Infant Oral Thrush: Symptoms, Treatment & Prevention

Oral thrush is a common Candida albicans infection in infants, caused by overgrowth of this commensal yeast.

Symptoms

• White, adherent plaques on tongue, buccal mucosa, palate (cannot be wiped off easily).
• Fussiness, feeding difficulty, clicking during nursing.
• Concurrent diaper dermatitis (satellite lesions).
• Maternal nipple pain, shiny/flaky areola (nipple thrush).

Diagnosis

Clinical (KOH prep or culture if atypical).

Treatment

• Infant: Nystatin suspension 100,000 U/mL, 1–2 mL QID × 10–14 days (apply after feeds).
• Mother (if breastfeeding): Topical nystatin or clotrimazole to nipples × same duration.
• Resistant cases: Fluconazole 3–6 mg/kg/day PO × 7–14 days.

Prevention

• Sterilize pacifiers, bottle nipples, pump parts (boil 5 min or steam).
• Wash hands before handling infant/milk.
• Treat maternal vaginal yeast in late pregnancy.
• Avoid unnecessary antibiotics (disrupt microbiome).

When to Escalate

• No improvement in 7 days.
• Spread to esophagus (dysphagia, weight loss).
• Immunocompromised infant.
• Recurrent (>3 episodes) → evaluate for immunodeficiency.

Thrush is benign in healthy infants but uncomfortable. Consistent treatment of both dyad members prevents ping-pong reinfection.