What to do if your child is not eating well due to oral thrush

• What kind of disease is candidiasis?
• Symptoms
• Causes
• Treatment
• Therapy methods
• Preventive measures

Many parents are aware of such a common problem in children as thrush, which is characterized by the appearance of a white coating on the tissues of the oral cavity. In medicine, this pathological condition is called “candidiasis” and refers to fungal diseases. Candidiasis most often develops in a child’s mouth in the first year of life. The symptoms of thrush are very disturbing for the baby, but timely treatment allows you to get rid of the fungus quickly and without consequences.

Who's at risk

First of all, these are people who have the following unfavorable factors:

1. Weakened immunity.

Defects in immune defense are the main factor predisposing to the occurrence of mycoses (fungal infections)1,2,4. The increase in their incidence in all countries of the world is due, first of all, to various types of conditions accompanied by weakened immunity1,[3]. It is not for nothing that “thrush” is called “the disease of the sick”1. Among its reasons:

• severe general diseases, for example, infectious2,3;
• cancer accompanied by sudden weight loss, lack of vitamins and microelements, requiring radiation and chemotherapy2,3;
• congenital and acquired forms of immunodeficiency, including AIDS2,3;
• endocrine disorders, for example, diabetes mellitus2,3.

1. Dental diseases.

• Inflammatory , such as caries and its complications, gingivitis, periodontitis, periodontal disease and others2. The huge number of bacteria present during inflammation weakens the immune system and contributes to the proliferation of fungal microflora2. A diseased tooth with a carious cavity “infested” with microbes or a periodontal pocket filled with pus may well provoke the development of “thrush”3,[4].
• Non-inflammatory , which change the structure of the oral mucosa, for example, folded tongue and leukoplakia4. It is easier for fungi to attach to a damaged surface than to a healthy one.

1. Constant dry mouth.

• Insufficient saliva (xerostomia), associated with a variety of problems, contributes to the development of oral mycosis4. Saliva contains many enzymes and antibodies that protect the mucous membrane from the action of microbes4. If there is little saliva, it dries out, its protection is weakened, which creates favorable conditions for the development of other infections.

1. Defects in oral hygiene.

• Insufficient care . Problems more often arise in those who rarely brush their teeth and ignore the care of their tongue, interdental spaces and dentures4.
• Injuries . Sometimes the cause of an “outbreak” of oral mycosis is a too hard toothbrush or rough manipulation of dental floss and toothpicks. Injured gums are easy prey for fungi2.3,4.

1. Incorrect use of removable dentures.

• Poorly customized removable dentures can rub the gums3,4, making them accessible to germs.
• No night break in using prostheses4. The gum located under the prosthesis is poorly enriched with blood, it lacks oxygen, it is not washed with saliva - this predisposes to the development of infection4.
• Improper care of dentures. Artificial teeth need care just as much as your own. Deprived of attention, they become covered with a thin film of various microbes, which then “attack” the gums.

1. Age.

• Most often, doctors find “ thrush” in the mouth of infants and the elderly4. The reason for this is the imperfections of the immune system, which create favorable conditions for the proliferation of pathogenic microflora1,4,[5]. In addition, in childhood, dietary habits affect, and in old age – constant dry mouth and lack of teeth, forcing you to wear dentures1,5.

1. Medicines

• Antibiotics. They kill not only pathogenic microbes, but also beneficial ones, thereby disturbing the balance of microflora and creating conditions for mycoses to flourish1,2.
• Drugs that inhibit cell proliferation (cytostatics). They interfere with the renewal of surface mucosal cells and disrupt local and general defense mechanisms against infections1,2.
• Immunosuppressive medications, which are prescribed when immune responses need to be suppressed, such as during transplantation1,2.
• Inhaled corticosteroids, which are used in the treatment of bronchial asthma and, due to their side effects, increase the susceptibility of the mucous membrane to infections2,[6].

