Stomatitis in a newborn baby: signs, how and what to treat

Stomatitis in newborns is an inflammation of the mucous membrane of the oral cavity in an infant. This causes a lot of unpleasant sensations, first of all, it disrupts the process of feeding the child, which indicates a big problem of such a disease. Knowledge of the etiology and pathogenesis of the development of this disease is very important, since the treatment tactics differ for different types of pathology.

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Epidemiology

Statistics on the spread of stomatitis indicate that in most cases this pathology occurs in children who after birth required invasive interventions or long-term antibacterial therapy. More than 65% of cases of stomatitis in newborns are of fungal etiology, and about 30% of bacterial origin. This indicates not only the etiological features, but also the treatment tactics that need to be used.

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Causes neonatal stomatitis

To understand what stomatitis is, you need to understand the concept of normal microflora of the child's oral cavity and the factors that affect it. In total, there are more than 100 different types of microorganisms in the oral cavity, but the mucous membrane of the child's oral cavity has slightly fewer bacteria. They get on the mucous membrane immediately after birth, and the first way is through the birth canal. Therefore, the bacteria that the mother has are transmitted to the child. This is the primary colonization of the oral cavity with the flora that is opportunistic. The next way is the direct entry of bacteria with food. For a newborn, the main nutrition is breast milk, so most of the bacteria that get in with food are lactobacilli and bifidobacteria. They live in the intestines, but still some amount can be in the oral cavity. In addition, in the oral cavity of a child under normal conditions there are non-pathogenic types of streptococci, veillonelle, and some types of fungi. All these bacteria are in a minimal amount, in which they cannot cause disease. On the contrary, they play the role of flora, which inhibits the growth of pathogenic microorganisms. But under certain conditions, this balance can be disturbed, and then pathogenic bacteria or fungi increase in number. These processes lead to the development of an inflammatory process of the mucous membrane, which is stomatitis. Thus, the pathogenesis of stomatitis development lies precisely in the fact that the amount of pathogenic flora increases, which causes inflammation.

The causes of stomatitis in newborns are primarily disturbances in the colonization of flora already in the neonatal period. The main cause in this case can be considered the mother's diseases that disrupt the microflora of the genital tract. Such diseases include bacterial vaginosis, vaginitis, inflammatory diseases of the ovaries and genitals. All these pathologies lead to the fact that the normal flora dies, and the child comes into contact with pathogenic flora at birth. This disrupts the ratio of bacteria in the child's oral cavity, which subsequently causes stomatitis.

Speaking about other causes of stomatitis in newborns, it is necessary to talk about the etiology of the disease. Stomatitis can be bacterial, viral and fungal. Viral stomatitis is often caused by the herpes virus. This type of stomatitis in newborns is less common, since the route of infection is contact. Fungal stomatitis is an inflammation of the oral mucosa, which is caused by fungi, most often Candida. The cause of such stomatitis can be long-term treatment of the child after birth with glucocorticoids and other drugs. This is due to the fact that any antibiotic kills not only pathogenic flora, but also normal flora of the oral cavity, which leads to active reproduction of fungi. Glucocorticoids by the mechanism of action lead to suppression of the immune response, which can also be the cause of decreased reactivity of the oral cavity. Often, children after birth who have breathing problems are on artificial ventilation. This leads to the fact that catheters that are in the oral cavity of a newborn are risk factors for the proliferation of pathogenic flora. And a frequent complication of such treatment is precisely stomatitis of fungal or other etiology.

Bacterial stomatitis in newborns is one of the most common pathologies. The cause of such inflammation in babies is often long-term antibacterial therapy. Such treatment leads to inhibition of the growth of normal flora along the entire gastrointestinal tract, including the oral cavity. Therefore, favorable conditions are created for the growth of pathogenic bacteria, which leads to the development of stomatitis. The most common pathogens include pathogenic strains of staphylococcus, hemophilic bacillus, neisseria, and bacteroides.

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Risk factors

Risk factors, based on the causes of stomatitis, can be identified as follows:

1. diseases of the mother's reproductive organs, which during pregnancy pose a risk of infection to the baby;
2. surgical or other invasive interventions immediately after the birth of the child (artificial respiration apparatus, esophageal catheterization, meconium aspiration during childbirth);
3. congenital malformations of the gastrointestinal tract that disrupt the entire digestive process;
4. dysbacteriosis in a child;
5. congenital immunodeficiencies, which are accompanied by a decrease in immune protection;
6. massive antibacterial therapy in the child immediately after birth.

