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Oral Thrush in Children – Symptoms & Treatment

Oral thrush in children is a painful inflammation of the oral mucosa, most commonly caused by herpes simplex virus type 1. It presents with blisters, fever, and mouth pain.

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Oral thrush in children is a painful inflammation of the oral mucosa, most commonly caused by herpes simplex virus type 1. It presents with blisters, fever, and mouth pain.

What is oral thrush in children?

Oral thrush (medically known as herpetic gingivostomatitis or stomatitis aphthosa) is a common and painful inflammation of the oral mucosa and gums, predominantly affecting toddlers and young children. It is most frequently caused by the herpes simplex virus type 1 (HSV-1) and typically represents the child's first encounter with this virus. The condition most commonly occurs between the ages of 1 and 5 years.

Causes

The primary cause of oral thrush in children is an initial infection with herpes simplex virus type 1. The virus spreads through close physical contact, including:

Kisses from infected adults or siblings
Sharing cutlery, drinking cups, or pacifiers
Contact with infected saliva

Less commonly, other viruses such as Coxsackie virus or bacterial infections may cause similar symptoms.

Symptoms

The illness often begins suddenly and progresses through several stages. Typical symptoms include:

High fever (up to 40 °C / 104 °F), often the first sign
Multiple small blisters on the oral mucosa, gums, tongue, and lips
Rupture of blisters forming painful ulcers (aphthae)
Severely red, swollen, and bleeding gums
Bad breath (halitosis)
Significant pain when eating, drinking, or swallowing
Increased salivation
Swollen lymph nodes in the neck
General malaise, loss of appetite, and irritability

Diagnosis

The diagnosis is typically made through a clinical examination by a paediatrician or general practitioner. The characteristic appearance of blisters and ulcers in the mouth, combined with fever and the age of the child, is usually sufficient for a reliable diagnosis. In uncertain or severe cases, a swab test for viral analysis may be performed.

Treatment

There is no specific cure; treatment focuses on relieving symptoms and supporting the body's natural defences. The illness typically resolves on its own within 1 to 2 weeks.

Pain and fever management

Age-appropriate doses of ibuprofen or paracetamol to reduce pain and fever
Topical anaesthetic gels applied to the oral mucosa, as advised by a doctor

Maintaining fluid intake

Adequate hydration is essential to prevent dehydration
Cold, soft foods and drinks such as yoghurt, ice lollies, or cooled herbal teas are well tolerated
Acidic, spicy, or hot foods should be avoided

Antiviral therapy

In severe cases or for immunocompromised children, a doctor may prescribe the antiviral medication aciclovir

When to see a doctor?

Parents should seek medical attention promptly if the child:

Is barely drinking and shows signs of dehydration (dry nappies, dry lips, sunken eyes)
Has a very high fever (above 39.5 °C / 103 °F) lasting more than 2 days
Is a newborn or infant under 3 months of age
Has a severely compromised immune system

Prevention and infection control

As oral thrush is highly contagious, the following measures are recommended:

Avoid kissing children when you have an active herpes lesion (cold sore)
Do not share cutlery, drinking vessels, or pacifiers
Wash hands regularly and thoroughly
Children with active infection should temporarily stay home from nursery or school

References

World Health Organization (WHO): Herpes simplex virus fact sheet. Geneva, updated edition.
Amir J. et al.: Clinical aspects and management of herpetic gingivostomatitis in children. Paediatrics and Child Health, 2020.
Fatahzadeh M., Schwartz R.A.: Human herpes simplex virus infections: epidemiology, pathogenesis, symptomatology, diagnosis, and management. Journal of the American Academy of Dermatology, 57(5): 737-763, 2007.

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