1. Unbalanced diet

• Lack of iron, vitamins C and B12, and folic acid1 in the diet, which leads to decreased immunity.
• Excess carbohydrates1,2. Excessive consumption of sweets, flour products, sweet fruits, starchy vegetables and other foods containing large amounts of simple carbohydrates contributes to the appearance of thrush in adults and children1,2.

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How to distinguish “bad” plaque from “good”

Photo: this is what a “milky” white coating looks like on a baby’s tongue

The appearance of a white coating on the tongue of an infant is not always a signal of concern. Take a closer look at your baby and let him take 1-2 sips of boiled water. If there are no negative changes in behavior, the baby is calm, eats well, and after drinking the amount of plaque decreases, then it is milk residue.

In the first weeks of life, the baby's main food is mother's milk, and it is not surprising that its remains are present on the tongue.

If the white coating on the tongue of a month-old baby has a dense consistency in the form of curdled flakes, you should urgently take the baby to the doctor

. Such symptoms indicate the development of thrush and other disorders in the child’s body.

Pathological plaque does not appear “alone”; changes in the baby’s behavior and well-being should also be observed: the baby is capricious, cries, refuses to eat, body temperature rises, and poor sleep is possible.

What does thrush look like in the mouth - its symptoms in adults

After Candida attaches to the mucous membrane, they multiply and “grow” deep into it2, causing inflammation, swelling and redness. There is a feeling of a “scalded mouth” and discomfort when eating and swallowing. There may be a change in taste and the appearance of a metallic, sour, salty or bitter taste1.

The proliferation of the fungus leads to the appearance of small white spots on the gums, tongue, inner surface of the cheeks and palate, reminiscent of curdled milk or grains of semolina porridge. Increasing in size, the “grains” turn into plaques, which, in turn, merge to form solid white films.

If plaques and films are removed with a spatula or a cotton swab (this does not require additional effort), then a bright red inflamed, eroded mucous membrane is revealed underneath them.

Oral mycosis can spread to the red border of the lips , causing redness, dryness and peeling. Seizures appear in the corners of the mouth: the skin becomes inflamed, covered with grayish-white scales and cracks5.

If candidiasis is not treated at this stage, the fungi “spread” to the tongue and pharyngeal tonsils.

When the tongue is damaged, glossitis develops - the tongue swells, its papillae are smoothed out, a characteristic white coating appears on its back and lateral surfaces1 - and when the pharyngeal tonsils are damaged, a sore throat occurs.

A sore throat caused by fungal microflora is very different from normal. With obvious inflammation of the tonsils and the presence of white films and plugs on them, there is no temperature or pain when swallowing, and the submandibular lymph nodes remain of normal size1.

Candidiasis can spread further - affecting the respiratory tract, causing pneumonia and blood poisoning, so it is important to stop the process at the very beginning.

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Stages of the disease

The disease begins at a mild stage, when reddish spots are barely visible on the mucous membrane, soon giving way to a cheesy white coating. At this stage, the child does not feel much discomfort, and the infection itself is easily treatable. If treatment is not carried out, then thrush enters the middle stage, when spots and plaque merge and form islands that fill almost the entire oral cavity. At this stage, when trying to clean the plaque, bleeding ulcers appear. The child becomes restless, especially during sucking. In the severe stage of thrush, bleeding increases and quite intense pain appears. Fever often develops and bowel movements are disrupted. It is advisable to treat this form of thrush in a hospital setting.

According to the course of the disease, acute and chronic forms are distinguished. The acute form is more common, and the chronic form is usually a companion to other diseases. In the acute form, the plaque is white, cheesy, with a tendency to expand the affected areas up to the corners of the mouth. In addition to discomfort, the child may experience increased temperature, enlarged and painful lymph nodes (usually submandibular). For diagnosis, the doctor will take a scraping of the plaque and, upon examination, will find in it epithelial cells, food debris, fibrin fibers and, of course, the pathogen itself.

In the chronic form, the coating is yellowish or brown and more dense. Touching the affected mucous membrane causes severe pain. There is swelling around the lesion, and nearby lymph nodes are also enlarged. As with the acute form, the child’s behavior changes - older children complain of pain when eating, and infants become whiny and restless. This form is difficult to treat, so it is important to prevent acute thrush from becoming chronic.

