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White coating on the tongue of a newborn with breastfeeding and artificial feeding

 

White language in a newborn is the appearance of a white plaque in the language of the baby and sometimes on the cheeks, caused by different reasons. This is a very common problem for children of the first year of life precisely because of their active way of life. But not always such a symptom is a sign of the disease, sometimes it's just the features of feeding the baby.

Causes of the white tongue in a newborn

The main thing to remember is that white language is not always due to pathology. There are a number of other reasons that can cause the appearance of such signs.

The mucous membrane of the mouth lends itself to the constant influence of external and internal stimuli. On it, as in a mirror, many pathological processes that occur in the body are displayed, so its diseases are numerous.

A very important point in understanding any problems that affect the oral cavity of the child and the tongue is the understanding of the normal features of the microflora. In a child, the oral cavity is one of the most vulnerable places, which can become an incoming gateway for infection. Therefore, saliva performs one of the most important functions - it protects the oral cavity from such microorganisms. This is due to the content of lysozyme in the saliva, and also with the participation of the normal flora of the oral cavity. Lysozyme is a natural substance, which in its properties has activity against many bacteria and fungi. It contains immunoglobulins that can inhibit the growth of pathogenic flora. This is one of the protective factors of saliva. Another factor is the conditionally pathogenic flora of the oral cavity. In normal conditions, the mucosa is non-pathogenic species of streptococci, veilonel, and some types of fungi. These all bacteria play the role of flora, which retards the growth of pathogenic microorganisms. The microflora of the oral cavity is presented in such a minimum amount in which it can not cause disease. But under certain conditions this equilibrium can be violated, and then pathogenic bacteria or fungi multiply intensively. These processes lead to the development of the inflammatory process of the mucosa, which is one of the links in the pathogenesis of the development of white plaque in the tongue. If the process of propagation of pathogenic bacteria or fungi occurs, then the leukocytes perform their function and are mobilized on the mucous membrane. With massive death of leukocytes, they are deposited on the mucosa, which has the form of a white coating.

All the reasons for the white plaque in the language of a newborn can be divided into two groups:

  1. white language, as a variant of the norm;
  2. white language, as a sign of pathology.

If it is a white language, as a sign of pathology, then the direct cause of this is precisely the bacterial, viral or fungal lesion, the pathogenesis of which has been considered.

Among the viruses, the most common cause of the formation of a white coating on the tongue is herpes. Acute herpetic stomatitis is an infectious disease who is the one that is more common in young children. The most prone to this disease are children with diathesis. One of the possible causes of herpetic infection is a lesion of the large intestine and a violation of the microflora in the intestine.

The most frequent fungal disease of the mucous membrane of the mouth and tongue in newborns is candidiasis. Candidiasis is caused by a Candida fungus. Most often children are sick of the first days of life and also newborns. The cause of excessive reproduction of fungi can be long-term treatment of the child after birth by glucocorticoids and antibiotics.

Thus, all these diseases can cause the child to become a white tongue. But there is another group of reasons that, under normal conditions, can leave a white coating on the tongue.

First of all, it should be noted that the reason may be simple feeding, which leaves white traces after the milk. Therefore, if you watch immediately after the baby ate, then he will definitely have a white touch on the tongue and that's fine. White language in a newborn with breastfeeding is less likely than in children who are fed with mixtures. This is due to the fact that the mixture is less adapted to the children's body and can cause such phenomena due to the immaturity of the child's digestive system. This should be taken into account when performing a correction of the baby's nutrition.

Another reason for the formation of a white coating on the tongue may be colic. Colic - this is the sensation of bursting in the abdomen of the baby and spasms caused by increased formation of gases. Due to the weakness of the muscular layer of the intestine, an increased amount of gases is difficult to remove, and this causes unpleasant sensations. In addition, the whole process of normal digestion is disrupted, which leads in the future to stool disorders and plaque formation in the tongue. A secondary problem may be dysbiosis, which can also be manifested by the formation of such a plaque.

Risk factors

Risk factors can be identified for reasons of:

  1. treatment with antibiotics in violation of the microflora of the oral and intestinal mucosa;
  2. Concomitant diseases in a child with intestinal involvement;
  3. Interventional interventions at the birth of the intestine with intubation or catheterization of the esophagus;
  4. colic, dysbiosis in the child;
  5. artificial feeding.

Symptoms of the white tongue in a newborn

If the symptoms of white language in the newborn manifest only after feeding, then most likely it is caused by the remains of food. White language in a newborn with artificial or mixed feeding happens often with improperly selected mixture or incorrect feeding technique. In children who do not have breast milk in their diet, the risk of developing functional disorders is much higher. In such newborn babies, regurgitation often occurs, which leads to the formation of a white coating on the tongue. Such a plaque may be uneven and it is easily removed, which distinguishes it from pathological. The general condition of the child in such a case should not be violated.

