White plaque on the tongue of a newborn during breastfeeding and artificial feeding

White tongue in a newborn is the appearance of a white coating on the baby's tongue and sometimes on the cheeks, caused by various reasons. This is a very common problem for children in their first year of life precisely because of their active lifestyle. But this symptom is not always a sign of a disease, sometimes it is simply the peculiarities of feeding the baby.

Causes white tongue in a newborn

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

The oral mucosa is constantly exposed to external and internal irritants. It reflects, like a mirror, many pathological processes that occur in the body, so its diseases are numerous.

A very important point in understanding any problems that affect the oral cavity and tongue of a child is understanding the normal features of the microflora. In a child, the oral cavity is one of the most vulnerable places, which can become an entry point for infection. Therefore, saliva performs one of the most important functions - it protects the oral cavity from such microorganisms. This occurs due to the content of lysozyme in saliva, as well as with the participation of the normal flora of the oral cavity. Lysozyme is a natural substance that, by 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 opportunistic flora of the oral cavity. Under normal conditions, non-pathogenic types of streptococci, veillonel, and some types of fungi are on the mucous membrane. All these bacteria play the role of flora that inhibits the growth of pathogenic microorganisms. The microflora of the oral cavity is presented in such a minimal amount that it cannot cause disease. But under certain conditions, this balance can be disturbed, and then pathogenic bacteria or fungi multiply intensively. These processes lead to the development of an inflammatory process of the mucous membrane, which is one of the links in the pathogenesis of the development of white plaque on the tongue. If the process of reproduction of pathogenic bacteria or fungi occurs, then leukocytes perform their function and are mobilized on the mucous membrane. With massive death of leukocytes, they are deposited on the mucous membrane, which has the appearance of a white plaque.

All reasons for white coating on the tongue of a newborn can be divided into two groups:

1. white tongue as a normal variant;
2. white tongue as a sign of pathology.

If we are talking about a white tongue as a sign of pathology, then the direct cause of this is precisely a bacterial, viral or fungal infection, the pathogenesis of which was discussed.

Among viruses, the most common cause of white plaque on the tongue is herpes. Acute herpetic stomatitis is an infectious disease who is which is more common in young children. Children with diathesis are most prone to this disease. One of the possible causes of herpes infection is considered to be damage to the large intestine and disruption of the intestinal microflora.

The most common fungal disease of the oral mucosa and tongue in newborns is candidiasis. Candidiasis is caused by a fungus of the genus Candida. Children in the first days of life and newborns are most often ill. The cause of excessive fungal proliferation may be long-term treatment of the child after birth with glucocorticoids and antibiotics.

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

First of all, it should be noted that the reason may be simple feeding, which leaves white marks after milk. Therefore, if you look immediately after the baby has eaten, then he will definitely have a white coating on the tongue and this is normal. A white tongue in a newborn with breastfeeding is less common than in children who are fed with formula. This is explained by the fact that formulas are less adapted to the child's body and can cause such phenomena due to the immaturity of the child's digestive system. This must be taken into account when correcting the child's diet.

Another reason for the formation of white plaque on the tongue may be colic. Colic is a feeling of distension in the baby's abdomen and spasms caused by increased gas formation. Due to the weakness of the intestinal muscle layer, the increased amount of gases is difficult to remove, and this causes discomfort. In addition, the entire process of normal digestion is disrupted, which subsequently leads to stool disorders and the formation of plaque on the tongue. A secondary problem may be dysbacteriosis, which can also manifest itself in the formation of such plaque.

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Risk factors

Risk factors can be identified based on the reasons:

1. antibiotic treatment with disruption of the microflora of the oral and intestinal mucosa;
2. concomitant diseases in a child with intestinal involvement;
3. surgical interventions immediately after birth with intubation or catheterization of the esophagus;
4. colic, dysbacteriosis in a child;
5. artificial feeding.

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Symptoms white tongue in a newborn

If the symptoms of a white tongue in a newborn appear only after feeding, then most likely this is caused by food residue. A white tongue in a newborn with artificial or mixed feeding often occurs with an incorrectly selected formula or incorrect feeding technique. In children who do not have breast milk in their diet, the risk of developing functional disorders is much higher. Such newborns often regurgitate, which leads to the formation of a white coating on the tongue. Such a coating can be uneven and it is easily removed, which distinguishes it from pathological. The general condition of the child in this case should not be disturbed.

The first signs of stomatitis, as the most common pathology causing white plaque on the tongue, can appear spontaneously without any provoking factors. Most often, the first symptom to appear is refusal to eat. This is all due to the fact that it is difficult for the baby to eat when there is inflammation on the mucous membrane. 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 health deteriorates sharply. Eating is almost impossible due to damage to the oral mucosa. The child cannot even calmly eat breast milk, since any effort causes burning and pain in the oral cavity. There may be increased salivation and, due to the proliferation of the virus, a feeling of an unpleasant odor. Regional lymph nodes are enlarged, they can be painful upon palpation. Objectively, you can see on the mucous membrane of the oral cavity, on the inner surface of the cheeks, and even on the upper palate - numerous bubbles that quickly form erosions and even ulcers. The disease can last about 2 weeks. White tongue often forms a few days after the onset of the disease, when immune forces, namely leukocytes, are actively involved in the process. Then there may be a white tongue, but against this background, vesicles are still clearly visible, which eventually burst.

