What IS that white stuff?

Another absolutely beautiful day in St. Louis. We don't get that many, so I hope you're out there enjoying it.

At least once a week, I get a visit or a phone call about white stuff in a baby's mouth. In spite of many warnings from grandparents about "thrash," not all that's white in the mouth is thrush. Thrush is a yeast infection in the mouth. Usually, we find it in babies whose immune system hasn't developed to the point of being able to fight it off. Breaset and bottle fed kids both get it. I seem to see it more often in breast fed kids, but I don't think that's generally true in all communities. The yeast comes off of the breast or bottle nipples. Sometimes, Mom will get the infection on her breasts and develop soreness and cracking.

Other kids will get thrush after a round of antibiotics. Thrush is also one of the primary side effects of inhaled steroids.

The best way to tell if a baby has thrush is to look for white patches on the insides of the cheeks. If these patches can not be scraped off, then it is likely thrush. Often, these same patches will appear on the gums. They usually do not appear on the tongue. There are several different treatments for thrush, all of which are reasonably effective. Preventing thrush involves boiling bottle nipples after use (or sending them through the dishwasher). Sometimes, we recommend mother be treated if it appears she is carrying the yeast and giving it to the baby.

Other white rashes in the mouth are also common. The most common misperception is that a white tongue is thrush. Again, if there are no white patches on the cheeks, there probably isn't thrush. The white tongue is usually caused by the environment in the mouth. Mild dehydration will dry the tongue a little and make it white. A recent meal can become somewhat adherent and look like a white coating on the tongue. Geographic tongue describes a tongue that develops serpentine patterns under certain conditions and these patterns are sometimes whitish, but sometimes reddish.

A big cause of white in the mouth is often confused for teeth coming through. The gums of newborns can develop little white cysts. These cysts are entirely developmental in nature. They seem to come and go over the course of the first several months of life. Unfortunately, they do not usually indicate teeth coming in and they are never an indication of thrush.

So next time it looks like there's white stuff in an infants mouth, think of the wide variety of things that turn the mouth white. Consider what part of the mouth has the white spots. Then, when all the information is in place, give your pediatrician a call.