Oral cavity of a baby: what should you pay attention to?

Features of the oral cavity

The mucous membrane of a healthy child's mouth is bright pink due to the large number of blood vessels. As she grows older, her shade fades.

The epithelial layer is distinguished by tenderness and vulnerability, as well as some dryness due to the not very active work of the salivary glands (up to 3-4 months).

The baby's mouth is ideally suited for sucking. A wide tongue, a fold on the gums formed by the mucous membrane, pads on the inside of the lips, a “suction cup” on the upper lip - all this provides a tight grip on the bottle or nipple and facilitates the process of obtaining food.

What features or problems can be detected by looking into a baby’s mouth? Main options:

1. white bumps on the palate;
2. abnormal appearance or position of the tongue;
3. white plaque on the inside of the mouth.

"Epstein's Pearls"

In 65-85% of babies after birth, several yellow-white tubercles with a diameter of 1-3 mm are found along the palatine suture. They are called palatal cysts or “Epstein's pearls.”

They are formed from residual fragments of the epithelial lining, which is destroyed under the influence of enzymes during fetal development. Epstein Pearls are filled with keratin.

Palatal cysts do not require treatment and do not cause discomfort to the child. They atrophy on their own in the first months of life.

Language

Normally, the tongue is located along the midline of the jaw. If there is a constant deviation (recession) to the right or left, parents should show the child to a neurologist. This symptom may indicate damage to the caudal group of nerves of the skull. An additional sign is a drooping soft palate.

Another reason to seek help is that the language is too broad. This symptom is observed with hypothyroidism (decreased functional activity of the thyroid gland) and some genetic syndromes.

The listed phenomena are rare, unlike a short hyoid frenulum. This minimal anomaly in the structure of the maxillofacial apparatus can be determined visually; in addition, when screaming, the tip of the baby’s tongue rises. A short frenulum is not dangerous, but it can make sucking difficult and, in the future, complicate the pronunciation of sounds. In infancy, it is easily cut with a scalpel in an outpatient setting without suturing and virtually no blood.

White plaque

The tongue and palate of an infant may be covered with a thin whitish coating. Main reasons:

• leftover food;
• mouth breathing;
• thrush.

Leftover food

Immediately after feeding, you can see the remains of breast milk or formula on the baby's tongue and palate. After some time, the plaque disappears on its own. Many pediatricians advise removing traces of food from the baby’s mouth, as they serve as a breeding ground for opportunistic microorganisms.

Cleaning methods:

1. give the baby 1-2 teaspoons of boiled water immediately after feeding;
2. wipe the epithelial membrane 2 times a day with soda solution or water (the procedure is described below).

If the plaque is easily removed or disappears on its own (it is not present before feeding), do not worry. But in cases where white marks on the tongue, palate and inner surface of the cheeks are constantly present, it is necessary to consult a doctor.

Mouth breathing

If a child breathes through his mouth, his mucous membrane dries out and a whitish coating forms on it. In children under one year of age, this phenomenon is most often caused by acute respiratory viral infections and dry air in the room, which leads to the formation of crusts in the nasal passages.

The only way to prevent the formation of white plaque is to restore nasal breathing in the baby. Basic methods:

• when the mucus dries out, instill saline and oil drops into the nose, as well as humidify the air;
• for a runny nose and congestion due to ARVI - similar measures, in addition, the doctor may recommend the use of vasoconstrictor drops (no longer than 5-7 days).

Location of plaque on other parts of the body

White plaque on a baby's butt and groin can be caused by a large number of skin folds, which cause severe friction of the skin. It is in these places that various bacteria often multiply. White plaque in a baby's groin can cause a very unpleasant odor.

In some cases, a white coating appears behind the ears of the baby. This is not a serious problem since the ears are an exposed part of the body. To treat white plaque in the ears of a baby, it is enough to apply Bepanten ointment to the affected area after the doctor’s permission.

White plaque in a baby's armpits may appear for the same reason as in the groin area. Due to skin friction, diaper rash and plaque may appear here. Irritation in this area is also common.

The essence and causes of thrush

Microscopic yeast-like fungi of the genus Candida live on the mucous membranes and skin of every person. They do not cause harm to health, but only if the immune system suppresses their active reproduction. Otherwise, an inflammatory disease called candidiasis occurs. If fungi colonize the oral mucosa, candidal stomatitis, or thrush, is diagnosed.