Such risk factors must be taken into account before starting treatment of the child and interventions that may lead to such complications must be minimized.

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Symptoms neonatal stomatitis

Symptoms of stomatitis in newborns vary slightly depending on the etiology. But there are some similar manifestations, and these are, first of all, rashes on the mucous membrane. If the cause of stomatitis is a viral infection, then the rashes on the mucous membrane have a characteristic appearance. The first signs of herpetic stomatitis are the appearance of vesicle-shaped rashes in the child. These are small bubbles that rise above the surface of the mucous membrane and are filled with liquid inside. But after a while, these bubbles burst and ulcers or aphthae are formed. This causes very unpleasant sensations in the child and pain. Aphthous stomatitis in a newborn is a process of herpetic etiology, which requires immediate action. Most often, the mother cannot notice single rashes, and simply pays attention to the fact that the child began to eat poorly. This may be the first manifestation of stomatitis. This is because the vesicles cause itching and burning with any touch, so the child cannot eat normally. If you look at the mucous membrane, then with viral stomatitis you can see small ulcers that have formed at the site of the vesicles. Sometimes this process is limited only to the mucous membrane of the tongue and cheeks, but it happens that the virus also affects the mucous membrane of the lips. In newborns, herpetic stomatitis is less common than other types of inflammation. Clinical manifestations of such a pathology have characteristic signs, so it is not so difficult to recognize a disease of herpetic etiology.

The first signs of bacterial stomatitis in a newborn usually appear some time after the start of treatment with antibiotics or glucocorticoids. A mother can see the first signs of the disease in her child when the child refuses to eat. Bacterial stomatitis is characterized by the proliferation of bacteria on the mucous membrane and its damage in the form of white dots. When these foci merge, it seems that the mucous membrane of the child's oral cavity is white. Symptoms of fungal stomatitis have a similar course. The elements of the rash with massive proliferation of fungi also have the color of white dots that cover the entire mucous membrane from the inside of the oral cavity. Sometimes such rashes can be located only on the back wall of the child's throat, and this is very difficult to distinguish from tonsillitis. Therefore, additional research methods are so important, which can accurately establish the etiology of such a process. Fungal stomatitis is most often caused by Candida. This is a fungus that is present in the oral cavity in small quantities and its growth is inhibited by other beneficial bacteria. But after antibacterial therapy, the process cannot be controlled by these bacteria, which causes massive growth of Candida. Candidal stomatitis in newborns is very common, especially in premature babies, which can also be caused by the immaturity of the baby's own beneficial flora.

Other manifestations of stomatitis are an increase in body temperature, refusal to breastfeed or eat any other food, as well as restlessness and capriciousness of the baby. Since stomatitis is caused by a viral, bacterial or fungal infection in the body, this is accompanied by an increase in body temperature. Such an increase can have different meanings from subfebrile numbers to high values. All this only indicates the presence of an infection in the body. Rashes in the oral cavity cause itching and burning, so the child cannot eat anything and refuses the breast or even just a pacifier. Such symptoms, in the absence of other possible causes of an increase in body temperature, should prompt the mother to think about possible stomatitis.

Complications and consequences

The consequences of stomatitis, if this problem is ignored for a long time, can lead to a disruption of the flora of not only the oral cavity, but also the intestines. Then dysbacteriosis occurs, which further disrupts the digestive processes. The child refuses to eat, and at this time diarrhea may occur, which leads to weight loss and dehydration. If we are talking about viral stomatitis, then ulcers form very quickly on the child's mucous membrane. They can be an entry point for infection. Complications of stomatitis, which occur in the absence of treatment, are secondary bacterial infections of the oral cavity with the formation of massive ulcers. Such ulcers can further threaten necrosis of soft tissues, since inflammatory processes spread very quickly in newborns.

