Shaken Baby Syndrome

A large number of child deaths are reported in South Africa each year. A lot of deaths relate to neglect, abuse or murder. Despite this, there's a knowledge gap in relation to understanding the issue....

Amniotic fluid problems

The importance of amniotic fluid Amniotic fluid is essential for pregnancy and foetal development. Amniotic fluid is a watery substances residing inside a casing called the amniotic membrane or sac. ...

Choosing a pre-school

Becoming a parent is a momentous; life-changing event filled with hopes, expectations and naturally some fears. Parents often learn and grow alongside their children, as they face the challenges of pa...

Newborn reflexes

Although newborn babies are physically helpless and vulnerable at birth, they have a number of amazing innate abilities or reflexes. Reflexes are involuntary movements or actions, designed to protect ...

Mastitis

Mastitis is an inflammation of the breast that can lead to infection. The word “mastitis” is derived from the Greek word “mastos” meaning “breasts”, while the suffix “-itis” denotes “inflammation”. Ma...

Pelvic floor exercises

Although your new baby will probably bring you immense emotional satisfaction, physically you may feel uncomfortable and strange in your own skin. After 9 months of pregnancy and hormonal changes, you...

Colic

Babies cry because they need to communicate something and most parents, especially new moms, find it distressing to see or hear an unhappy baby. In time, you will learn to recognize the various causes...

Antenatal Classes

Antenatal classes are informative sessions provided to prepare expecting parents for the birth of their child and the early days of being a parent.Most antenatal classes are run by Midwives and occasi...

Strap-in-the-Future

The Decade of Action for Road Safety 2011-2020 was launched on the 11 May 2011. It is a global declaration of war against road crashes and fatalities. According to Mr Sibusiso Ndebele, MP Minister of ...

  • Shaken Baby Syndrome

    Tuesday, 21 July 2015 16:28
  • Amniotic fluid problems

    Thursday, 14 May 2015 12:54
  • Choosing a pre-school

    Friday, 10 April 2015 17:50
  • Newborn reflexes

    Tuesday, 03 March 2015 15:49
  • Mastitis

    Tuesday, 03 March 2015 15:41
  • Pelvic floor exercises

    Wednesday, 11 February 2015 17:20
  • Colic

    Wednesday, 11 February 2015 17:11
  • Antenatal Classes

    Monday, 03 June 2013 09:34
  • Strap-in-the-Future

    Thursday, 30 June 2011 13:52

Thrush

Thrush is a common ailment in infants and toddlers because their immune systems are still in the developing stages and do not have the capability of fighting off all infections. Thrush is caused by a type of yeast called Candida albicans. Oral thrush occurs in the mouth and throat; appearing as white, curd-like patches on the cheeks, tongue, gums and the roof of the mouth. Thrush can also be associated with a yeast infection of the oesophagus. This condition is known as Candida Esophagitus and may make it particularly difficult to chew and swallow, and increases the chances of malnutrition and further illness (About.com; Demand Media, 2010; MedicineNet, Inc., 2006-2011).

How do children get oral thrush?

Outbreaks of thrush in child care settings are often the result of the increasing use of antibiotics or steroids (such as cortisone related asthma medications), rather than due to newly acquired candida infections. These medications affect the balance of microbes in the mouth, causing an overgrow of candida (MedicineNet, Inc., 2006-2011).

Thrush in the diaper area

Thrush can affect an infants diaper area or worsen diaper rash. This is because yeast grows rapidly on irritated, moist skin. This type of yeast infection has a fiery red appearance, with a raised red border. Small red bumps  may appear near the edge of the rash (About.com; MedicineNet, Inc., 2006-2011).

Yeast infections in the genital area

Genital yeast infections are common, and can occur in both boys and girls. Boys with a penile yeast infection might have extreme redness, dryness or a painful rash on the genital area. In girls, symptoms might include itching, redness or burning in the vaginal area, and a white or yellow discharge (Demand Media, Inc., 2003-2011).

Pregnant women in particular, are prone to vaginal yeast infections, due to higher levels of estrogen during pregnancy. Estrogen causes the vagina to produce more glycogen, making it even easier for yeast to grow there. Vaginal yeast infections are also called, monilial vaginitis or vaginal candidias (BabyCentre, L.L.C., 1997-2011).

