Baby Thrush

Baby thrush is a common yeast infection affecting the mouth (oral thrush) or the diaper (nappy) area or both.

If you have a specific question, click on the link below to go straight there, otherwise read on for an overview.


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What is Baby Thrush?

Thrush is an infection caused by a yeast, Candida albicans. It is common in babies. It usually involves the mouth or the diaper (nappy)area.

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What does Mouth Thrush look like?

oral thrushOral thrush

Babies are particularly likely to get oral (mouth) thrush in the first weeks of life, with a peak in the second week. You baby will have white, cheesy coating of the tongue and you won't be able to wipe it off (compared to milk coating of the tongue whih you can wipe off). The tongue and the mouth generally can also look red and inflamed. It is often associated with thrush in the diaper area.

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What is the Treatment of Mouth Thrush?

Babies with oral thrush need to have treatment with an antifungal agent, such as:

  • Nystatin oral suspension - 1 ml (1 milliliter is equivalent to 100,000 units) given 4 times per day for 10 days
  • Miconazole gel - 25 mg given four times per day for 7 - 10 days
  • Fluconazole (most often known as Diflucan) which is given orally for 7 - 14 days given at a dose of 6mg/kg for the first dose then 3 mg/kg. Read more

Miconazole gel and Fluconazole are both more effective than Nystatin and should be used if Nystatin has failed.

Breast-feeding mothers will often need to apply some nystatin, miconazole or clotrimazole cream (Mycostatin, Micatin, Daktarin, Canesten) to the area around the nipple. Apply after feeding.

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thrushNapkinThrush in diaper area

What does Baby Thrush look like in the diaper (nappy) area?

Many diaper (nappy) rashes caused by moisture will get colonized by the Candida yeast if they continue for more than a few days, so any diaper (nappy) rash that has been present for 4 days or more, is likely to also have thrush.

The key features of the thrush diaper (nappy) rash are that there is redness and there may be white scaling as well.

Unlike moisture rashes that spare the skin creases in the thigh, thrush will involve the skin creases. You will also see what we call "satellite lesions" - these are spots that are distant to the main rash.

So it isn't just one big red rash, there are outlying spots - as in the photo above.

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What is the treatment of Baby Thrush in the Diaper (Nappy) area?

When you have diaper (nappy) thrush or any diaper (nappy) rash that has lasted at least 4 days, the treatment involves both:

  • topical treatment - apply some nystatin, miconazole or clotrimazole cream (Mycostatin, Micatin, Daktarin, Canesten) to the diaper (nappy) area with every diaper (nappy) change for at least 10 days
  • oral treatment -
    • Nystatin oral suspension @ 1 milliliter (100,000 units) given 4 times per day for 10 days
    • Miconazole gel 25 mg four times a day for 10 days
    • Fluconazole (Diflucan) oral suspension for 7-14 days - this will usually treat the diaper (nappy) rash as well (without the cream)

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Why do you need to treat diaper (nappy) thrush with oral suspension as well as cream?

If your baby has thrush in the diaper area, you need can use the cream (topical treatment). But you need to also use the oral Nystatin suspension. If you don't use the oral suspension, the thrush will often come back. The yeast is in the gut and so comes out with your baby's poop (poo) - if you don't treat from the top end, you won't get cure the thrush.

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If my baby has thrush, is there something wrong with his immunity?

No. Baby thrush is common in the mouth and diaper (nappy) area. If your baby has thrush in other places (like the esophagus), it may signify an immune problem. If that is the case, speak to your doctor.

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References

  • Pediatric Pearls. Rosenstein B, Fosareeli P, Douglas Baker M. 4th edition. Mosby 2002
  • Pankhurst C. Candidiasis (oropharyngeal). In Clinical Evidence. BMJ Publishing. 2007
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To read about Fluconazole in infants, click here

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Last reviewed 8 July 2012

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Dr Maud MD

Dr Maud MD (MBChB, FRACP, FRCPCH), a specialist pediatrician, provides health information and medical advice for parents of babies and toddlers. Read more about Dr Maud.



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