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Diagnostics neonatal stomatitis

Diagnosis of stomatitis in newborns is not complicated, and it should begin already at the stage of complaints. The mother cannot always carefully examine the child's oral cavity, so at the first rise in temperature she consults a doctor. And it is very important to pay attention not only to complaints, but also to detail all the circumstances.

It is very important for diagnosis that the mother draws the doctor's attention to the fact that the child stops eating. At the same time, he is capricious, because he remains hungry, because he cannot suckle normally. When examining the oral cavity, you can see elements of the rash in the form of white dots on the mucous membrane that rise above the surface. It is important to examine the oral cavity with a spatula or spoon, because at the beginning of the disease, the rash can only be on the lateral surface of the cheeks or on the tonsils.

Anamnesis data that may indicate a benefit for stomatitis include previous treatment with antibiotics, glucocorticoids, and invasive interventions after the birth of a child.

The tests that need to be done for stomatitis are most often to determine the etiology of the disease. To choose the treatment tactics, it is very important to know what caused the stomatitis. Therefore, first of all, it is necessary to take a smear from the mucous membrane and determine the pathogenic bacteria or fungi that are there. To do this, it is necessary to conduct a cytological and bacteriological examination of the smear. Along with this, they look at the sensitivity of the bacteria or fungi that are sown to antibiotics or antifungal agents, which will determine further treatment tactics.

Sometimes it is necessary to determine the condition of the entire gastrointestinal tract of the baby to prevent dysbiosis, then it is necessary to take a dysbacteriosis test. This is also important for treatment, because if the child does not have normal flora in the intestines, then there may be problems with the oral cavity. A dysbacteriosis test is also necessary if the child has problems with stool. Therefore, a dysbiosis test for stomatitis can be considered mandatory, at least for the purpose of a more in-depth diagnosis.

Stomatitis is more common in children who have already been compromised. But it also happens that stomatitis occurs in a newborn, and then recurs many times without any reason. In this case, you need to think about the fact that perhaps the child has more complex problems and we are talking about immunodeficiency. Then you need to consult an immunologist and possibly an immunogram.

Instrumental diagnostics of stomatitis is not used in most cases, since the problem is “local” and is diagnosed well by external symptoms.

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Differential diagnosis

Differential diagnostics of stomatitis is necessary first of all to determine the treatment. If it is not difficult to differentiate viral herpetic stomatitis from others by clinical manifestations, then bacterial and fungal are very similar. They have the same appearance of small white films on the mucous membrane, which are tightly attached to it. But fungal stomatitis merges and forms an almost continuous film, while bacterial stomatitis can be accompanied by simple inflammation of the mucous membrane and a white coating on the tongue. But such differential signs are not very clear, so sometimes they begin treatment, and only if it is ineffective can we say that the etiology is different.

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Treatment neonatal stomatitis

Of course, the treatment of stomatitis should have an etiopathogenetic focus. And already at the diagnostic stage, we can say what should be used for treatment. Considering that the child's body is sensitive to various drugs and in the neonatal period the use of such drugs should be minimal, it is better to use local remedies for the treatment of stomatitis. But it is also necessary to know that this is not always possible and effective. Medicines that are used to treat stomatitis can be antiviral, if we are talking about viral herpetic stomatitis. If we are talking about fungal stomatitis, then only antifungal agents are certainly effective.

Herpes viruses are sensitive only to a group of drugs that have direct antiviral activity. Therefore, in the case of such stomatitis, the issue of using systemic drugs in the form of local treatment is decided. Most of these antiviral drugs have many side effects and their use is limited in infancy, so the only option is to use them in the form of local agents. Acyclovir drugs are the most effective in this regard.

