White Tongue in Babies: Is It Thrush or Just Milk?

White tongue: what can it be?

Having a newborn can often mean observing them closely to catch any conditions before they progress too far. While noticing a white coating on your child's tongue might seem like a cause for worry, more often than not, it's simply milk residue left behind after feeding. In some cases, however, it could be a sign of oral thrush. There are some telltale signs for each condition that can help you differentiate the two:

White spots on the tongue: signs it’s a milky tongue

Upon observing, you may wonder 'what is that white stuff on tongue of my baby?' If your baby's tongue shows the following signs, it's quite probable that it's a case of the milky tongue:

• The white coating is restricted to only the tongue
• It generally only appears after breastfeeding, and not throughout the day
• Gently cleaning or wiping may reduce the white film on tongue, revealing a pink tongue underneath

White coating on the tongue: signs it’s a thrush

Oral thrush is a common condition affecting babies under two months old. The main cause is a yeast infection known as Candida Albicans. The fungus Candida is present in both newborns and adults, and only become an issue when it overgrows under certain conditions.

Thrush thrives in damp, warm environments (around 37 degrees Celcius or degrees Fahrenheit), making the mouth an ideal spot. Babies may contract oral thrush while passing through the birth canal, or if they're treated with antibiotics that kill off the bacteria, causing a change in the delicate natural balance of the body's flora. Studies have shown that premature babies with low birth weight are more likely to contract oral thrush than full-term babies.

Risk factors for oral thrush include neutropenia (a low level of neutrophilsa, type of white blood cell), immunocompromised status, being in the ICU, and recent use of antibiotics or corticosteroids.

The following symptoms may indicate oral thrush in your baby:

• White spots on tongue and inner cheek, and bumps on the roof of the mouth
• The white patches on tongue may be seen throughout the day
• Small, white lesions that resemble cottage cheese
• When wiped, the patches reveal red, raw, or bleeding areas
• Begin as small, white spots on the tongue and inner lip, progressing to thick, curd-like, white-coated tongue
• Baby shows discomfort or irritation when breastfeeding
• Red rashes in the diaper area (if thrush has progressed to other areas)

What to do if you suspect the white stuff on the tongue is thrush? 

If your baby is showing some of the above signs, it could point to oral thrush. But this isn't generally cause for worry, as oral thrush is easily treatable in babies. Here are some key things to keep in mind if your baby has oral thrush:

• Most cases of oral thrush clear up in 1-3 weeks without treatment, though some cases may progress and require medical treatment.
• If you consult a doctor, they may prescribe anti-fungal gels and drops to treat the condition. These often must be applied multiple times per day in your baby's mouth.
• If you are breastfeeding, you may also need to treat the nipple area, since thrush may have developed there as well. This helps avoid passing the infection back and forth between you and your baby.
• Before using any anti-fungal medicine, consult your doctor to ensure it's safe for newborns.

Oral care basics for newborns

While oral thrush is common in newborn babies, there are a few ways to help prevent it. The following pointers will ensure your baby's good oral hygiene and reduce the chances of thrush and other oral conditions:

• Clean your baby's mouth after each feeding. You can do this by dipping a soft, clean cloth in water and gently wiping your baby's mouth in circular motion.
• Massage your baby's gums after every feeding to ensure healthy and strong gums.
• If you bottle feed your baby, sterilize all parts of the bottle, including the nipples.
• Keep your nipples clean.

As a new parent, you may be wondering, 'what does a white tongue mean for my baby?' The two most common causes of white tongue are milk residue or oral thrush. If it only appears after feeding and can be wiped away without much difficulty, it's likely a milky tongue. However, if there are raised, white patches on the tongue, inner cheeks, and roof of mouth, and they're wiped to reveal raw and red skin, it may point to oral thrush. Oral thrush is a common condition in newborns, and usually clears up without treatment. If it doesn't go away on its own, you should consult a doctor. Anti-fungal gels and drops usually work well and treat the thrush without any issues.