One of my biggest mom-fails/pediatrician-fails to date must be the episode with the oral thrush…
‘Love never fails’ 1 Cor 13:8
I still feel really red-in-the-face when I tell this story, but it is important to share. I think we all try our very best as moms to do only what is best for baby, but sometimes the sleepless nights and hormones overwhelm us and then we need our support system to keep us on track. It is also important to know that as a pediatrician I also want what is best for your child, but we are only human and can make mistakes.
At about 3 weeks old I noticed that our baby boy’s tongue had a white patch on the middle of his tongue. I did not think much of it as we have been giving him white, crushed “Magnesium Phosphate” tablets for cramps before each feed and that left a white residue everywhere. I did not notice that the white patch became thicker and larger. At our next weigh-in the sister asked me if I saw that my baby has oral thrush… I immediately objected and told her about the tablets, but she was wise enough to show me that you cannot remove this patch with a tongue-spatula, and that it was indeed oral thrush. I was very upset, not only because my poor baby had a problem, but also because I realised that the pediatrician-me missed a very easy diagnosis! Luckily I have a very supportive husband who quickly calmed me down and reminded me that I am Eran’s mother, not his pediatrician, and as such I do not need to make diagnoses on him, I only need to love him and care for him.
Let me tell you a little bit more about oral thrush:
It is caused by a fungal organism (mostly Candida Albicans)1 and presents as white patches on your baby’s tongue, cheeks and palate. This white patch cannot be easily wiped off with a washcloth as a milk-patch would be, and if it is removed it might bleed. It can be asymptomatic, but it can also cause a burning sensation in your baby’s mouth or be painful and prevent baby from drinking well.
It is very common in babies under one month of age, and can also affect children/adults with a defective immune system. Candida is a fungus that normally resides in your mouth/other mucosal areas together with other organisms we call “flora”, and that all form part of your microbiome. When the balance between these organisms are disrupted, then you get an overgrowth of the Candida which then causes thrush. We started washing Eran’s dummies in Milton when he was 2 weeks old, and I think this wiped out all the “good” flora in his mouth, leaving ample space for the Candida to thrive.
The infection can spread to the mother’s nipples (presenting as very red, tender or a burning sensation of the nipples, or it can cause a red ring to form around the areola), and then can spread back to the baby, so it is very important to treat both the mother and the baby. The baby also swallows the spores, and thus the infection can easily spread to the buttocks where it presents as a red rash that does not improve only by using barrier creams, affects the skinfolds and scrotum, and may have red satellite lesions.
Specific treatment with an antifungal (usually Nystatin drops or Miconazole oral gel) aims to kill the overgrowth of Candida in baby’s mouth and on the mother’s nipples. There are many more “natural” ways to regain the balance in your baby’s mouth, but these should only be used in mild cases, and if it does not resolve, rather get an antifungal. We used a mixture of 1 cup cooled boiled water, ½ teaspoon salt and ¼ teaspoon Bicarbonate of Soda to create a more alkaline environment in which the Candida cannot grow, and then we applied Miconazole gel after every feed. Within 3 days the patches improved dramatically, and within 5 days it was totally cleared up. It is important to continue using the medication for 7-10 days to make sure the Candida does not take over again.
Other measures to ensure there are no more infective spores around baby, is to wash your bras / pajamas in hot water and to properly boil / sterilize his dummies / bottle teats.
Hopefully you will do better in noticing this condition in your baby than I did… Luckily it is not a very serious condition, but we don’t want anything making breastfeeding harder than it already is in the beginning, so rather sort it out asap!
“Even on the days you feel like you are failing, look around, I promise your kids still think you are the best mom in the whole UNIVERSE.” Julie Clark, Motivating Mother
Photo’s courtesy of Pixabay and Google Images
Pediatrics and Playdough 
Thank you for this post as it made me aware of the “milk patch” (that I told everybody) that wasn’t the milk patch. I bought Miconnazole 2% oral gel but saw the leaflet said it’s not recommended for babies under six months. He is now 15 weeks and asymptomatic. Should I rather use a more natural approach? X
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Hello! I am glad the post helped you! Sorry for the late reply.
I used miconazole oral gel on my 3 week old and he is ok! The medications usually cannot be approved in babies below 6 months because nobody wants to do studies on babies that young. It should however be used sparingly and as necessary. If your baby is asymptomatic you can try the more natural approaches first, but if you get any symptoms on your nipples it is better to treat it!
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