The first signs of stomatitis, as the most common pathology that causes a white coating on the tongue, can appear spontaneously without any provoking factors. Most often, the first symptom of refusal to eat. This is all due to the fact that the baby is difficult to eat when there is inflammation on the mucosa. The clinical features of different types of inflammation are slightly different.

Acute herpetic stomatitis is acute. Very often, the temperature rises and the child's well-being deteriorates. The reception of food is practically impossible due to the defeat of the mucous membrane of the mouth. The child can not even calmly eat breast milk, because any effort causes burning and pain in the oral cavity. There may be an increased secretion of saliva and a feeling of unpleasant odor due to the multiplication of the virus. Regional lymph nodes are enlarged, with palpation they can be painful. Objectively you can see on the mucous membrane of the mouth, on the inner surface of the cheeks, and even in the upper sky - numerous vesicles that quickly form erosions and even ulcers. The disease can last about 2 weeks. White language is more often formed a few days after the onset of the disease, when the immune forces actively participate in the process, namely leukocytes. Then it can be white language, but against the background of this, vesicles are still clearly visible, which eventually burst.

The clinical picture of candidiasis is characterized by the appearance on the hyperemia of the mucous membrane of point-like rashes. These pinpoint eruptions can merge, forming films that look like curds. These films can easily be removed, and under them one can see a sharply hyperemic mucosa. With a prolonged inflammatory process, these films tightly fuse with the tissues and are removed with difficulty. This symptom is very characteristic for a fungal lesion. This is very often the case in newborns and as the cause of pathologies that cause a white raid on the tongue, occupies the first place in prevalence. This is due to the fact that fungi have the structure of small filaments, and with a significant spread, they cover the tongue with a fine white film. If stomatitis is manifested only in the tongue, then it does not cause any other symptoms other than local manifestations. But if the candidiasis sites are on the mucous cheeks or lips, then there is a high probability that there will be a rise in body temperature.

A prolonged process of bacterial or fungal stomatitis causes a violation of the flora along the entire gastrointestinal tract. Therefore, after a while, symptoms of stool disorder, regurgitation, and hypotrophy may appear. Since the violation of the flora violates the absorption of the basic nutrients, the child may not receive enough calories from the meal and do not gain sufficient weight. 

Complications and consequences

The consequences can be if there are diseases that cause the appearance of a white coating on the tongue. Most often, fungal or herpetic stomatitis causes a stratification of a secondary bacterial infection. If ulcers on mucous membranes are formed due to herpetic lesions, they can become infected very quickly.

Complications can be if the child has concomitant diseases. This can cause a weakening of immunity and the spread of infection with generalization and the risk of developing even sepsis. But it happens in children of HIV-positive, with immunodeficiencies.

Diagnostics of the white tongue in a newborn

Diagnosis of white language in a newborn should begin with the exclusion of the fact that it is caused by the process of feeding. If the mother is absolutely sure that the symptom is manifested all the time regardless of the feeding, and if there is an increase in body temperature, then it is necessary to conduct further diagnostics.

According to the clinical features of the rash on the mucous to determine herpetic stomatitis is not difficult. It can also be assumed from the characteristic dense plaque in the curdled tongue language about the fungal etiology.

Analyzes allow you to determine the etiology of the disease accurately, as well as the causative agent that can cause such changes. To do this, most often, the oral cavity is examined. For this, it is necessary to perform a cytological and bacteriological study of the smear. At the same time, they look at the sensitivity of bacteria or fungi that are sown to antibiotics or antifungal agents, which will determine the further treatment tactics.

If there are symptoms of stool disorder, then it is necessary to determine this primary process in relation to the white language or secondary. To do this, research feces for dysbiosis. The results of the analysis include the indication of all the microbes that are in the stool. Under normal conditions, a healthy child is determined by the total amount of intestinal flora, as well as the number of E. Coli, streptococci, hemolytic and non-hemolytic strains of staphylococci, fungi. An increase in the number of these bacteria indicates not only a dysbacteriosis, but also an active infection with a predominance of certain bacteria. This suggests that white plaque is caused by intestinal infection or intestinal dysbiosis, which is important for treatment.

Instrumental diagnosis of white language in a newborn is carried out only if there is a suspicion of congenital abnormalities of the esophagus, the intestine, which may be accompanied by symptoms of regurgitation.

Differential diagnosis

Differential diagnosis should be performed with different types of mucosal lesions in infectious diseases, as well as with congenital malformations of the gastrointestinal tract.

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Treatment of the white tongue in a newborn

It is absolutely clear that the treatment of white language in a newborn depends primarily on etiology. If the herpetic stomatitis is accurately diagnosed, the treatment should consist in the use of antiviral agents. Fungal infection requires the appointment of antifungal agents. In addition, they use local therapy.