Complications from thrush are usually associated with disruption of the digestive tract and respiratory system, however, there is a risk of developing diseases of other organs. If adequate treatment is not carried out in time, thrush can develop into a chronic, recurrent form.

Features of “thrush” in the mouth in children of the first year of life

Mycoses in children, and very young ones at that, are not that uncommon. According to statistics, the first illness of a newborn in 33% of cases is associated with Candida fungi5. Moreover, they mainly affect the skin and tissues of the oral cavity5.

Why does thrush appear in the mouth of a child under one year old?

Mycotic stomatitis, or fungal inflammation of the oral mucosa, is the most common form of mycosis in children under one year of age1.5. How do mushrooms get into a baby’s mouth and why do they take root there? There are many reasons for this.

• Infection during childbirth.

During childbirth, the fetus comes into contact with the microflora of the woman’s vagina. If the mother suffered from vaginal candidiasis before giving birth and did not undergo the necessary course of treatment, the baby has every chance of inheriting a large amount of the causative agent of this disease1.5, which is a big burden for the immature immune system. According to statistics, on the first day of life, Candida fungi are found in the oral stool of 25-40% of newborns5.

• Unsanitary conditions.

Infection is possible due to violation of the rules of care for the newborn and defects in the hygiene of the nursing mother herself1,5. The infection is transmitted through dirty nipples and hands during feeding, through toys, nipples, dishes and linen.

• Imperfect immunity1, 5.

In a baby under one year old, the immune system is only “gaining experience”, because in the womb it did not come into contact with the infection and therefore “did not learn” to fight it.

• Prematurity and illness.

Candida can only harm a weakened body. The best conditions for their development are created if the birth occurs before term, the fetus is premature and/or has developmental defects or congenital diseases5.

• Nutritional features.

The threat is posed by regurgitation, the habit of putting the baby to bed with a bottle of milk and feeding with sweet artificial formulas. If milk remains in the mouth, which also contains a large amount of sugar, it becomes an ideal breeding ground for mushrooms.

• Features of salivation.

Due to physiological characteristics, the salivary glands of infants produce little saliva1 - they simply do not need it, since food is already liquid. At the same time, saliva has antifungal activity, and when there is little of it, the likelihood of oral thrush in a newborn increases1,5.

What does oral candidiasis look like in children?

The symptoms are the same as in adults: first, white “grains” appear on the mucous membrane, then “clumps” resembling curdled milk, and white films1. The difference is that the process is almost always accompanied by severe tissue swelling and the formation of numerous painful ulcers on the oral mucosa and tongue1,5. Therefore, due to oral thrush, infants often refuse to eat5.

In children, a fungal infection can affect not only the tonsils (tonsillitis), but also the pharynx (pharyngitis) and larynx (laryngitis). If the larynx is affected, the baby's voice becomes hoarse and low, and there is a risk of swelling of the airways and breathing problems1, 5.

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Why does thrush occur?

The child is born without immunity. From the first days of life, immunity begins to develop. Mother's breast milk plays the role of a “donor” of immune cells. But along with the mother’s milk, the fungus enters the child’s body. The second way Candida fungi enter the baby’s body is during his birth. And the third is the transmission of microorganisms from other people through contact: through hands during play and feeding, through the mouth and by air.

The fungus can enter the baby's body through mother's milk.

General tips for caring for a small child, which are also preventive protection against thrush.

1. Boiling nipples, pacifiers, and bottles should be done every day.
2. Periodically, you need to wash the pacifiers in a soda or honey solution.
3. You also need to boil those toys that the child can put in his mouth. If they are not subject to boiling, wash thoroughly with soap and water and rinse in the solution described above.

   Parents should boil toys that the child may put in his mouth.

4. Use antiseptic solutions to wash the mother's nipples if the baby is breastfed. In this case, if the child has thrush, the mother should be treated along with him.
5. The rapid disappearance of plaque from thrush should not mean that the disease is already over. It is necessary to complete the entire course of treatment so as not to provoke a relapse of the disease.