1. Acyclovir is a drug that has a direct antiviral property against the herpes simplex virus and other herpes infections. It acts by inhibiting the introduction of the virus into the cell and its reproduction. For children, the drug can be used in the form of tablets. The dosage is calculated at 20 milligrams per kilogram of the child's body weight. This dosage should be divided into four doses at equal intervals. Treatment usually lasts five days. Oral administration of such a drug for newborns with herpetic stomatitis is limited to those cases when the child has immunodeficiency. If viral stomatitis in a child with a normal immune status, then local use of the drug is recommended. To do this, you need to divide one tablet into four parts and grind finely. Dissolve the tablet in boiled water, if possible, lightly apply to the mucous membrane of the oral cavity. This procedure should be done five times a day. But it should be taken into account that there may be additional trauma. Side effects of the drug when used systemically may include fever, tremors, vomiting, diarrhea, and allergic rashes.
2. Novirin is an antiviral drug that is highly effective against many viruses, including the herpes group. The active substance of the drug is the inosine compound pranobex, which affects the viral particle by inhibiting its reproduction. It has a wider application in pediatrics and is less dangerous than direct agents in the form of acyclovir. It is allowed for children from 1 year old, but can be used for newborns in certain cases. It is available in tablets, which are dosed at 50 milligrams per kilogram. For the treatment of stomatitis, it is better to use it in the form of local agents. Side effects with local treatment are minimal - there may be digestive disorders when absorbing the drug.
3. Laferobion is an antiviral agent with a wide range of effectiveness. The active substance is interferon, which helps fight viral infections through the natural immune defense that is in the human body. The drug is available in the form of suppositories, so it is convenient to use in newborns and is approved in this group. The dosage of the drug is 150 thousand units of suppository twice a day for five days. For viral stomatitis, this drug is quite effective, especially if there are other systemic manifestations of the pathology. Side effects can be in the form of allergic reactions and intestinal disorders.
4. Nystatin is an antifungal drug used to treat stomatitis of fungal etiology. The active ingredient of this drug is nystatin, which is synthesized by a fungus that has antagonistic properties against pathogenic fungi. The drug is used to treat candidal stomatitis in the form of local agents. To do this, you need to divide the tablet into parts and lubricate the child's oral cavity. Side effects are rare due to local use. Precautions - do not use the drug for systemic treatment of fungal infections of other etiologies.
5. Stomatidin is a medicine for the local treatment of stomatitis, which can be used for any etiology. The active substance of the drug is hexetidine, which is an antiseptic. Using such a drug as a rinse leads to the death of many bacteria, fungi and viruses. The dosage for newborns should not exceed such an amount that the child does not swallow the drug. It can be used by soaking a bandage in the solution and wiping the mouth several times a day. Side effects can be in the form of a burning sensation, to which the baby will immediately react, so if there are ulcers, the drug is not recommended.

Physiotherapeutic treatment of stomatitis is not used, but vitamins can be very useful, since any infection weakens the body, while vitamins fill it with useful substances. It is necessary to use vitamins that are allowed for newborns.

Agvantar is a vitamin that contains the metabolically active substance levocarnitine. It promotes the absorption of biologically useful substances and accelerates metabolism in cells, which accelerates the child's recovery and increases the immune status after an infection. The drug is available in the form of a syrup. One milliliter of syrup contains 100 milligrams of the substance, and the dosage is 50 milligrams per kilogram. The drug can be used even in premature babies. Side effects may include tremors, diarrhea, and drowsiness in the child. It should be used for one month after stomatitis.

Folk treatment of stomatitis

Traditional methods of treating stomatitis in newborns can only be used locally, because the child should not receive anything other than breast milk or formula during this period. There are many traditional medicines that act due to local antiseptic and anti-inflammatory properties.

1. Cabbage juice has pronounced wound-healing properties and helps kill many microbes and fungi in the oral cavity. For treatment, you need to squeeze out fresh cabbage juice and wipe the child's mouth several times a day. For a better effect, you can add a few drops of liquid fresh honey to the juice, then the solution will taste better and the baby will hold it in his mouth longer.
2. Juice from fresh sea buckthorn berries also has good anti-inflammatory and antifungal properties. To make the medicine, take one hundred grams of berries, grind them into a pulp, and add the same amount of boiled water. The solution is sour in itself, so to avoid burning, you also need to add a little honey. You need to rinse your mouth well, and for a newborn, wipe it with a napkin soaked in the medicine several times a day.
3. Aloe and Kalanchoe juice are known for their antiseptic and wound-healing properties. For treatment, you also need to lubricate the mucous membrane several times a day with fresh aloe and Kalanchoe juice in a one-to-one ratio. After such treatment, it is not recommended to give food for 20 minutes so that the medicine works better.
4. Propolis is a well-known useful remedy that is widely used to treat many wounds and cuts. It is also a very effective remedy for treating stomatitis. To treat it, you first need to treat the mucous membrane with an antiseptic, by lubricating it with hydrogen peroxide or hexetidine. After that, you need to prepare a propolis tincture by pouring boiled water into it up to half a liter jar. You need to lubricate the affected areas of the mucous membrane with this solution. Propolis forms a film over the inflamed areas, which protects against the penetration of bad microbes and thus heals faster and better.