If the problems of white plaque in the language are caused by artificial feeding, then it is probably necessary to change the mixture, especially if the baby also regurgitates. In this case, add an antireflux mixture (NAN antireflux) to the daily ration and give it to the child in a small amount, for example 30 grams at the beginning of the feeding. Then you need to give the bulk of the usual mixture. Also, it is advisable for children to give sour-milk products and mixtures that are close to women's milk - "AGU-1", "Malyutka", for older children - "Acidolact", "Narine", "Lactobacterin", "Vita", "Bifidokefir". After such a correction of nutrition, problems should disappear if they are caused by food.

Treatment of diseases of the oral cavity requires the appointment of medications.

In herpetic lesions of the mucous membrane, antiviral agents are prescribed. The mucous membrane is treated with antiviral ointments, which include oxolin and tebrofen ointment, and also apply leukocyte interferon applications. For the purpose of anesthesia, ulcers are treated with a 5% anesthetic solution. For better regeneration of the mucosa appoint applications with a solution of vitamin A, sea-buckthorn, aloe, and also with a solution of lidocaine, solcoseryl. 

  1. Acyclovir  is a drug that has a direct antiviral effect against the herpes simplex virus and other herpetic infections. It acts by inhibiting the introduction of the virus into the cell and its multiplication. For children, the drug can be used in the form of tablets. 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. Admission of such a drug inside for newborns with herpetic stomatitis is limited to those cases when the child has an immunodeficiency. If viral stomatitis in a child with normal immune status, then the local application of the drug is recommended. To do this, one tablet is divided into four parts and finely grinded. After dissolving the tablet in boiled water, it is necessary, if possible, to be applied to the mucous membrane of the oral cavity. Do this procedure five times a day. But you need to consider that there may be additional traumatization. Side effects of the drug in systemic application can be in the form of fever, tremor, vomiting, diarrhea, allergic rashes.

If the child developed candidal stomatitis, which caused the formation of a white coating on the tongue, then in the first place it is necessary to treat concomitant diseases. If a child takes antibiotics, then it is worth considering the duration of their use. For newborns, it is mandatory to take antibiotics together with probiotics. If this condition is not adhered to, then it is necessary to prescribe a probiotic. A solution of methylene blue or solutions of B and C vitamins can treat affected areas. If the mother is breastfeeding and developed a candidal lesion of the tongue, then in the diet of the mother, it is necessary to limit digestible carbohydrates. The use of antifungal drugs is considered mandatory by topical application.

  1. Pimafucin  is an antifungal drug that is used to treat lesions of the tongue and mucous fungal etiology. The active substance of this drug is natamycin, which is an antibiotic of a wide spectrum of activity, including against pathogenic fungi. A medicine is used to treat candidal lesions in the form of local remedies. To do this, you need to divide the tablet 100 milligrams into 4 parts and lubricate the baby's mouth. Side effects are rare due to topical application. Precautions - do not use the drug for systemic use in newborns.
  2. Clotrimazole  is a broad-spectrum drug. It is prescribed for lesions of the tongue and mucous membranes caused by different kinds of fungi, as well as candidiasis mucosa with secondary infection. In small concentrations, clotrimazole has a fungistatic effect, in large concentrations fungicidal, not only on proliferating cells. The method of application is the same - the tablet needs to be rubbed and applied to the affected areas 2-3 times a day and gently rubbed. Single dose should not be more than a quarter of the tablet. Before applying the drug and after that you need to rinse with warm boiled water by the mouth of the child.
  3. Probiotics as an adjuvant can be used in the treatment of white raids in the tongue, as this disrupts the useful microflora that needs to be restored. The mechanism of this phenomenon is complex, contributes to the renewal of the level of useful flora that displaces pathogenic fungi, bacteria or viruses from the oral cavity. Bifido- and lactobacilli show antagonistic activity against a wide range of pathogenic and conditionally pathogenic microorganisms. The settlement of bifido- flora ensures normalization of the activity of the gastrointestinal tract, improves the metabolic processes, prevents the development of protracted forms of infection, increases the nonspecific resistance of the organism. They have the properties to suppress the growth of pathogenic bacteria by synthesizing antibacterial substances. However, this property is largely realized due to the production of lactic and acetic acid, which reduces the pH of saliva. In the treatment of raids in the language of infectious etiology, dried or lyophilized monocultures of microbes or a mixture of 2-4 species of bacteria can be used.