Thumb sucking

Children who suck their thumbs or other fingers, may develop candida around their fingernails. This produces redness around the nail bed (MedicineNet, Inc., 2006-2011).

Nursing

Mothers who breastfeed can develop a candida infection around their breasts and nipples, causing pain while breast-feeding. (MedicineNet, Inc., 2006-2011).

What causes thrush?

Candida is a naturally occurring fungus in the body, existing in small quantities in the mouth, digestive tract and skin. In most healthy people, candida is kept in balance by other bacteria and micro-organisms in the body. Some conditions such as certain illnesses, medications or stress, may disturb this balance, causing candida to grow out of control and produce thrush (About.com).

Who is at risk of developing thrush?

Certain medications, such as corticosteroids, antibiotics and birth control pills, may upset the balance of micro-organisms in the mouth and may cause thrush.

Individuals with uncontrolled diabetes, HIV infection, cancer, dry mouth and pregnant women (due to hormonal changes) have an increased risk of developing thrush.

Babies can pass the infection to their mothers during breastfeeding. Similarly, breastfed infants may contract the infection from their mothers during nursing.

  • Smokers and people who wear dentures that don't fit properly, have an increased risk of developing thrush.
  • Infants born to mothers who have a vaginal yeast infection at the time of delivery.
  • Infants born to a diabetic mother.
  • Infants born with an oral birth defect, such as a cleft lip or palate.
  • Autistic children almost always have a fungal overgrowth component.
  • Individuals who have had long term urinary catheters, intravenous catheters, or people who have had the prolonged use of intravenous drugs (Candidasupport.org, 2002-2011; Demand Media, 2010).

Signs and symptoms of oral thrush:

Sometimes milk residue is mistaken for thrush. If you wipe off the white patches and they come off easily- it is milk residue. If the patches are difficult to remove, or cause bleeding or inflammation- you are dealing with thrush.

  • When babies or toddlers have oral thrush, their mouths become very sore and tender. As a result nursing or eating may become highly uncomfortable for them.
  • You may notice that your infant or toddler is refusing to eat or they may nurse vigorously, stop, cry, and repeat the process again.
  • White or yellow spots in the mouth, especially on the tongue and on the insides of the cheeks.
  • Raised spots in the mouth.
  • A burning sensation in the throat.
  • Difficulty chewing and swallowing  (Womens-Health.co.uk; raising Children's Network, 2006-2011).

Diagnosis:

A diagnosis of thrush is generally made on the basis of symptoms and no other testing is usually required. A quick examination of the mouth and skin, usually confirms a diagnosis of Candidiasis. However, if your child is unusually fussy and is refusing to eat, your pediatrician may explore whether another condition in addition to thrush, is producing your child's symptoms. If there is any confusion regarding the diagnosis, your doctor may take a small scraoing from an affected area and place it under a slide with potassium hydroxide. The sample is then examined for a branching pattern consistent with yeast. Yeast cultures may also be taken from a sample of blood or other bodily fluids. Occasionally, if the infection persists or involves the entire body, more extensive tests will be performed. This may include a chest x-ray to look for signs of infection in the lungs (About.com; Dr. Stoppard, M., 2005; WedMD, LLC., 2005-2011).

Treatment and prevention:

Doctors commonly prescribe nystatin, an oral suspension, to treat thrush. Nystatin is an anti-fungal medication derived from soil-based bacteria and yeast. It is completely safe because it does not enter the blood stream. Nystatin is most effective when swiped around all infected areas and then swallowed. The medication is given 4x daily for approximately 7-10 days, and for at least 3 days after you no longer see signs of thrush. In infants under 30 days, the dosage is 0.5ml to each side of the child's mouth. For older infants and toddlers, 1ml should be applied to each side of their mouth. If the infection appears to be resistant to treatment, gently rub the medication directly onto white patches with a piece of gauze.

An alternative to nystatin is Fluconazole (Diflucan). It has the advantage of once a day dosing but it is more expensive and is generally used as a second option if Nystatin is ineffective.

A non-medical alternative is Gentian Violet. However, it is a less popular treatment because it is messy and can turn your baby's lips and clothing purple.