Herbal treatment is also widely used for stomatitis, but mainly herbal infusions are used for local rinsing.

1. Chamomile, string and sage are known for their antiseptic and antibacterial properties. To prepare a medicinal tincture, take thirty grams of each herb and pour hot water over it. After it has been infused for half an hour, it can be used to wash the mucous membrane.
2. An infusion of oak bark also has antiseptic properties and promotes wound healing, especially when ulcers form on the mucous membrane. To prepare the infusion, take 50 grams of bark and pour 250 grams of water. After the solution has been infused for two hours, you can add a few drops of aloe and rinse the mucous membrane.
3. You need to take one hundred grams of calendula flowers and fifty grams of bluehead grass, pour water over them and let this solution sit for two hours. After that, drain the water and pour the same amount of clean boiled water over it again. You need to rinse the mucous membrane with this solution several times a day.

Homeopathic treatment can be used both in the acute period and at the time of recovery to prevent relapses of fungal or viral infections.

1. Borax is a homeopathic herbal medicine used to treat stomatitis. It is especially effective against stomatitis that is accompanied by the formation of ulcers on the mucous membrane and their bleeding. The dosage of the medicine for newborns can be three granules, which must first be dissolved in boiled water and used three times a day for the first week, and then once for another three weeks. Side effects include reddening of the skin of the face, which indicates the need to reduce the dose.
2. Potassium muriaticum is a homeopathic remedy of organic origin, the main element of which is potassium. The drug is used to treat stomatitis, which is accompanied by the formation of white plaque with pronounced systemic manifestations - an increase in body temperature, an increase in lymph nodes. Therefore, systemic use of the drug is recommended, and if the mother is breastfeeding, then it is recommended that the mother take it. The drug is used for the mother in a dose of one grain six times a day. Side effects can only be with intolerance by the mother, and the newborn may have problems with stool.
3. Creosotum is a homeopathic remedy used to treat stomatitis, which is accompanied by inflammation of the gums and their redness. This is a common complication when local immunity is impaired during stomatitis and pathogenic flora multiplies, which causes inflammation of the gums. In this case, this drug is indicated. For treatment, you need to take two tablets of the drug and dissolve them in 50 grams of water. You need to lubricate the mucous membrane carefully several times a day, and for a better effect, the mother can take the drug one tablet once a day. Side effects are rare.
4. Carbo vegetabilis is a well-known homeopathic remedy used to treat bacterial stomatitis and intestinal problems. The drug is effective in cases where stomatitis is accompanied by the formation of a white coating on the tongue. The dosage is one granule per day, which can be used for a newborn in its pure form. To do this, simply grind the granule into a fine powder and give it to the child to hold in his mouth. It dissolves quickly, so there should be no problems. Side effects may include darkening of the gums or their coloring in a bluish tint, which quickly goes away on its own.

Homeopathic treatments and folk remedies can be effective in treating stomatitis, but it should be remembered that we are talking about a newborn baby and it is necessary to consult a doctor.

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Prevention

Prevention of stomatitis in a child is, first of all, a planned pregnancy with a thorough examination. After all, a healthy mother with a normal pregnancy and physiological birth can give the child good immunity and good microflora, which will protect his body from such problems. Primary preventive measures also include the use of any medications in a newborn only for strict indications, especially antibiotics and glucocorticoids. If the child is premature and needs ventilation or other invasive interventions, then you need to take care of him to avoid complications such as stomatitis.

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Forecast

The prognosis for recovery from stomatitis is positive, since the pathology is easily corrected. Relapses in healthy children are very rare, which also indicates a good prognosis.

Stomatitis in newborns is not so rare, especially if the child is premature and has risk factors. This pathology can be caused by bacteria, viruses, but most often it is still a fungus. A child with stomatitis cannot eat normally, which is the main symptom and the main problem. But the treatment is not difficult and, if timely, is successful.

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