Baby oral thrush: how to spot it, treat it and stop it coming back

If you see white patches in your baby's mouth that don't wipe off, it may be baby oral thrush, a yeast infection. The NHS says it's common in babies and usually harmless. Milk on the tongue wipes away. Thrush sticks to the cheeks, gums and lips, and a GP or polyclinic doctor can check it and give an antifungal treatment for your baby.

What to do about baby oral thrush, step by step

1. Check where the white is. The NHS says thrush shows as creamy white spots or patches on the tongue, gums, roof of the mouth or inside the cheeks.
2. Wipe one patch gently with a clean cloth. The AAP says milk wipes off easily but thrush sticks, and Raising Children Network says rubbed-off patches can bleed, so don't scrub.
3. Book a visit to your GP or a polyclinic. KKH says these doctors are trained to treat common conditions in young children, and HealthHub advises seeing a doctor rather than treating thrush yourself.
4. See the doctor first if your baby is under 4 months old. The NHS says the pharmacy mouth gel it describes is only for babies over 4 months.
5. Give the antifungal exactly as the doctor or label says. Raising Children Network says a course of drops or gel often runs 1 to 2 weeks.
6. Get yourself checked too if you're breastfeeding and your nipples are sore, itchy or red. HealthHub says the doctor may prescribe antifungal medicine for you and your baby, and you can keep breastfeeding.
7. Wash your hands well, especially after nappy changes, and use separate towels. The NHS asks everyone in the home to do this, so tell your helper and the grandparents the plan.
8. Sterilise bottles after each use and dummies regularly, and replace teats and nipple shields weekly, as the NHS advises. Our bottle sterilising guide has the steps.
9. Hot-wash bras, breast pads, bibs and muslin cloths (NHS). If you pump, our pumping guide covers cleaning the parts.
10. Look again after a week. The NHS says to see a GP if there's no improvement after 1 week of treatment with a mouth gel.

Thrush or milk tongue? How to tell

Milk tongue is the thin white coat a milk diet leaves on your baby's tongue. The AAP says it's normal and goes away once your baby starts solids. If the tongue is the only white part, the AAP says it isn't thrush. Thrush also coats the inner cheeks or inner lips.

The table draws on the AAP, the NHS and HealthHub, which says scraping thrush off leaves raw, red spots. If your baby is drooling and chewing everything but the mouth looks clear, our teething guide may fit better.

Why babies get oral thrush

Thrush comes from a yeast called Candida albicans, HealthHub says. Raising Children Network says oral thrush is very common in the first 2 years of life. Some babies pick it up during birth. Others get it from sucking on nipples, teats or dummies that already carry it.

Medicines can tip the balance too. Raising Children Network names corticosteroids and antibiotics, and the NHS lists long courses of antibiotics and asthma inhalers. The AAP adds that lots of time sucking on a pacifier can make thrush worse through friction. Our pacifier guide covers sizes and cleaning.

Thrush can show up in the nappy area as well. The NHS says some babies get a nappy rash that won't clear up, and Raising Children Network says it needs treating at the same time. Our diaper rash guide shows how to spot a yeast rash.

Breastfeeding with thrush: treating you both

The NHS says you and your baby can pass thrush back and forth. So HealthHub's advice is to see a doctor, who may prescribe antifungal medicine for you both. You can carry on breastfeeding while you're treated, HealthHub says.

On your side, look for itchy, red or sore nipples (HealthHub) or a burning nipple pain after feeds (NHS). Nipple pain isn't always thrush, though. The NHS says a poor latch can cause it. Our breastfeeding support guide covers the latch and where to get help in Singapore.

Too sore to feed? The NHS suggests expressing your milk instead. Your GP may also take swabs from your nipple and your baby's mouth. If you're given a nipple cream, Raising Children Network says to wipe it off before your baby latches on.

