Newborn Q&A
Q:My three-month-old baby is on formula and has recently developed white spots on his tongue from what looks like a build-up of milk residue. I’ve tried cleaning his tongue with a damp facecloth, but it doesn’t seem to help. I’ve been told by some friends to clean his mouth with glycerine, but then I’ve also heard this is not safe to do – is this true? Could this be thrush, and if so, how should I treat it?
A:Dr Strachan answers: White residue in the mouth of a baby is either milk deposits, thrush or the normal papillae of the tongue.
Milk deposits are normal and appear on the tongue as a white covering that dissolves with rubbing or comes off very easily with a wipe. This residue may also appear on the inside of the cheeks, usually just after a feed, and it comes off by wiping with a finger or a cloth. It’s not painful for your baby and does not interfere with feeding. In fact, in the vast majority of cases, if you leave the white tongue alone, the saliva before the next feed will digest the residue. Rubbing glycerine or any other oral gel is of no value and is actually unnecessary. However, glycerine is not harmful, but if ingested in large quantities will cause diarrhoea.
Thrush is caused by the fungus Candida albicans. This fungus grows best in dark, warm and damp places. The thrush in the mouth occurs mainly on the tongue, on the inside of the cheeks, on the gums and inside the lips. This can cause discomfort for the baby and may well interfere with feeding. The thrush is white in colour and can look like cottage cheese in the mouth. These white marks do not come off or wipe away easily, and if you really try hard to wipe them off, they will come off but leave a bleeding area to heal.
If you are breastfeeding, the thrush is very likely to have been transferred to your nipples, and so they may be a little sensitive and itchy. You can treat this by using a good anti-fungal cream for the nipples and an oral preparation for the mouth – either Daktarin oral gel or nystatin solution.
If your baby has thrush in the mouth and you’re bottle-feeding, the teats of the bottles and the bottles themselves will have thrush in and on them too. Dummies and any other toys that baby puts into his mouth will also be infected. All bottles, teats, toys and dummies will have to be sterilised. Remember that sterilising bottles and teats on an ongoing and frequent basis is of no value unless the person preparing the bottles remembers to wash their own hands. Try to make bottles as you need them rather than preparing them in batches.
If oral thrush is severe, it may pass through your baby’s intestines and appear on the anus and genital area as a red rash that spreads in red dots (called satellite lesions). This will need an anti-fungal cream, not an antibiotic or cortisone cream. In worst cases an oral anti-fungal medicine is used.
The tongue papillae are right at the back and on the surface of the tongue. They look like little eruptions or pits. These are part of the tastebud system and are normal.
Small white lumps on the top of the palate are called Epstein’s pearls and are just an accumulation of mucus under the lining of the palate. They disappear with time. YB