your nipples, your baby can get some that way. You can also dab a little coconut oil on the thrush spots.
  2. Infant Probiotic: I really like this infant probiotic. If you had to have antibiotics for any reason or delivered by c-section so your baby didn’t get any good bacteria from your vaginal tract, I would highly recommend a good probiotic supplement regardless of whether or not your baby has thrush. But if your baby does have thrush (obviously, because that’s why you’re probably reading this) this will really help your baby to populate his or her gut with beneficial bacteria that can crowd out the yeast and help to get rid of the oral thrush. You can mix a little bit with your breast milk and feed it to your baby with a dropper, and/or you can make a little mixture and paint it on the thrush spots with your finger or a q-tip.
  3. Gentian Violet: Gentian violet is an anti-fungal that can be used topically to help get rid of thrush. When Ophelia’s thrush progressed from a few white spots to her entire tongue being coated white (after I misused Grapefruit Seed Extract), I turned to Gentian Violet as a last resort. It tastes awful, it can cause your baby to have an upset tummy, and it shouldn’t be used excessively because there are claims that it can be a carcinogen (when used regularly for two years at 600 times the recommended dose…sorry mice) and lead to mouth ulcers (when not diluted), but after three days of meticulous treatment, Ophelia’s thrush was totally and completely healed. I highly recommend this as a cure for baby’s oral thrush. Here’s are a few tips for using it so that it will be effective:
    Treating Ophelia's Thrush with Gentian Violet

    Treating Ophelia’s Thrush with Gentian Violet

    • Gentian violet will stain everything purple, so put some Vaseline or Bag Balm on your baby’s lips and around her or his mouth before applying it. This will make it easier to clean up the purple drool.
    • Dress your baby in clothes that you don’t mind ruining. (This goes for you too.) I found it helpful to put a bib on Ophelia as well.
    • Get the 1% solution, and mix with equal parts water. (It is too strong if left undiluted. Don’t be fooled into thinking that it will be more effective if you don’t dilute it.)
    • Using a q-tip, paint every part of your baby’s mouth, especially the tongue. This stuff tastes awful and your baby will hate it. I found it best to paint once in the morning, maybe once in the afternoon if it wore off, and once at night. (Don’t exceed three dosages in a day.)
    • Do your best to make sure your baby doesn’t swallow any. It can lead to an upset tummy.
    • You need to do this for three full days/nights. If you miss a dosage and don’t complete the cycle, the fungus will come back stronger and be even harder to treat.
  4. *Grapefruit Seed Extract: I read a lot of articles, reviews, and blogs about Gentian Violet and grapefruit seed extract when Ophelia had thrush, and I decided to go with the grapefruit seed extract first, but it did not go so well. First of all, I made the mistake of not diluting it, so maybe it would actually work if you didn’t do this. (It should be more effective if it’s stronger, right? Not.) I painted it on the thrush spots in her mouth, and they seemed to completely go away in a day, but then the next day, there were more and more and more spots until her entire tongue was coated white. It was like in the absence of the Grapefruit Seed Extract, the fungus grew even stronger and completely took over. It was at this point that I turned to the Gentian Violet which totally worked.
  5. Nystatin: Nystatin is what your doctor will probably prescribe if you take your baby to the doctor to treat the oral thrush (which I don’t recommend unless this is your last resort). Nystatin is an oral medication that is meant to be used topically on the areas where thrush is appearing. There are claims that it’s 80% effective, but that seems a bit high to me. When Ophelia got thrush, I combed threads on the Internet (not always the most reliable sources, I know, but I like reading about personal accounts) and read time and time and time again about how mothers would go to the doctor, get Nystatin for their babies, deal with the side effects of: mouth irritation, diarrhea, nausea, vomiting, stomach upset, rash, skin irritation, and/or allergic reactions, have the first dose not work, try another dose, still not have it work, and eventually give up on breastfeeding. I actually knew someone who got thrush at the same time as I did with her new baby and she used Nystatin as a remedy. It did not work, and she ended up not being able to breastfeed anymore. Personally, I would try all of these other remedies before turning to Nystatin as an absolute last resort.

In Conclusion

Dealing with oral thrush was probably one of the toughest postpartum things I’ve ever had to deal with, and through much trial and error, I’m glad we were able to finally beat it. With baby number four, I made darn sure to get rid of my yeast infection during pregnancy so that we would not have to deal with this again, and let me tell you, prevention is a much easier path! I also enjoyed researching and learning about why pregnant women are more prone to yeast infections, and I learned some fascinating information along the way. The bottom line is that thrush is nasty nasty business and it is worth all of the effort to prevent it and get rid of not just the symptoms, but the root cause as well.