Thrush and Other Yeast Infections in Children

  • Medical Author:
    David Perlstein, MD, MBA, FAAP

    Dr. Perlstein received his Medical Degree from the University of Cincinnati and then completed his internship and residency in pediatrics at The New York Hospital, Cornell medical Center in New York City. After serving an additional year as Chief Pediatric Resident, he worked as a private practitioner and then was appointed Director of Ambulatory Pediatrics at St. Barnabas Hospital in the Bronx.

  • Medical Editor: William C. Shiel Jr., MD, FACP, FACR
    William C. Shiel Jr., MD, FACP, FACR

    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

What are yeast infections?

Picture of thrush

What are commonly known as "yeast" infections are caused by various species of a yeast-like fungus called Candida, particularly the species Candida albicans. Yeast organisms are some of the germs (including bacteria) that are normally found on various parts of the body and that ordinarily cause no symptoms or signs.

Why do yeast sometimes cause symptoms and signs?

Certain conditions, such as antibiotic use, may upset the balance of microbes in the body (particularly between the bacteria and fungi) and allow an overgrowth of Candida. Yeast also can thrive in chronically moist folds of skin, such as in the groin.

Yeast infections may flare up and then heal in most people. However, in newborns or individuals with impaired immune systems, yeast can cause more serious or chronic infections.

How do babies get yeast infections?

Many infants acquire Candida infections from their mothers during the process of birth. Yeast exists naturally in the mother's vagina. When the child is delivered through the birth canal, the baby comes in direct contact with the yeast.

Many babies who escape this infection at birth soon acquire Candida from close contact with other family members.

What is oral thrush? What are oral thrush symptoms and signs?

Thrush is yeast infection of the mouth and throat. Thrush can also be associated with yeast infections of the esophagus. Thrush appears as creamy white curd-like patches on the tongue and inside of the mouth and back of the throat. As mentioned above, in individuals with impaired immune systems, yeast infections are more common. For example, in a non-infant population, thrush may be a sign of underlying HIV infection.

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Is a Yeast Infection Contagious?

Most yeast infections are not contagious. They usually occur when conditions on the skin, mouth (mucosal surface), vagina and penis/foreskin develop extra moisture and warmth, often associated with a suppressed immune system. It is in these situations where Candida can ideally grow and multiply.

How do children (and adults) acquire thrush?

Outbreaks of thrush in child-care settings may be the result of an increased use of antibiotics and growth of the yeast normally present in the mouth, rather than newly acquired Candida infections. In children (and adults) taking antibiotics or steroids (such as cortisone-related asthma medications), the balance of the normal microbes in the mouth can be disturbed. This may cause an overgrowth of Candida, which in turn results in oral thrush.

How does yeast affect diaper rash?

Candida may infect an infant's diaper area and worsen a diaper rash. This is because yeast can grow very readily on irritated, moist skin. The infected skin is usually fiery red with areas that may have a raised red border and is usually intensely itchy (pruritic).

Can thumb sucking cause problems with yeast?

Children who suck their thumbs or other fingers may occasionally develop Candida around their fingernails. This causes redness at the edges of the nails.

Can a nursing mother acquire yeast infections from her infant?

Nursing mothers are at risk for developing Candida infections on their breasts (this is called mastitis) and can be treated with the same medication that is used for infants.

What is the treatment for thrush and other yeast infections?

Oral thrush and yeast infections, such as Candida diaper rash, usually are treated with antifungal medicines; these include nystatin (Mycostatin), clotrimazole (Lotrimin), or miconazole (Monistat) either by mouth or in a topical cream. Luckily most Candida are very sensitive to nystatin, and resistance is rare. There are many topical antifungals available as over-the-counter brands. Oral thrush requires an oral medication that is available by prescription only.

For children with diaper rash, diapers should be changed frequently and the child's skin gently cleansed with water and a mild soap, rinsed, and patted dry. Barrier creams or ointments, such as Desitin or A&D, are helpful. While cornstarch may be recommended for mild diaper rash, it should not be used for children with significantly inflamed skin. High-absorbency disposable diapers may help keep the skin dry. A baby's bottom is very sensitive, so staying dry is very important. Plastic pants that do not allow air to circulate over the diaper area should be avoided, although the diapering system should be able to hold urine or liquid feces.

What if the medication does not effectively treat the yeast infection?

There are some situations when a different medication is needed to clear a yeast infection. A health-care provider may prescribe another type of antifungal cream or oral preparation that may include ketoconazole (Nizoral, Extina, Xolegel, Kuric), fluconazole (Diflucan), or itraconazole (Sporanox).

Should a child with yeast infection be kept out of child care?

There is no need to remove a child with yeast infection from child care. Since most healthy people already harbor Candida, children with thrush and Candida diaper rash do not have to be excluded from child care (as long they are able to participate comfortably).

Child-care providers should follow good hygiene, including careful hand washing and disposal of nasal and oral secretions of children with thrush, in order to avoid transmitting the infection to children who may not already be infected.

Are there other names for yeast infection?

Medically, a yeast infection is referred to as candidiasis because Candida causes the infection. Thrush is known as oral candidiasis. The old name for Candida was Monilia. The infection is still sometimes called moniliasis, and thrush is still at times known as oral moniliasis.

REFERENCES:

American Academy of Pediatrics. "Candidiasis (Moniliasis, Thrush)." In: Pickering, L.K., ed. Red Book: 2009 Report of the Committee on Infectious Diseases. 28th ed. Elk Grove Village, IL: American Academy of Pediatrics, 2009: 245-249.

American Academy of Pediatrics. "Thrush and Other Candida Infections." HealthyChildren.org. Aug. 20, 2015. <https://www.healthychildren.org/English/health-issues/conditions/infections/Pages/Thrush-and-Other-Candida-Infections.aspx>.

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Reviewed on 11/6/2015
References
REFERENCES:

American Academy of Pediatrics. "Candidiasis (Moniliasis, Thrush)." In: Pickering, L.K., ed. Red Book: 2009 Report of the Committee on Infectious Diseases. 28th ed. Elk Grove Village, IL: American Academy of Pediatrics, 2009: 245-249.

American Academy of Pediatrics. "Thrush and Other Candida Infections." HealthyChildren.org. Aug. 20, 2015. <https://www.healthychildren.org/English/health-issues/conditions/infections/Pages/Thrush-and-Other-Candida-Infections.aspx>.

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