What Causes a Baby to Have a White Tongue?

Baby with white tongue

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Two conditions that cause a baby’s tongue to appear white are oral thrush and milk residue. Both are common and can create a thick, white coating on the tongue resembling cottage cheese. Neither condition is serious in healthy infants—although thrush can cause some irritation. Both are highly treatable.

Other oral conditions, such as Epstein pearls (tiny, harmless cysts that are usually white or yellow in appearance), are also common in babies, but these typically appear on the gums or roof of the mouth and not the tongue.

Oral Thrush

Oral thrush can affect anyone, but it’s most common in very young babies from about 1 month to 9 months of age. Research indicates it affects between up to 37% of infants in the first month of life, occurring equally in females and males and those born vaginally or through cesarean section.

Oral thrush, which occurs in both breastfed and bottle-fed babies, generally appears on the parts of the mouth involved with sucking, including the tongue, outer corners of the mouth, and inner lips and gums.

Causes

Thrush is a yeast infection most often caused by Candida albicans, a naturally occurring fungus present in the gut and mouth. In most cases, our body’s immune system keeps the yeast from growing out of control. But babies have immature immune systems, making them more susceptible to infections from fungi and bacteria.

What’s more, the mouth—with the dark, warm, moist environment that yeast favors—is the perfect place for Candida albicans to take up residence and flourish.

Babies can also develop oral thrush if they’re delivered vaginally to a mom with an active yeast infection or if they’re given antibiotics or steroids, which can kill some of the body’s good bacteria that keep yeast in check along with the disease-causing bad bacteria.

Symptoms

Oral thrush usually appears as creamy, white, slightly raised bumps on the:

  • Tongue
  • Inner lips
  • Gums
  • Roof of mouth
  • Back of throat

These bumps can sometimes merge, giving the appearance of a white—sometimes yellowish—coating in the mouth.

A baby with thrush may also have cracks in the corners of the mouth and can be irritable, especially when trying to feed. The patches can make sucking and swallowing uncomfortable—although many babies won’t experience any discomfort. Thrush can’t be scraped or wiped away and may bleed slightly if you try. 

Treatment

Your baby’s healthcare provider can often diagnose oral thrush just by looking in your baby’s mouth. Treatment will depend on severity:

  • Mild cases that don’t seem to be affecting your baby’s feeding may not need any treatment at all and will go away in a week or two.
  • Moderate to severe cases need treatment, usually with an antifungal medication like nystatin, which is applied directly to the white patches using an applicator (or via drops) several times a day. 

Prolonged sucking can irritate an already sore mouth. You may try these tactics:

  • If you’re breastfeeding, limit feeding to 20 minutes per feeding. 
  • If you’re bottle-feeding and your baby is resisting, try feeding with a dropper. 
  • If your baby takes a pacifier, use it sparingly.

Oral thrush usually improves with treatment in four to five days. Call your healthcare provider, however, if your baby:

  • Isn’t eating well
  • Is particularly fussy
  • Develops a fever

Preventing Spread of Thrush

Oral thrush is highly contagious. Take these measures to prevent spread:

  • If you’re breastfeeding and your nipples are red, painful, or cracked, see your healthcare provider. You might also have a yeast infection that you and your baby are passing between you.
  • If you’re bottle-feeding, place bottle nipples and pacifiers in the dishwasher (or wash with hot, soapy water) after each use to kill any yeast. 
  • Store prepared formula or bottled breast milk properly (for example, in the fridge overnight) to prevent yeast growth. 

Milk Residue (Milk Tongue)

Not every white coating on the tongue is thrush. Sometimes it’s something completely innocuous, like what stays clinging to the tongue after a baby nurses or is given a bottle.

Causes

A young baby’s sole diet should consist of either breast milk or infant formula—so seeing a white coating on your baby’s tongue, especially after a feeding, isn’t all that surprising. It may be even more pronounced if your baby is a newborn, as babies younger than 3 months of age naturally produce less residue-cleansing saliva than older babies and children.

Symptoms

Unlike thrush, which can affect the whole mouth and even its outside corners, milk residue only affects the tongue. It’s hard to distinguish between the two just by looking, but milk residue can be gently scraped away whereas thrush cannot.

Cleaning Your Baby’s Tongue

After thoroughly washing and drying your hands, wrap a clean piece of gauze slightly dampened with tepid water around your finger and gently wipe your child’s tongue. If the milky residue is easily removed, your child likely has milk tongue and not thrush.

Treatment

Milk residue doesn’t need any treatment. It comes and goes and won’t give your baby any pain or discomfort. Milk tongue generally disappears as babies start developing teeth and eating solid foods. This is also when saliva production picks up, helping to rinse the mouth of milk and food particles.

A Word From Verywell

If you notice a whitish, bumpy coating on your baby’s tongue, it could be one of two relatively harmless conditions: thrush or milk residue. Milk residue is a byproduct of your baby’s diet and can easily be wiped away. But thrush remains on the tongue and can also appear on the gums, roof of the mouth, and inner creases of the lips.

If your baby is otherwise healthy, neither of them necessarily require treatment. Yet, if the thrush seems extensive and/or is making your child resistant to feeding or causing discomfort, don’t hesitate to contact your child’s healthcare provider. Thrush responds very well to antifungal medication.

Be sure to practice good bottle and breast hygiene to prevent reinfection with thrush. Wash bottles and nipples in warm, soapy water or the dishwasher (some experts advise boiling them while others say it’s unnecessary) and if your breasts are displaying signs of a yeast infection (they’re red, sore, or your nipples are cracked) call your healthcare provider for guidance.

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Article Sources
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