It is important to complete treatment, since the disappearance of symptoms does not guarantee that a relapse will not occur.

Pathogenic proliferation of fungi in a child’s body can cause hot and dry air in the room where the baby is often located. Candida fungi are always found in small quantities in a child's mouth. Saliva, which contains special substances, inhibits their rapid reproduction. Therefore, it is so important that the baby’s oral mucosa does not dry out. In addition to incorrect temperature conditions, a runny nose or frequent crying can cause dry mouth in a child.

Important! A dry and warm environment is ideal for the growth of Candida fungus. Therefore, it is so important to control the air temperature in the room, humidify it, and ventilate it often.

It is worth humidifying the room in which the baby is located

The following problems can also cause thrush:

• frequent regurgitation and retention of food in the mouth;
• formation of microscopic cracks on the gums and lips;
• congenital disorders of the oral mucosa
• the use of antibiotics and hormonal drugs to treat diseases, which make the child’s immunity weaker;
• the child was born premature;
• feeding the child with artificial formulas.

Due to artificial feeding, the baby may develop such a pathology

Premature babies, formula-fed babies and those taking antibiotics for a long time fall into the category at high risk of developing thrush. This is explained by one reason - weak immunity.

Important! In healthy breastfed children, thrush appears much less frequently. And if it does appear, it goes away much easier and faster.

Children who are breastfed are less likely to develop oral thrush

Diagnosis of oral mycosis

Most often the diagnosis is obvious. However, in difficult situations, for example, in the presence of complications or individual intolerance to certain drugs, to confirm it, microscopic and cultural analysis of scrapings from the surface of the mucous membrane is used to determine the sensitivity of the microflora to antifungal drugs. Moreover, the mere presence of Candida threads in scrapings from the oral cavity is not always enough to make a diagnosis - fungi can be present in the mouth, but not cause any diseases. In such a situation, quantitative assessment is important, that is, counting the pathogen cells, and increasing their number when re-analyzed after 2-3 days.

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How and with what to treat thrush in the mouth

Since candidiasis often develops as a secondary disease1, treatment of oral thrush requires an individual approach. What do we have to do?

1. Eliminate the factors that contributed to the appearance of oral mycosis

To do this you need:

• cure diseased teeth and gums, relieve exacerbation of chronic tonsillitis, pharyngitis;
• replace old “outdated” removable dentures with new ones, follow the rules for using and processing dentures;
• every time after using inhalers with steroid drugs (for bronchial asthma), rinse the mouth and gargle with water6;
• take antibiotics only as prescribed by a doctor;
• use toothbrushes with soft bristles, toothpastes, and mouthwashes with an anti-inflammatory effect1;
• follow the rules of caring for a newborn and feeding hygiene (if the disease manifests itself in an infant);
• use formulas that do not contain sugar for artificial feeding of a newborn.

2.Keep a diet

Meals include:

• limiting the daily intake of simple carbohydrates: sweets, flour products, potatoes, rice, legumes, boiled beets and carrots, sweet fruits and dried fruits;
• supplementing the diet with fresh vegetables with a lot of fiber, which contribute to the formation of normal microflora in the intestines and the formation of immunity9;
• consumption of sour berries and lactic acid products, which, due to their acid content, hinder the spread of fungi1;
• taking vitamins1 necessary for the normal functioning of the immune system;
• eating enough easily digestible meat and eggs for the normal functioning of the immune system.

3. Carry out local treatment

For oral thrush in both adults and children, treatment may include topical use of drugs with antifungal activity. Moreover, if the fungus affects only the oral cavity, local therapy may be sufficient5 to cope with the problem.

To treat the oral mucosa, today it is recommended5 to use hexetidine preparations, for example, HEXORAL® solution and HEXORAL® aerosol .

