Oral Candidiasis in a Breastfed Infant: Treat the Mother As Well?

I read with interest Dr Alexander K. C. Leung and Dr Alex H. C. Wong’s “What’s Your Diagnosis?^®” quiz featuring a 3-month-old girl with oral candidiasis (CONSULTANT FOR PEDIATRICIANS, September 2012, page 279). The child had been born to a 24-year-old, gravid 2, para 1 mother at 37 weeks’ gestation after an uncomplicated pregnancy and normal spontaneous delivery. The infant had presented with a white tongue (Figure). The child was breastfed and healthy, and neither she nor her mother had been taking an antibiotic.

My question is whether the mother had complained of sore nipples. If a breastfed infant has candidiasis, so does the mother. They both need to be treated, at same time. All Purpose Nipple Ointment (APNO) works very well for the mother. The infant’s infection may resolve with nystatin gtts; if it does not improve, fluconazole gtts can be tried.

—— Pat Young, APN, IBCLC

Oral candidiasis is the most common fungal infection in the oral cavity of infants and children.¹ Several species of Candida can colonize the oral cavity and result in candidiasis. Candida albicans is the species most often associated with oral candidiasis. The condition affects 2% to 5% of otherwise healthy newborn infants.¹ The incidence is higher in premature and very low birth weight infants. Candida can be acquired at delivery during passage through an infected birth canal, during nursing from the skin of the mother’s breasts, and from contaminated fomites such as pacifiers and bottle nipples.

We agree with the reader that the affected infant can be treated with nystatin gtts and fluconazole gtts should be reserved for resistant cases, as was stated in our article.²

Although studies are limited and the knowledge is evolving, most lactation consultants would agree that breast feeding mothers of infants with oropharyngeal candidiasis, with or without nipple symptoms from candidiasis, would benefit from treatment with an antifungal cream such as nystatin cream or the All Purpose Nipple Ointment (APNO) (a combination ointment of mupirocin 2% ointment [15 g], betamethasone 0.1% ointment [15 g], and miconazole powder added to a concentration of 2% miconazole of the final product).

—— Alexander K. C. Leung, MBBS,
 RCPC, FRCP(UK&Irel),
 RCPCH, FAAP
Clinical Professor of Pediatrics
The University of Calgary
Pediatric Consultant
The Alberta Children’s Hospital
Calgary, Alberta, Canada

—— Alex H. C. Wong, MD, CCFP
Clinical Assistant Professor of
 amily Medicine
The University of Calgary
Calgary, Alberta, Canada

REFERENCES:

1. Leung AK. Oral candidiasis. In: Leung AK, ed. Common Problems in Ambulatory Pediatrics: 
Specific Clinical Problems, volume 2. New York: Nova Science Publishers, Inc., 2011, pp133-136.

2. Leung AK, Wong AH. Oral candidiasis. Consultant for Pediatricians. 2012;11(9):279-280.