Hilak Fort  is a probiotic that contains the products of the vital activity of lactobacilli. This drug, getting into the intestines of the baby, immediately begins to work at the expense of the prebiotic. It inhibits the multiplication of pathogenic bacteria and prevents their further growth. This inhibits the growth of bacteria, fungi, viruses and in the oral cavity. Method of use in newborns in the form of drops - the first few days of illness take three times a day for 20 to 60 drops. Prophylactic reception can continue for another two weeks.

Linex  is a probiotic, which includes 2 kinds of live anaerobic bacteria (Bifidobacterinum infants, Lactobacillis acidophillus) and one aerobic strain (Streptococcus teacium). Due to this composition Linex well regulates the physiological balance of the microflora at all levels - the oral cavity, the small and large intestines, produces lactic, acetic and propionic acids, promotes the enzymatic digestion of proteins and carbohydrates, and the absorption of electrolytes of the intestine. Thus, it prevents the adhesion of bacteria and fungi to the epithelium of the mouth and tongue, improves the absorption function of the intestine. It is prescribed for 1-2 sachets 3 times a day, diluting the powder in water for 3-4 weeks. Lineks is resistant to the action of antibiotics of penicillin, lincomycin, aminoglycoside, tetracycline, and sulfanilamides, which allows using it for antibacterial therapy with these drugs.

Alternative treatment

Alternative methods of treating the white tongue are used very often, since the problem is common and has been known for a long time. How to clean a newborn's language from a white raid? The best known methods are the use of baking soda.

  1. To make a soda solution, take 2 grams of soda, which is half a teaspoon, and add 250 milliliters of water. Water should be well boiled, and then it is necessary to stir well this solution. After careful hand hygiene, the mother should wrap a sterile bandage on her index finger and moisten it in a soda solution. With this solution, you need to wipe the tongue of the baby gently without any additional effort to not damage the mucous membrane. Repeat the procedure four times a day for several days.
  2. It is very effective in caring for the mouth of a newborn when a white plaque appears in the tongue of candida-solution. This is a special solution that can be used to treat such a pathology, containing an antifungal agent. You can buy it at the pharmacy. Apply the same way - moistening the bandage in this solution and rubbing the mucous membrane several times a day.
  3. Very important is the fact that a white coating on the tongue is formed after the baby is fed and left with food left in his mouth. Milk is a breeding ground for many bacteria and fungi, so in the future a simple plaque in the language after eating can become a stomatitis. To avoid this in the treatment it is very important after each feeding to give the baby a little boiled water. It rinses off the rest of the food and eliminates the problem very quickly, like a kind of mouth rinse.
  4. Honey has many useful properties, including a pronounced antibacterial property. To use at home, you need to make a teaspoon of honey in 100 grams of boiled water and wipe the baby's mucous. But you need to use honey carefully, because it is a very allergenic product.

Treatment with herbs is used to antiseptic the oral cavity, which quickly allows you to see the result.

  1. The medicine from the infusion of chamomile and calendula flowers also has antiseptic properties and promotes the healing of wounds, especially when forming ulcers on the mucous membrane. To prepare the infusion, you need to take 50 grams of chamomile and the same number of flowers of calendula, add 250 milliliters of water. After the solution is infused for two hours, it is necessary to wash the mucous membrane or wipe with a bandage.
  2. It is very useful to give the child tea from a dogrose, because it has pronounced antitoxic properties. To do this, take ten rose hips on a liter of water and make a tincture. Give the child you need half the teaspoon twice a day.
  3. To wipe the oral mucosa and tongue, you can also use sage. To prepare medicinal tinctures, you need to take forty grams of grass and pour hot water. After insisting half an hour - you need to wash the mucosa every three hours.

Homeopathy in an acute period is used very rarely. If the child has recurrent mucosal problems that indicate a chronic infection, then some homeopathic remedies are used.

Prevention

Preventing the formation of white plaque in the language of the baby is the proper feeding, hygiene of the breast, the hands of the mother and the child. If the white tongue of a newborn is conditioned by eating habits, then one must wash the mucosa after each feeding. In case of stomatitis of different etiology, the main principle of prevention is washing the hands of the mother before each feeding, the toys of the child and the hygiene of the baby.

Forecast

The prognosis is always favorable, if it is a question of simple stomatitis. When stomatitis is recurrent, there may be problems with immunity in the child, which in the future should be carefully diagnosed. The risk of complications and unfavorable prognosis is always higher in children with concomitant pathologies - infantile cerebral paralysis, congenital pathologies.

White language in a newborn is a very common problem at this age. The main thing to remember is that if the child normally eats and does not have a fever or changes in the stool, then this is not considered a problem. In this case, you just need to pay attention to hygiene. If there are any other symptoms, then this may be a manifestation of stomatitis, which already requires treatment.

Last update: 17.06.2018
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Medical expert editor

Portnov Alexey Alexandrovich

Education: Kiev National Medical University. A.A. Bogomolets, Specialty - "General Medicine"

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