The disease is detected in 4-5% of infants. Its main reasons:

1. low level of immunity, characteristic of all newborns;
2. decrease in protective forces as a result of teething, acute respiratory infections, dysbiosis, intestinal infection, and so on;
3. non-compliance with hygiene standards - insufficient cleaning of children's dishes, toys, mother's skin (during breastfeeding);
4. antibiotic treatment, which disrupts the balance of bacteria on the mucous membranes;
5. drinking sweet tea, water, compote or a mixture - leftover sugar in the mouth contributes to the growth of fungi.

In addition, a baby can “get” too many candida when in contact with adults. Most often, infection occurs during childbirth if the mother has genital thrush. Kissing and sharing utensils can also lead to infection if an adult has candidal stomatitis.

What kind of disease is candidiasis?

According to statistics, about 30% of infants experience candidiasis. The causative agent of the disease is Candida fungus. These specific microorganisms are normally present in the body of every person, even in the absence of health problems, but only in small quantities.

Oral candidiasis in children is much more common, since the immune system of children is not yet formed and is not able to resist pathogenic microorganisms and the effects of negative external factors.

With weakened immunity and the concomitant influence of provoking factors, the fungus begins to actively multiply, affecting the mucous membranes. Without therapeutic treatment, candidiasis is eliminated in exceptional cases. Much more often, if thrush is not treated, complications arise, and the infection itself spreads throughout the body.

Symptoms of oral candidiasis

The main sign of thrush in an infant is a permanent white coating, reminiscent of cottage cheese or yogurt, on the tongue, palate, gums, inner surface of the cheeks, and lips. At first it looks like small spots (“plaques”), which gradually grow. If you remove them with a bandage, a bright red inflamed mucous membrane is revealed.

As the disease progresses, the white spots become yellow or grayish. Small bleeding erosions form under them. The child experiences discomfort, therefore behaves restlessly and sleeps poorly. When sucking, the unpleasant sensations intensify, as a result, many infants refuse to eat.

In severe cases, fungal microflora leads to the formation of a dense film on the oral mucosa. Over time, it spreads to the throat, tonsils, esophagus and internal organs. The child may have a fever and a significant deterioration in general condition.

Symptoms of the disease

As a rule, the highest concentration of fungus is found on the surface of the inside of the cheeks, tongue, pharynx and tonsils, and palate. At an early stage of the development of the disease in children, redness of the mucous membranes is observed; they become swollen, the sensitivity of the mucous membrane increases, which is why children are often irritable, capricious, and their appetite and sleep are disturbed. The primary episode of the disease usually occurs in a more acute form; Patients may experience general symptoms: fever, headaches and dizziness, nausea or vomiting, deterioration in general health.

Some time after the onset of the disease, white grains begin to appear on the surface of the mucous membranes of the oral cavity, which gradually increase in size and merge together, forming plaques, and then plaque covering large areas of the mucosa. During this stage, patients suffer from severe dryness and swelling in the mouth. The mucous membranes become painful. Burning, itching and other unpleasant sensations are most often associated with the development of an allergic reaction caused by the proliferation of pathogenic microorganisms and the release of toxins during their life processes. The pain intensifies when eating and swallowing food, when eating hot, sour, spicy foods and drinks. Infants often refuse to eat.

The plaque formed during candidiasis has a very characteristic appearance and resembles milk films or remains of cottage cheese. It consists of destroyed cells of the mucous membranes, food debris, bacterial mass, fibrin and keratin. Flakes, scales and plaque can also appear outside the mouth - on the edges of the lips. The spread of infection to the lips is called candidiasis. Because of this disease, the skin in the corners of the lips dries out and cracks; In some cases, the infection affects the entire surface of the lips, resulting in cracking and peeling.

In mild and moderate forms of the disease, plaque is easily scraped off, and underneath it, areas of erosion (ulceration) or maceration (softening) of the mucous membrane are found. A longer course of the disease and the lack of adequate treatment leads to deep damage to the mucous membranes, as a result of which blood appears on their surface, turning the plaque brown or brownish.

Help for thrush

A pediatrician may suspect thrush based on an examination of the oral cavity. To confirm the diagnosis, it is worth taking a swab from the throat and determining the state of the microflora. If the number of Candida fungi exceeds the norm, the child has candidal stomatitis.

Local treatment

In most cases, local treatment of thrush is carried out in infancy. The safest method is to wipe the oral mucosa with baking soda. Stages:

1. Prepare a weak solution of soda - 1 small spoon per 1 glass of boiled warm water.
2. Wrap a sterile bandage around your clean index finger.
3. Soak the bandage in a soda solution.
4. Wipe the baby's mouth. There is no need to try to remove the plaque, just carefully treat it from above.

The procedure should be repeated every 2-3 hours for several days. If the child does not open his mouth, you should press your finger on the chin and hold it.

