Oral candidiasis in Child
See also in: Oral Mucosal LesionAlerts and Notices
Synopsis
Although not common in children over the age of 12 months, it may occur in children who are on antibiotics, who have an underlying endocrine disorder (eg, type 1 diabetes mellitus), or who are immunosuppressed due to primary immunodeficiency disorders or secondary to malignancy, immunosuppressive medication, or human immunodeficiency virus (HIV) infection.
The child may be symptom free or may complain of a burning tongue and soreness or pain in the mouth or pain on swallowing.
Oral candidiasis occurs in children in three main clinical forms. The most common form in children is the pseudomembranous variety: white plaque formation typically appears on the tongue, lips, inner surface of the cheeks, and palate and can leave behind punctate bleeding and patches of reddened mucosa when scraped.
In children with HIV infection, oral thrush is the most common candidal infection. The presentation, however, differs, and these children may show signs of all of the types of mucous membrane infections.
Candida at the corners of the mouth is known as angular cheilitis or perlèche. Crusting, small ulcers, or fissures can be present at the angles of the mouth.
In median rhomboid glossitis, a smooth, red, diamond-shaped area is present on the dorsal surface of the tongue.
Related topic: Angular cheilitis
Codes
ICD10CM:B37.0 – Candidal stomatitis
SNOMEDCT:
79740000 – Oral candidiasis
Look For
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- Aphthous ulcer
- Lichen planus – Usually reticulated and erythematous rather than plaque-like.
- Geographic tongue
- Diphtheria – The membrane in diphtheria can be mistaken for candidiasis, although in diphtheria there may be hemorrhagic crusts around the mouth and nares.
- White sponge nevus – There may be a family history of this very uncommon genodermatosis.
- Chronic cheek chewing
Best Tests
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Management Pearls
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Therapy
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Drug Reaction Data
Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.Subscription Required
References
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Last Reviewed:09/04/2017
Last Updated:02/10/2023
Last Updated:02/10/2023
Patient Information for Oral candidiasis in Child
Overview
Thrush (oral candidiasis), also known as oral moniliasis, is a yeast infection of the mouth or throat (the oral cavity). The yeast that most commonly causes oral candidiasis is Candida albicans.Who’s At Risk
Thrush is very common in newborn babies and infants.Other factors leading to thrush in children include:
- Diabetes or other glandular (endocrine) disorders
- Genetic disorders such as Down syndrome
- A course of oral antibiotics
- Chemotherapy
- Leukemia or lymphoma
- Poor nutrition
- Immune deficiency, such as HIV/AIDS
- Use of inhaled steroids for certain lung conditions
Signs & Symptoms
Thrush may appear as white or pale yellow spots on the inner surfaces of the mouth and throat, the tongue, and the lips. It may resemble cottage cheese or milk curds. Scraping off these membranes may be difficult and may leave slightly bleeding sores.Thrush may be accompanied by a burning sensation in the mouth or throat (oral cavity).
Self-Care Guidelines
Thrush may make eating and drinking uncomfortable, and children with thrush may lose water in their body tissues, becoming dehydrated. It is important to make sure your child maintains good nutrition and fluid intake (hydration) while infected with thrush.See your child's doctor for treatment of thrush with prescription medications.
When to Seek Medical Care
Thrush requires medication, which your child's doctor will prescribe after a visit for evaluation. If your child has an immune system deficiency, you will need even quicker and more aggressive treatment to keep the yeast out of the bloodstream and prevent it from infecting other parts of the body. Seek immediate medical attention if the white or yellow membranes of thrush are accompanied by fever, chills, vomiting, or overall illness.Treatments
Your doctor will instruct you on how to keep your child's oral cavity very clean (hygiene practices), and treatments will center on killing the overgrown yeast with anti-fungal medications:- Nystatin - This medicine must touch the yeast in order to kill it. Nystatin comes in a suspension or liquid, and also in a lozenge, called a troche. Have your child swish the suspension around the mouth and then swallow it. The lozenge dissolves in the mouth. Use the suspension and/or lozenges several times a day until the lesions are completely gone.
- Amphotericin B suspension - Swish the suspension around in the mouth and swallow it several times a day until the lesions heal completely.
- Clotrimazole lozenge - Let the lozenge dissolved in the mouth several times a day until the lesions have healed completely.
- Fluconazole pill or suspension - Swallow this medication once daily for 5-10 days.
References
Bolognia, Jean L., ed. Dermatology, pp.837, 1095, 1096, 1185. New York: Mosby, 2003.
Freedberg, Irwin M., ed. Fitzpatrick's Dermatology in General Medicine. 6th ed, pp. 2013. New York: McGraw-Hill, 2003.
Oral candidiasis in Child
See also in: Oral Mucosal Lesion