  • Rinse your child's mouth with boiled water, that has been cooled to a comfortable temperature, after they nurse or eat. This serves to clear anything that is left in their mouths and helps to prevent the spread of infection.
  • Don't share bottles, pacifiers or any other items that may pass the infection from mouth to mouth.
  • Wash bottles and any other toys or items, that your infant or child has put in their mouth during teething or playing, with boiling water.
  • If your baby has recurrent candida infections, be sure that they are not overusing a pacifier or bottle. This may cause the sides of their mouths to become overly moist and cracked, producing the perfect environment for thrush to flourish.
  • Encourage your child not to put their fingers in their mouth.
  • Add naturally unsweetened yoghurt, with live cultures to your child's diet, to help restore the balance of bacteria in their body.
  • Because thrush can be painful and make it difficult to eat, ensure that your child does not become dehydrated.
  • For diaper rash, ensure that your baby's nappy is changed frequently, keep the affected area clean and dry, and use barrier cream for a speedy recovery.
  • Mother's of breastfed infants should be treated with an anti-fungal cream, to prevent the infection from being passed back and forth between mother and child.
  • If your child suffers from recurrent yeast infections, certain dietary modifications may be suggested. This may involve the elimination of peanuts, peanut butter, maize, bananas and yeast products because these food products are universally contaminated with mould. Foods such as sugar, grains and dairy should be restricted, so that you don't continue to feed the yeast.
  • Give your child a probiotic supplement, such as colostrum. Probiotics help to build their immune systems and restore a balance between good and bad bacteria in their bodies. Probiotics; take up residence in the intestinal tract and help to defend the mucous linings in the body, kill yeast and bacteria, and aid the body in the defense of viral attack. For very young children, you can use colostrum powder.
  • You are less likely to develop a yeast infection in the genital area, if you keep this area dry and maintain a balance of vaginal flora.
  • Wear breathable cotton underwear and avoid tight pants or pantyhose.
  • Teach your child to remove a wet bathing suit immediately after swimming or to   change their underwear promptly after playing sport or exercising, if they break a sweat.
  • Avoid bubble baths, perfumed soaps, scented laundry detergents, and feminine hygiene sprays, as they may produce genital irritation.
  • Clean your genital area with warm water. Vaginal douches should not be used during pregnancy.
  • Teach your child to wipe from back to front.
  • To relieve discomfort, add some bicarbonate of soda to your bath water (Babycentre, L.L.C., 1997-2011; Peters, 2009; WebMD, LLC, 2005-2011; yeastinfectionadvisor.com., 2003-2010).

Consult your doctor if:

  • You suspect that your child has thrush.
  • Your child is generally unwell or has a fever for no apparent reason. If your infant has recurrent thrush or thrush that is unresponsive to treatment, it may be associated with immune system problems, especially if they are failing to gain weight and/ or have other infections or medical problems.
  • In older children, thrush can be a sign of uncontrolled diabetes mellitus or immune system disease, especially if they have not had any antibiotics or corticosteroids recently.
  • Your child has not taken any liquids for longer than 12 hours. They may require IV fluid replacement.
  • Your child has a fever or has prolonged problems with feeding.
  • The rash worsens at any time or the lesions do not disappear within 1-2 weeks.
  • The development of a fever, nausea, vomiting or the rash spreading to other parts of the body, may be indicative of a more serious illness.
  • All people with weakened immune systems, should contact  their doctor with any new symptoms or infections. All forms of candidiasis should be taken seriously and require prompt treatment. The infection may indicate poor immune system functioning and your doctor should evaluate symptoms of all candidal infections.
  • Your child develops a fever and begins having sores or discharging yellow liquid at the site of the yeast infection. These symptoms could indicate a bacterial infection, for which antibiotics are required (Demand Media, Inc., 1999-2011; Raising Children Network, 2006-2011; WedMD, LLC., 2005-2010; Womens-Health.co.uk).

Prognosis:

In general, thrush can be treated safely and effectively. However, if left untreated, the infection can spread throughout the body and eventually be fatal. Prognosis therefore depends on the extent of the infection and on the person's overall general health (Dr. Stoppard, M., 2005).