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Thrush

thrush; candida; ;

Thrush is a common infection in the mouth of babies, on rashes (especially nappy rashes and rashes in moist places such as under the chin of a dribbling baby), on the nipples of breast feeding mothers and in the vagina of women. It can be very irritating but it is treatable.

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What is thrush?

  • Thrush is caused by a yeast (a very small living cell) called candida.
  • Most people have candida on their skin, in their mouths, in the genital region and in their gut most of the time without having any problems from it.
  • Sometimes the candida can start growing fast and can cause an infection (thrush).
  • Babies and young children can get thrush in the mouth and on the skin (usually on top of a nappy rash or other rash).
  • Breastfeeding mothers can get thrush on their nipples, causing pain when feeding.
  • Women can get thrush in the vagina, with itchiness and a discharge. (This happens most often in women who are sexually active, but it can also happen without sexual activity).

Thrush in the mouth (oral thrush)

  • Babies get candida in and on their bodies at birth or soon after.
  • Many babies get thrush in the mouth in the first few weeks or months of life.
  • There is no clear reason why for some babies the candida, which is normally in their mouth without causing problems, becomes thrush.
  • The first sign may be that the baby is unsettled, especially when feeding (his mouth is sore). However, many babies are not bothered by thrush.
  • Thrush shows as white patches on the roof of the mouth, inside the cheeks and on the tongue. There may be redness around the patches, and they might look like ulcers. Unlike bits of milk, the patches do not wash or rub off easily.
  • Sometimes the baby will have a nappy rash which may also have thrush in it.
  • If an older child or adult gets thrush in the mouth, or ulcers that look like they may be thrush, it may be a sign of another disease, so get your doctor to check.

Treating thrush in the mouth

  • If you think your child may have thrush in the mouth, you will need to go to a doctor or child health nurse to be sure, and to get advice about treatment.
  • The treatment may be drops or a gel which needs to be spread around the inside of the mouth, not just put on the tongue. The drops should be used for babies under 6 months as the gel has caused some young babies to choke.
  • You will need to treat the baby's mouth 3 or 4 times a day for a few days.
  • If the baby is breastfeeding, the mother's nipples may need to be treated at the same time as the baby to prevent the infection passing back and forth.

Protecting babies from thrush

  • As almost everyone, including babies, has candida in and on their bodies, you can't really protect a baby from thrush.
  • If a parent has a thrush infection, it is worth treating it well to try to prevent an overgrowth in the baby. 
  • Good hygiene (including washing hands well) is important.
    • If bottle feeding, clean and sterilise teats and dummies (or replace them) to help prevent re-infection.
    • It is wise not to allow anybody to wet the baby's dummy in their own mouth.
  • Babies and children with thrush do not need to be excluded from child care, but careful hand-washing and cleaning must be done at all times, not only when a baby has an obvious infection.

Skin rashes and thrush

  • Sometimes thrush can develop on a nappy rash or on rashes on other parts of a child's body (for example under the chin).
  • The rash may be red with small red spots near the edge. A skin rash with thrush does not have white spots like thrush in the mouth.
  • A nappy rash with thrush may not clear up with the usual nappy rash treatments.
  • Any nappy rash that is not clearing after 3 days, or not responding to your usual cream, may have thrush in it that needs treating.

Treating thrush on a skin rash

  • You will need to see your doctor or pharmacist (chemist) to get a special cream for the rash, and sometimes they will suggest that you also use a treatment that needs to be taken by mouth to reduce the amount of candida in the gut. (Make sure that you use creams, not gels, on the rash. Gels will sting.)
  • At the same time you will need to do the usual treatments for nappy rash (see the topic 'Nappy rash' for more information).
  • Rashes under the chin and moist rashes in other areas often respond to the same treatment as nappy rashes, but get them seen by a doctor as well.

Thrush on nipples

  • Breastfeeding mothers may get thrush on the nipples, especially if the nipple is cracked or the baby has thrush in the mouth.
  • Thrush can stop a cracked nipple from healing.
  • Sometimes thrush can be on the surface of the nipple even when the nipple is not cracked. Thrush might cause reddening, tenderness and moistness of the nipple and areola (dark area around the nipple).
  • Thrush may cause shooting pains when feeding and pain in the breast after feeds. Research has not clearly shown that thrush is the cause of these pains.
  • If you are having pain when feeding or you have a cracked nipple that is slow to heal, talk to your doctor or breastfeeding adviser.
  • If you need treatment, your doctor will usually give you treatment for the baby as well.

See 'Breastfeeding - sore breasts and nipples' for more information. 

Vaginal thrush

  • Thrush in the vagina can cause severe itching, a discharge which is usually white and 'cottage cream' like, and sometimes pain when passing urine (wee).
  • It is more common among women who are sexually active, but it often occurs among women who are not sexually active. The candida which causes it usually lives on the lining of her vagina most of the time, or comes from her skin or gut.
  • For some reason the candida starts growing more rapidly and causing an infection.
  • Many things seem to trigger thrush, such as being ill, using some antibiotics, some types of the 'pill', and rubbing of the lining of the vagina during sex.
  • Thrush that keeps coming back may be a sign of diabetes, but more often women who get lots of episodes of thrush do not have other health problems.
  • Some women seem to get it often while others get it rarely even when they have the same 'triggers'.

Treating vaginal thrush

  • It is important to have an examination by a doctor, as other things can cause the same symptoms.
  • Treatment can be a cream or pessary (dissolving tablet) which is placed in the vagina daily for up to a week.
  • There are also oral tablets that can be taken.
  • Some people find that avoiding tight pants or synthetic underwear or tights which keep the area moist, can help.
  • Perfumed sprays or other 'feminine hygiene' products (such as douches) on the genital area can also irritate the skin and keep the thrush going.
  • Some practitioners suggest that yoghurt placed into the vagina can help get rid of thrush (use plain yoghurt).

Sexual partners

  • If the thrush comes back, it may be of use to treat sexual partners, but this has not been proven to be effective. Thrush is usually caused by candida living on the skin and in the vagina rather than coming from a sexual partner.

Resources and references

SA Health - Department of Health (South Australia) 
http://www.sahealth.sa.gov.au/  

Raising Children Network   Raising Children website is produced with the help of an extensive network including the Australian Government.
http://raisingchildren.net.au/ 

Pregnancy, birth and baby  Pregnancy, Birth and Baby is a national Australian Government service providing support and information for expecting parents and parents of children, from birth to 5 years of age.
http://www.pregnancybirthbaby.org.au/  

Better Health Channel 
http://www.betterhealth.vic.gov.au/ 

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The information on this site should not be used as an alternative to professional care. If you have a particular problem, see a doctor, or ring the Parent Helpline on 1300 364 100 (local call cost from anywhere in South Australia).

This topic may use 'he' and 'she' in turn - please change to suit your child's sex.

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