So your baby is fussy and has white spots on the tongue? It could be thrush, a fungal infection common in infants.

This yeast infection is usually no big deal, but it’s no fun either – for you or your baby. Thrush will require a professional diagnosis and a trip to the pharmacy to get some antifungal medicine. Read on for symptoms, causes and treatment.

What is thrush and what does it look like?

Thrush is a type of fungal infection that most often occurs in infants and babies. Also known as a Candida infection, it is most likely to occur in the mouth.

You will notice white or yellowish patches on the baby’s tongue, gums and inner lips. Although you won’t be able to see it, the infection can also spread down the throat and into the esophagus.

Thrush can also affect the baby’s genitals, appearing around the vulva or groin.

What causes thrush in babies?

Yeast is present in everyone’s mouth, digestive system and vagina – it’s perfectly natural. But infection occurs when there is an imbalance between the yeast and the area in which it lives.

There are several ways that babies can get oral thrush.

• If you give birth vaginally and happen to have a yeast infection at the time, your baby may come into contact with the infection during its journey through the birth canal.
• Babies can also get thrush from your nipples if you have an infection while breastfeeding.
• Antibiotics can also cause thrush because while they fight the “bad” bacteria in your baby’s system, they also kill the “good” bacteria that normally keep the yeast in balance.

Babies can also get diaper rash when their diaper area is too hot and wet, when their clothes are too tight, or if they don’t change diapers often enough.

Is thrush contagious?

In short, yes. Some moms and babies pass the infection back and forth: Your baby can spread thrush to you if you breastfeed, resulting in a painful yeast infection on your nipples that will require treatment.

You can also give your baby thrush if you breastfeed and develop a yeast infection on your nipples.

On the other hand, it is possible to remain symptom-free, even if you are breastfeeding a baby who has thrush. Similarly, your breastfed baby may not be affected by a yeast infection.

What are the symptoms of thrush?

If you only notice a white coating on your baby’s tongue, it’s probably just leftover milk (especially if you can wipe it off easily). But call your baby’s doctor if you see any of the following signs:

• White or yellow spots on the baby’s lips, tongue, roof of the mouth or inside the cheeks, gums or throat. Thrush stains look like cottage cheese and do not wash off easily.
• Crying while breastfeeding or sucking on a pacifier or bottle. Thrush can be painful and make feeding uncomfortable if the infection is severe. (Note: Some babies with thrush experience no pain or discomfort and can feed normally.)
• Some babies with thrush also develop a diaper rash – a raised, blotchy or bright or dark red rash with clearly defined borders. Small red spots often appear around the edges of the main rash. The affected area is red and may be tender or painful, and the rash may creep into the folds of skin around your baby’s genitals and legs. It almost never appears on the butt.

How to treat thrush

If your baby’s doctor diagnoses thrush, he or she may prescribe oral antifungal medications (often nystatin) and recommend giving your baby acetaminophen for pain. It may take about two weeks for the infection to clear.

“Your doctor will probably instruct you to use an antifungal medicine for a few days after the white spots have disappeared, just to make sure that any remaining yeast is completely eliminated,” says Liz Donner, MD. MD, Pediatric Hospital and member of the BabyCenter Medical Advisory Board.

For diaper rash, your doctor may also prescribe nystatin ointment to use in the diaper area.

If you’re breastfeeding a baby with thrush, many providers recommend applying nystatin or clotrimazole to your nipples so you and your baby don’t pass the infection back and forth.

Check with your doctor if the infection still doesn’t seem to clear up – it’s not uncommon for thrush to recur.

Home remedies for thrush

If you want to try an alternative therapy, ask your baby’s doctor about gentian violet.

Gentian violet is a dye that can also be an effective antifungal treatment, but if used for too long or in too high a concentration, it can cause sores in your baby’s mouth. It will also stain anything it comes in contact with. Be sure to talk to your child’s provider before using it.

If you want to try gentian violet and your health care provider is okay with it, you can ask your local pharmacist to prepare a gentian violet solution for you or prepare it yourself at home.

Can you prevent thrush?

Not always. Some people are naturally more prone to yeast infections, but you can take the following steps to reduce your baby’s chances of getting thrush. (These measures can also help you avoid re-infection if you and your baby are being treated for thrush.)

• Do not give your baby antibiotics unless absolutely necessary. (Antibiotics do not help against viral infections.) Thrush is often caused by taking antibiotics.
• Clean and sterilize pacifiers after each use and disinfect any toys that go into your baby’s mouth.
• Allow nipples to dry between feedings.
• If you’re bottle-feeding, thoroughly clean all equipment—including nipples—after each use by washing it in warm, soapy water or running it through the dishwasher.
• Wash your hands often, especially after feeding and changing diapers.
• Change your baby’s diapers often.

Can thrush be harmful to your baby?

Most cases of thrush are not harmful and will not have long-term effects on your baby, but they can be uncomfortable. If your baby is fussier than usual, thrush could interfere with feeding. It can be very distressing (for both of you) when a hungry baby finds it painful to eat.

Give your baby all the comfort she needs and follow your doctor’s instructions for pain relief and medication. And remember that this infection too will pass.