Thrush in Babies: How It Differs from Milk Residue and What to Do

When you see white patches inside your baby's mouth, the first question that comes to mind is probably: Is this milk, or is something wrong? Thrush (oral yeast infection) is common in babies and, according to the NHS, usually harmless. This guide is based on recommendations from the NHS and the American Academy of Pediatrics (AAP).

What is thrush? According to the NHS, thrush is an infection caused by a yeast called Candida. The AAP notes that newborns can be exposed to this yeast during birth, and that antibiotic use can also make it easier for the yeast to grow. This does not mean anything was missing in your baby's care.

Symptoms: According to the NHS and the AAP, watch for:

• A white coating on the tongue that looks like cottage cheese
• Creamy or white patches on the gums, the roof of the mouth and the inside of the lips and cheeks
• Fussy sucking or not wanting to feed
• In some babies, a diaper rash that will not go away

According to the AAP, most babies feel only mild discomfort or have no symptoms at all.

How can you tell it from milk residue? According to the AAP, a white-looking tongue is common in milk-fed babies; if there are no other signs and only the tongue is white, it is not thrush. Thrush patches, however, stick to the mouth and do not wash or wipe away easily like milk residue. The NHS also says these patches do not come off when gently wiped with a clean cloth. If the white is not only on the tongue but also inside the lips and cheeks, talk to your doctor.

Nipple thrush in breastfeeding moms: According to the NHS, if you are breastfeeding, you and your baby can pass this yeast back and forth to each other. See your doctor as soon as possible if you have these symptoms:

• Burning nipple pain, especially after each feed
• Itchy nipples that are tender to the touch
• Flaky or shiny-looking skin on the nipple or areola
• White patches or small blisters on the nipple
• Loss of color on the nipple or areola

The NHS reminds moms that nipple pain is not always caused by thrush and that a baby not latching on properly can also be a cause.

Can you keep breastfeeding? According to the NHS, yes, keep breastfeeding if you can. If it hurts a lot, you can try expressing your milk. The NHS notes that there is currently no evidence that milk expressed and stored during an infection reinfects the baby.

See a doctor or pharmacist for treatment: According to the NHS, thrush can be treated with an oral gel available from a pharmacy, but this gel is suitable for babies older than 4 months. So always choose the medicine with advice from your pharmacist or doctor, and do not use medicine on your own. Babies younger than 4 months need to be seen by a doctor. The NHS says treatment is important, because otherwise the thrush may come back. Your doctor may take a sample from both your nipple and your baby's mouth. According to the AAP, with treatment, thrush usually clears up in 4-5 days.

Pacifier and bottle hygiene: The NHS recommends sterilizing pacifiers regularly and bottles after every use. According to the AAP, thrush is often linked to prolonged sucking: sucking on a pacifier or bottle for a long time irritates the inside of the mouth and makes it easier for the yeast to grow. During this time, limiting the pacifier to the moments your baby really needs it and not putting your baby to sleep with a bottle may help.

To prevent it from spreading: The NHS's suggestions for the household:

• Wash your hands well, especially after diaper changes.
• Wash and sterilize pacifiers, bottle nipples and toys your baby puts in their mouth.
• Change breast pads often.
• Wash towels, baby clothes and bras at a high temperature.

When to see a doctor, when to go to the emergency room? See your doctor if:

• Your baby is younger than 4 months and has signs of thrush (NHS)
• You think your baby has thrush; the NHS recommends getting an appointment with your family doctor as soon as possible for breastfed babies, and the AAP says prescription medicine may be needed
• There is bleeding in the mouth, a fever or your baby is drinking less; the AAP recommends contacting a doctor within 24 hours
• It is not getting better or is getting worse despite treatment
• Thrush keeps coming back or appears in a child older than 2-3 years; the AAP notes that this can sometimes be a sign of an immune system problem or diabetes
• You have signs of nipple thrush (NHS)

According to the AAP, go to a health care facility right away without waiting if:

• There are signs of dehydration: no urine for more than 8 hours, dark urine, a very dry mouth, no tears when crying
• Your baby is younger than 1 month and does not seem like their usual self
• Your baby looks or acts very sick

Dear mom, thrush is annoying but usually easy to treat. With a little hygiene, the right treatment and some patience, your baby will soon be feeding comfortably again. Don't ignore your own pain either; you both deserve care.