HEXORAL® with hexethidine:

• is active against biofilms[7] that are resistant to other drugs, and is harmful to fungi of the genus Candida, which cause oral candidiasis;
• has a high safety profile;
• can be used not only in adults, but also in children from 3 years old8;
• eliminates discomfort and relieves pain7;
• lasts for a long time, up to 12 hours[8];
• Available in the form of a solution and an aerosol, for comfortable use in any situation (for fungal laryngitis in children, it is especially convenient to use the aerosol form of the drug)2.

Important: doctors prescribe general antifungal drugs only if local treatment is ineffective and multiple relapses of candidiasis occur against the background of severe immunodeficiency and/or severe concomitant diseases. In these cases, HEXORAL® can be an addition to the main therapy1, 2, 5.

When treating oral thrush in newborns, there is often no need to use systemic antifungal agents1, 2, 5.

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Causes of black plaque on the tongue in adults

“Stick out your tongue” - probably everyone has heard this phrase in the doctor’s office. “Why is it so important for a doctor to see a patient’s tongue?” – patients are lost in conjecture. The doctor will determine whether the tongue is clean or coated, and can suggest a diagnosis based on the nature and color of the plaque. Dark coating on the tongue is a sign of what disease? Do not be afraid of the appearance of a strange shade of the mucous membrane of the tongue. The reasons for the color change may be temporary and completely harmless.

Causes of black plaque on the tongue in adults:

• changes in bacterial flora after a course of antibiotics;
• poor oral hygiene;
• xerostomia;
• glossitis;
• regular use of mouthwashes containing irritating oxidizing agents;
• smoking or chewing tobacco;
• drinking excessive amounts of coffee or black tea;
• alcohol abuse.

What does brown coating on the tongue mean? Discoloration usually occurs when the papillae on the surface of the tongue grow larger than normal. The waste products of microorganisms accumulate between them, which leads to an unpleasant tint of the tongue. If the root of the tongue is covered with a green coating, the cause may be oral candidiasis (thrush). When taking antibiotics or eating “colored” foods, the white-gray coating characteristic of thrush can turn different shades of green.

What does a red coating on the tongue mean:

• about a lack of folic acid and vitamin B12, which causes a reddish tint;
• about “geographic tongue” (benign migratory glossitis), which is characterized by the appearance of reddish spots on the surface of the tongue;
• about scarlet fever, one of the symptoms of which is “strawberry tongue.” Read more about the symptoms and treatment of scarlet fever on our website Dobrobut.com;
• about Kawasaki syndrome, observed in children under the age of five and characterized by damage to the blood vessels. The syndrome is accompanied by redness of the tongue (“strawberry tongue”).

How to prevent the disease

So, what will help avoid an “outbreak” of fungal infection?

• Careful oral care.
• Solving dental problems and treating common diseases.
• Compliance with the rules of personal hygiene, hygiene of infant feeding and care1.
• Mandatory treatment of the disease during pregnancy and after childbirth1.
• Prophylactic use of antifungal agents, for example, during treatment with antibiotics and immunosuppressive drugs (radiation or chemotherapy)1.

Important: frequent outbreaks and severe cases of candidiasis are a reason to consult a doctor and undergo a full examination. Taking into account the fact that mycoses develop against a background of reduced immunity, they can act as a marker of serious diseases2. According to the World Health Organization, recurrent candidiasis should be a reason for testing for HIV.

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Features of the treatment of candidiasis in children

The disease treatment program involves the use of antifungal agents and the adoption of measures aimed at comprehensively strengthening the body of the infected child. Until recently, nystatin was the drug of choice for this disease, but in modern dental practice more effective and harmless dental agents are used. Foods rich in carbohydrates (sweets, cookies, honey and others) must be excluded from the diet of a sick child.

There are a number of non-pharmacological methods to combat candidiasis in childhood. In particular, the following help to cope with the manifestations of this pathology:

• warm saline solution (used as a mouth rinse for children over three years old);
• lollipops with antiseptic components (prescribed for adolescents and children over 8 years old);
• solution of baking soda (used for systematic wetting of epithelial tissues of the mouth in infants and newborns).

When a disease is detected in breastfed babies, not only the babies, but also their mothers undergo treatment. This approach to therapy helps prevent re-infection of infants during feeding.