Baby thrush (oral thrush) is a common condition caused by candida infection (fungal infection) and mostly affecting new-born babies. Thrush can affect breastfeeding mothers (thrush present in the breast) and babies, with thrush affecting the inside of the mouth or causing a nappy rash. This post will focus on the treatment of oral baby thrush. Parents have only one option for baby thrush treatment – over the counter antifungal oral gel (Daktarin Sugar-Free 2% Oral Gel), which be purchased from pharmacies only. Certain restrictions apply for the supply of Daktarin Oral Gel. This post will focus on the treatment of oral thrush in babies. The nappy rash in babies can be treated with over the counter antifungal cream called clotrimazole.
Symptoms of baby thrush
Oral thrush in babies usually affects the tongue; however, it may also spread to chicks. The main features of oral thrush include:
- patches, which cover the tongue, cheeks or gums
- patches are curd-like, white, or yellow plaques (coating)
- the white layer may be present on the lips
- may be accompanied by the presence of a nappy rash
Causes of baby thrush
Generally speaking, babies are more prone to oral thrush infections due to a weaker immune system as compared with adults, for example. Other causes of oral thrush in babies:
- A recent course of antibiotics, which affects the presence of ‘good bacteria’, which have protective properties
- Use of inhaled steroid inhalers (common side effect)
Baby thrush treatment over the counter – restrictions on supply
As I mentioned in the introductory paragraph, Daktarin Oral Gel I the only medicine available for the baby thrush treatment over the counter. Daktarin is a sugar-free, orange flavour oral gel which contains 2% of miconazole, an antifungal drug.
The following restrictions exist on the availability and supply of Daktarin Oral Gel:
- Daktarin Oral Gel is a pharmacy-only medicine. It can only be purchased from registered pharmacies, including an online chemist.
- Daktarin Oral Gel is licensed for the treatment of oral baby thrush from 4 months of age.
Parents of children younger than four months should speak to the GP, who may prescribe (outside of its license) the same gel or an alternative product – oral nystatin suspension.
When left untreated, the oral fungal infection will often persevere. Oral thrush can spread in the body; therefore, treatment is always recommended.
How to use Daktarin Oral for baby thrush?
Follow the directions found in the leaflet of the product.
For babies and children from 4 months of age to 2 years old:
- Daktarin Oral gel should be applied four times a day after meals.
- 1.25ml of the gel (one quarter a measuring spoon) should be placed at the from on the mouth. The gel should not be applied to the back of the throat, to avoid chocking.
- Treatment should be continued for seven days after the symptoms are cleared.
- The gel can be applied directly to the affected area with a clean finger.
Daktarin Oral Gel – common side effects
Common side effects of Daktarin Oral Gel include:
- Feeling sick (nausea)
- Being sick (vomiting)
- Dry mouth
- Regurgitation (bringing swallowed gel back again to the mouth)
In one clinical trial involving children, nausea and vomiting were classified as ‘very common’ side effects whereas regurgitation a ‘common’ side effect (eMC, 2020).
Less commonly, Daktarin Oral Gel may cause:
- severe allergic reactions characterised by face, lip, tongue or throat swelling and breathing difficulties.
- Severe skin reactions
Both side effects require product discontinuation and contact with a doctor.
Baby thrush – concomitant treatment of mother’s symptoms
Mothers who breastfeed their babies may experience fungal infection on their nipples, which can be easily transferred from the baby’s mouth and vice versa. The main symptoms of a fungal infection present on the nipples may include newly developed pain of the nipple(s), very often lasting beyond the feed.
The fungal infection, however, needs to be distinguished from other conditions which may affect breastfeeding moms, such as mastitis or breast abscess.
How is a fungal infection on the nipple treated?
NHS recommends treatment of both baby and breastfeeding mother, regardless of whether one or the other has symptoms. Daktarin Oral Gel should not be applied to the nipples to treat a fungal infection on the mother’s breasts.
Thrush in breastfeeding mothers can be treated with over the counter antifungal cream, such as clotrimazole, which needs to be applied after feeding, on and around the nipples.
If no improvement is seen is seven days, mothers should seek advice from a GP.
Baby thrush – Failed over the counter treatment
Miconazole oral gel (Daktarin Oral Gel) is recommended as the first choice in baby thrush treatment – over the counter and when prescribed. Nystatin suspension (prescription-only medication) is offered when miconazole oral gel is not suitable or when miconazole little or no effect (NICE, 2017).
Patients/parents of children who did not respond to the treatment with over the counter Datarin gel (7 days), should contact their GP for an advice.
Alternative options for baby thrush treatment over the counter
Miconazole oral gel (Daktarin Oral Gel) is the only over the counter antifungal medicine. No alternative products/drugs can be purchased for the treatment of oral thrush in babies.
Oral thrush in babies – FAQ
How can I treat my baby's thrush at home?
Baby thrush can be treated at home with over the counter antifungal cream called Daktarin Oral Gel.
Can pharmacist treat baby thrush?
A pharmacist can sell Daktarin Oral Gel for the treatment or oral thrush in babies 4 months and older.
Should I take baby to doctor for thrush?
Babies with symptoms of oral thrush can be treated at home with over the counter antifungal gel. Medical advice should be seen if no improvement is seen in 7 days of starting the treatment.
Can I buy oral thrush treatment over the counter?
Daktarin Oral Gel is a pharmacy-only medication which can be purchased over the counter for the treatment of oral thrush.
eMC (2020). SmPC: Daktarin Sugar-Free 2% Oral Gel. Available at: https://www.medicines.org.uk/emc/product/6597/smpc Accessed on 20/10/2020
NICE (2017). Candida – oral. Scenario: Treatment of oral candida in children. Available at: https://cks.nice.org.uk/topics/candida-oral/management/children-not-immunocompromised/ Accessed on 20/10/2020