Our maternity experts get many questions from concerned mothers about their baby’s white tongue. And indeed, many parents are in doubt about the colour of their baby’s tongue and whether the white colour that can be seen in breastfed babies, means that the baby has thrush in her mouth. In this post, we will gradually explain the topic.

What is thrush?

There is a type of thrush sometimes presenting in babies’ mouths, that is also known as candida or oral candidiasis. It is a fungal infection in the baby’s mouth or digestive tract, that sometimes also appears in the nappy area and it is a fairly common situation in babies. It is caused by a fungus called candida albicans. This fungus is naturally present in our body, but in certain situations of a weakened immune system of the organism, or after the baby has taken some medication, it can appear with intensity.

How do I know if my baby has thrush?

You will see small spots the size of a grain of rice inside your baby’s mouth: on the cheeks, inside the lips and at the corners of the mouth. They look like small velvety spots and sometimes they do not cause any discomfort to the baby. Other times they may cause mild discomforts such as burning and irritation. When it spreads further and occupies a large part of the oral cavity, a baby may refuse the breast or want to feed less.

Does a white tongue always mean thrush or not?

Breastfed babies often have a naturally white tongue. This is due to the lactic bacteria that cover the entire surface of the tongue and give it this appearance. But to find out if it is thrush or not, you have to check the rest of the baby’s mouth and see if the spots we were talking about appear outside the tongue area and are spread everywhere in the mouth.

My baby has been prescribed cream for the treatment of thrush, but she only has a white tongue.

If the tongue only is partially or completely white and nothing else is visible in the mouth, it probably may not be a fungal infection and your baby has, as we have mentioned before, the typical white tongue of a breastfed baby. You could check about this situation again or try to ask another healthcare professional.

My baby’s tongue is only partially white, what is it?

Sometimes the white tongue can only be seen on part of the tongue, while the front of the tongue has a normally pink tongue colour. In this case, there is no thrush either, but it may indicate a latching difficulty or a tongue-tie (short frenulum). If you also feel pain when breastfeeding, please consult a breastfeeding expert such as IBCLC or a midwife.

My baby has thrush and I have pain when breastfeeding, do I have thrush on my breast?

Oral Candida usually only colonises the mucous membranes, but cannot colonise the skin of the breast and even less so the milk ducts. So if your baby has thrush and you are in pain, seek the support of a lactation consultant, who can assess whether you are experiencing subacute mastitis. If you do, it is not the baby that has infected you and this is where you got the infection from, but the other way around. The bacteria that have been altered are the ones that produce a substance, that favours the growth of thrush in your baby’s mouth. Each one should be treated accordingly: the baby with antifungals and you should consult with a breastfeeding expert to assess what steps to take. Do not apply the antifungal cream for your baby’s mouth onto your breast.

My baby does have thrush and it comes back frequently.

Sometimes it is difficult to completely eradicate thrush. It will be necessary to treat your baby with the medication prescribed by the paediatrician or healthcare professional, but if it is an older baby who crawls and puts toys and things she finds in her mouth, you need to disinfect all toys, soothers and any other items she has put in her mouth, in order to prevent her from being reinfected. If you are mixed feeding or formula feeding, you will also need to disinfect any teats and bottles that have been in contact with your baby’s mouth and this can also be done in the dishwasher.

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