White tongues and bumps in the baby's mouth

What is this white area in my baby’s mouth?

A baby’s central tongue may look white. This is most likely normal and no cause for concern. The top of the tongue is covered with tiny bumps, which make the tongue feel rough. Some of these bumps are covered in soft spikes that gives the tongue its white colour and furry appearance. Some parents think the furriness is a sign of an infection called thrush, but thrush rarely affects only the tongue. When it does, the tongue has a very different appearance. Thrush usually starts on the inside of the lips and cheeks and leaves a distinctive lacy white coating in these areas. Babies may also have several small white bumps on the roof of the mouth or on the gums. These are not thrush and they don’t need treatment. They disappear in the first months after birth. The roof of the baby's mouth is pale and again, this is not thrush.

A) White tongues

A normal baby's tongue.

1) Normal tongues

The central part of the top of the tongue is covered with bumps called papillae. Some of these bumps have spikes that are covered in a protein called keratin. The keratin gives the tongue its white colour and furry appearance. Others are pink, round bumps. 

Some babies have more “fur” and others have less. The amount can increase or decrease as the baby grows. It should be left alone. 

The white appearance is not caused by milk. It cannot be washed off. Again, it should be left alone.

2) Concerns that white tongues are caused by thrush

Parents often worry that a furry tongue is a sign of thrush, a yeast infection, and may be the cause of nipple pain. The fur can look quite thick, but that doesn’t mean the baby has thrush. It is normal and doesn’t need treatment.  

Thrush rarely infects only the tongue. It usually starts on the inside of the lips and cheeks and has a distinctive appearance if it does spread to the tongue.

Some mothers try to scrape off the fur to see whether it is thrush. This is not an accurate test. Rather thrush is easily diagnosed by its appearance and location. 

B) White bumps in the baby’s mouth

Babies often have small, white or yellow bumps in the middle of the roof of the mouth (palate) or on the gums. They are about one to three millimetres (1/32 to 1/8 inches) wide. These are cysts (fluid-filled bumps) that disappear during the first months of life. These bumps can be divided into two groups, based on their makeup: Epstein’s pearls and Bohn’s nodules.

These bumps don’t need treatment and should be left alone.

They are not teeth. Teeth are easily felt; they are very hard and sharp whereas these cysts feel rubbery. Furthermore, while it is possible for a baby to be born with one or more teeth, it is uncommon. The first teeth will generally only come in after 8 months of age.

These bumps are also sometimes misdiagnosed as thrush.

C) Pale area on the roof of the mouth

Normal babies have a white or pale area on the roof of the mouth. This too is not thrush.