How long oral thrush takes to clear

The AAP says thrush usually clears in 4 to 5 days with treatment, and in 2 to 8 weeks without. Raising Children Network says a baby who is otherwise well may not need treatment at all. Your doctor will tell you which applies.

Finish the course even when the white fades. The NHS says thrush can come back if it isn't treated.

Going to infant care? Ask your centre what it needs from you. The AAP's view is that thrush can't spread through normal skin, so a child can go to child care with it. Raising Children Network agrees it doesn't easily spread among children.

Thrush in older children and after steroid inhalers

Toddlers and older children can get thrush too, for example after antibiotics or steroid medicines (Raising Children Network). HealthHub lists an oral fungal infection, seen as white patches in the mouth, as a side effect of a steroid inhaler used to control asthma.

HealthHub says rinsing the mouth with water and spitting it out after using the inhaler helps prevent it. Raising Children Network gives the same advice for asthma preventers. If your child is too young to rinse and spit, ask the doctor what to do instead.

Thrush that keeps coming back needs a doctor's look. HealthHub says an underlying problem has to be ruled out, and the NHS names a weak immune system as a reason to see a GP. For other common bugs, see our guide to common childhood illnesses in Singapore.

When to see a doctor

Most thrush needs a GP or polyclinic visit. Go sooner, or to Children's Emergency, for these signs:

• Your baby is under 4 months old and has signs of thrush. The NHS says to see a GP.
• Your baby is under 1 month old and looks or acts unwell in any way. The AAP says to get care now.
• Your baby is under 3 months old and seems ill. KKH lists illness in a baby this young as a reason to go to its Children's Emergency.
• Your baby is feeding poorly or can't keep fluids down. KKH lists this for the Children's Emergency too.
• Fewer wet nappies, dark urine, a very dry mouth or no tears. The AAP treats no urine in more than 8 hours, with these signs, as possible dehydration that needs care now.
• A fever, bleeding in the mouth, or drinking less than normal. The AAP says to contact your doctor within 24 hours.
• Trouble or pain swallowing, or drooling. Raising Children Network says thrush can spread down the food pipe and make swallowing hard, and KKH lists inability to swallow with drooling for the Children's Emergency.
• Thrush that keeps coming back despite treatment (Raising Children Network), or no better after 1 week of treatment (NHS).

In Singapore, start with your GP or a polyclinic for most of these. Our paediatrician map can help you find a children's doctor nearby. For poor feeding, signs of dehydration, a sick baby under 3 months, or a child who can't swallow, go to KKH Children's Emergency or NUH Children's Emergency. KKH says to call 995 in an emergency, such as trouble breathing, a seizure or a child you can't wake.

Frequently asked questions

Is baby oral thrush contagious?

It can pass between you and your baby during breastfeeding, the NHS says. Raising Children Network says it doesn't easily spread among children. Wash your hands and keep towels separate while you're both being treated.

Can I still breastfeed if my baby has oral thrush?

Yes. HealthHub says you can continue to breastfeed, and the doctor may treat you both. If it's too painful, the NHS suggests expressing your milk instead.

Will oral thrush in babies go away on its own?

Sometimes. Raising Children Network says a baby who is otherwise well may not need treatment, and the AAP says untreated thrush clears in 2 to 8 weeks. Let a doctor check first, especially if your baby is under 4 months or not feeding well.

Is it oral thrush or just milk on my baby's tongue?

Wipe gently with a clean cloth. The AAP says milk comes off easily, and a white tongue on its own isn't thrush. White that sticks to the cheeks, gums or lips points to thrush, so book a doctor's visit.

Can toddlers and older kids get oral thrush?

Yes. Raising Children Network says it's very common in the first 2 years, and antibiotics and steroid medicines can bring it on. A child on a steroid inhaler should rinse with water and spit after using it, HealthHub says.

Do I need to replace bottles and teats after thrush?

The NHS says to sterilise bottles after each use and dummies regularly, and to replace teats and nipple shields weekly. It also advises a hot wash for bibs, muslins, bras and breast pads.