Another method of treatment is wiping the mouth according to the scheme described above with a solution of honey and warm water (in a ratio of 1:2). Honey has antimicrobial and anti-inflammatory effects. But you should remember that it is a very strong allergen.

If traditional methods do not help get rid of stomatitis, the doctor may prescribe external antifungal agents. Here are some of them:

• acidophilus powder;
• Candide solution;
• nystatin ointment;
• Shostakovsky balm;
• gentian violet solution and so on.

The method of their use is indicated in the instructions. Usually it is necessary to apply an ointment or solution to the mucous membrane several times a day. The duration and dosage are determined by the doctor.

Systemic drugs

In case of advanced candidiasis, systemic antimycotics are prescribed in parallel with local remedies in a dosage that is safe for a small child. The main drugs are Diflucan, Mycomax, Nystatin, Amphotericin B, Ketoconazole. They should be given to the baby for 5-10 days. It is important to follow the treatment period determined by the doctor, even if the symptoms of candidiasis have disappeared.

If your baby suffers from pain, you can give him ibuprofen in an age-appropriate dosage or paracetamol. In addition, it is advisable to use local analgesic gels, which are used during teething.

Along with the destruction of fungal flora, it is important to pay attention to increasing the child’s immunity. According to the doctor's decision, it is worth giving him B vitamins. If dysbiosis is present, it must be treated. It is recommended that a nursing mother undergo antifungal therapy with her baby, even if she has no symptoms.

Treatment

Fungal diseases in children can be treated by a pediatrician, an infectious disease specialist or a dermatologist. If we are talking about the treatment of oral thrush, then therapy can also be carried out by a dentist.

The diagnosis of candidiasis is determined in most cases based on an examination of the oral cavity performed by a specialist. If there is any doubt, the doctor refers the patient for additional examinations. More often, to confirm the disease, a laboratory test is used to test a smear taken from the mouth for the presence of fungus.

Treatment of thrush in children requires an integrated approach. If the disease is not advanced, then local therapy is carried out in combination with measures to strengthen the immune system. In severe cases, oral candidiasis in children is treated with systemic drugs, local agents and compliance with preventive recommendations.

Prevention

The risk of developing candidal stomatitis is especially high in the first 6 months of a baby’s life, since his immune system is just developing. To prevent disease, it is important to follow the following rules:

1. rinse your breasts with clean water before feeding;
2. offer the baby some water after a meal or burping;
3. strictly observe the rules of hygiene for all adults in contact with the child;
4. Regularly sterilize bottles and pacifiers.

After an illness, to prevent re-infection, it is worth boiling all toys and children's dishes. If the item cannot be treated with hot water, it is recommended to rinse it with a soda solution.

The main reason for a white palate in a baby is the accumulation of food debris in the mouth after feeding. Traces of formula or milk disappear on their own and are not visible before the next meal. Persistent plaque in most cases is a sign of candidal stomatitis (thrush). This disease is treated with local and/or systemic agents with an antiseptic effect. At the initial stage, thrush is not dangerous, but as it progresses it can lead to the formation of ulcers on the mucous membrane and the spread of infection.

Risk group

The risk group for the development of oral candidiasis are those children who require regular examination of the oral cavity by their parents and timely implementation of preventive measures.

There is an increased risk of white spots in a child's mouth if:

• The baby is premature (this applies to neonatal candidiasis, when white spots appear in the mouth of an infant)
• The mother is sick with candidiasis (infection can occur during birth through the mother’s contaminated birth canal or after it due to infection while caring for the baby)
• The child has chronic inflammatory foci in the oral cavity (caries), nasopharynx and oropharynx (tonsillitis, sinusitis, etc.)
• The child suffers from viral infections that sharply suppress the immune system (herpetic, cytomegalovirus, etc.)
• Patients from oncohematology clinics
• Children with positive HIV status
• Intestinal dysbiosis
• Increased susceptibility to allergic reactions
• Children with anemic syndrome
• Children with underweight (hypotrophy).

If a child has at least one of the risk factors listed above, then this is a compelling argument for observing the following rules:

1. Brushing your teeth after every meal (use special children's toothpastes)
2. Regular dental examinations at least once every 6 months
3. Periodically rinsing the mouth with decoctions of medicinal plants with antiseptic and anti-inflammatory properties
4. Taking antibiotics and corticosteroids only as prescribed by a doctor, strictly following his recommendations
5. Limiting a large amount of sweets in the diet, because... glucose is an integral component of the existence of candidiasis (a child should generally limit sweets, as this significantly increases the risk of not only candidiasis, but also multiple caries).