My Baby’s Thrush Won’t Go Away

Dear Mamas,

I have twin boys who will be a year old next week. One of them has had thrush for almost 2 weeks now. He has 2 little spots left on the center back of his tongue and I can’t seem to get rid of them. We are on a refill of nystatin and the spots seem to be where the medicine won’t stay. Is there anything else I can do to get rid of it? Thankfully, his brother hasn’t shown any signs of catching it.

Dear Randi,

Thrush is a common infection that’s caused by candida, or yeast. Babies’ mouths are the perfect petri dish for yeast, because those little suckers thrive in wet, dark, milky places. They congregate and form those little white patches on the cheeks and tongue that can’t be wiped away.

Thrush can be stubborn, as you know since you’re on your second go around with Nystatin — the most common treatment. For those other moms reading this, Nystatin is a prescription liquid that needs to be squirted onto the cheeks and tongue 4x a day.

When Nystatin isn’t quite doing it, there are some other things to try. First, try applying the Nystatin directly to the stubborn places with a Q-tip or gauze. Don’t attempt to ‘scrub’ the spot — it won’t work and may make the area bleed.

If that doesn’t work, try asking your pedi for a prescription for fluconazole (Diflucan).  It’s a second line treatment that’s more expensive than Nystatin, but it’s only given once a day and can be more effective.

Another alternative is gentian violet, an older tried-and-true remedy that doesn’t require a prescription, you can just ask your pharmacist for it.  It’s a bright purple liquid that’s applied directly to the patches. The downside is that it looks awful and stains everything in sight, including lips and clothing.  But it works.

Some other things you need to know about thrush:

  • Breastfeeding mothers can carry thrush on their breasts and nipples.  If your baby has thrush, you probably have it too, so ask your doctor for tips on how best to treat it. I recommend applying Nystatin directly and keeping nipples clean and dry after each feeding.
  • If your baby is getting thrush over and over, he may be over-using pacifiers or other comfort items that are irritating the inside of the mouth and making it more yeast-friendly.
  • Sterilize or replace pacifiers and rubber nipples often to make sure you’re not reintroducing yeast.
  • Some medications can make your child prone to thrush, like antibiotics and steroids.  Thrush in older children can be a sign of an underlying illness.

Hope this helps!

~ The Mamas

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Rachel Zahn, MD is a pediatrician turned health writer who had three kids during medical school and pediatric training—crazy, huh?

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