Mouth thrush

What does mouth thrush look like?

Babies with mouth thrush have lacy white patches on the insides of their cheeks or lips. The infection may also appear on the tongue as flat white patches that reach the sides and the tip. Most babies have a furry white patch in the middle of the tongue, which should not be confused with thrush. In a healthy tongue, the white patch has little pink bumps amid the fur and the rest of the tongue is pink and not red. Most babies don’t seem bothered by thrush and continue behaving normally. Thrush should be treated with antifungal medication.

A) Describing mouth thrush

Thrush of the lips and tongue.

Some babies develop a yeast (Candida) infection in their mouth (Shirazi 2019). This is commonly called thrush. It has been reported in 1% to 37% of otherwise healthy babies (Goins 2002).

Unlike adults who find thrush painful, most babies don’t seem bothered by thrush and continue behaving and feeding normally. Without treatment, it can become more severe and more likely to be painful. If the baby is breastfeeding, thrush can increase the chances of the mother getting a nipple yeast infection and needs to be treated with antifungal medication.

B) Signs of thrush

Classic lacy white appearance of early thrush on the inside of the lower lip.

Babies with thrush have lacy white patches on the insides of the cheeks or lips. If you suspect thrush, this is the first place to look. It is rare to see thrush on the tongue without it also being on the inside of the cheeks and lips.

Breast milk and infant formula may also create white patches on the insides of the cheeks and lips, but these can be easily wiped off by gently stroking the area with a clean finger or cloth. Thrush cannot.

Some mothers will scrape their baby’s mouth to test for thrush. This is not helpful or appropriate.

Babies with thrush may also have a yeast diaper rash.

C) Changes in the tongue

Extensive thrush on the insides of the lips and cheeks and on the tongue.

Severe thrush can also involve the tongue and cause a typical change in its appearance.

Nearly all babies have a white, furry patch in the middle of the tongue. This is normal but is sometimes confused with thrush, resulting in unnecessary treatment of the baby. The table below describes how to tell the two apart.

Table: Comparing a Normal Tongue With a Thrush-Infected Tongue

Please see your health-care providers if you think your baby has thrush.

D) Other signs that can be mistaken for thrush

The following are NOT signs of thrush:

  • White pimple-like bumps on the gums
  • White pimple-like bumps on the roof of the mouth
  • Areas on the roof of the mouth (hard palate) that are slightly paler or whiter than the rest.

References

Goins RA, Ascher D, Waecker N, et al. Comparison of fluconazole and nystatin oral suspensions for treatment of oral candidiasis in infants. Pediatr Infect Dis J. 2002 Dec;21(12):1165-7

Shirazi JH, Ali MI, Akhtar Z, et al. Pediatric oropharyngeal candidiasis: A comprehensive study on risk factors and most prevalent species of Candida. Pak J Pharm Sci. 2019 Nov;32(6(Supplementary)):2873-2878