The clinical picture of candidiasis is characterized by the appearance of punctate rashes on the sharply hyperemic mucous membrane. These punctate rashes can merge, forming films that look like cheesy masses. These films can be easily removed, and under them you can see the sharply hyperemic mucous membrane. With a long-term inflammatory process, these films tightly grow together with the tissues and are removed with difficulty. This symptom is very characteristic of fungal infection. This is very common in newborns and as a cause of pathologies causing a white coating on the tongue, it ranks first in prevalence. This is explained by the fact that fungi have a structure of small threads, and with significant spread they cover the tongue with a fine white film. If stomatitis manifests itself only on the tongue, then this does not cause any other symptoms, except for local manifestations. But if areas of candidiasis are on the mucous membrane of the cheeks or lips, then there is a high probability that there will be an increase in body temperature.

A long process of bacterial or fungal stomatitis causes a disturbance of the flora along the entire gastrointestinal tract. Therefore, after some time, symptoms of stool disturbance, regurgitation, and hypotrophy may appear. Since the disturbance of the flora disrupts the absorption of essential nutrients, the child may not receive a sufficient number of kilocalories from food and not gain weight in sufficient quantities.

Complications and consequences

Consequences may occur if there are diseases that cause the appearance of white plaque on the tongue. Most often, fungal or herpetic stomatitis causes the layering of a secondary bacterial infection. If ulcers form on the mucous membranes as a result of herpetic lesions, they can become infected very quickly.

Complications may occur if the child has concomitant diseases. This may cause weakening of the immune system and spread of infection with generalization and the risk of developing even sepsis. But this happens in HIV-positive children with immunodeficiencies.

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Diagnostics white tongue in a newborn

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

It is not difficult to determine herpetic stomatitis by the clinical features of the rash on the mucous membrane. It is also possible to assume a fungal etiology by the characteristic dense cheesy plaque on the tongue.

The tests allow to determine the etiology of the disease precisely, as well as the pathogen that can cause such changes. For this, a smear of the oral cavity is most often examined. For 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.

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

Instrumental diagnostics of a white tongue in a newborn is carried out only if there is a suspicion of congenital pathologies of the esophagus and intestines, which may be accompanied by symptoms of regurgitation.

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Differential diagnosis

Differential diagnostics should be carried out with different types of mucosal lesions in infectious diseases, as well as with congenital defects of the gastrointestinal tract.

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Treatment white tongue in a newborn

It is absolutely clear that the treatment of white tongue in a newborn depends primarily on the etiology. If herpetic stomatitis is accurately diagnosed, then the treatment should consist of using antiviral agents. Fungal infection requires the prescription of antifungal agents. In addition, local therapy is used.

If the problems of white coating on the tongue are caused by artificial feeding, then it may be necessary to change the formula, especially if the child also regurgitates. In this case, you need to add an anti-reflux formula (NAN anti-reflux) to the daily diet and give it to the child in a small amount, for example, 30 grams at the beginning of feeding. Then you need to give the main part of the regular formula. It is also advisable to give children fermented milk products and formulas close to breast milk - "AGU-1", "Malutka", for older children - "Atsidolact", "Narine", "Lactobacterin", "Vita", "Bifidokefir". After such a correction of nutrition, the problems should disappear if they are caused by nutrition.

Treatment of oral diseases requires the prescription of medications.

In case of herpetic lesions of the mucous membrane, antiviral agents are prescribed. The mucous membrane is treated with antiviral ointments, which include oxolinic and tebrofen ointments, and leukocyte interferon applications are also used. For pain relief, ulcers are treated with a five percent solution of anesthesin. For better regeneration of the mucous membrane, applications with a solution of vitamin A, sea buckthorn, aloe, as well as with a solution of lidocaine, solcoseryl are prescribed.

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.

If a child has developed candidal stomatitis, which has caused the formation of a white coating on the tongue, then first of all it is necessary to treat concomitant diseases. If the child is taking antibiotics, then it is worth considering the duration of their use. For newborns, it is considered mandatory to take antibiotics together with probiotics. If this condition is not met, then it is imperative to prescribe a probiotic. A solution of methylene blue or solutions of vitamins of group B and C can be used to treat the affected areas. If the mother is breastfeeding the child and he has developed a candidal lesion of the tongue, then easily digestible carbohydrates should be limited in the mother's diet. The use of antifungal drugs is considered mandatory by local application.

2. Pimafucin is an antifungal drug used to treat fungal lesions of the tongue and mucous membranes. The active ingredient of this drug is natamycin, which is a broad-spectrum antibiotic, including against pathogenic fungi. The drug is used to treat candidal lesions in the form of local agents. To do this, you need to divide a 100-milligram tablet into 4 parts and lubricate the child's oral cavity. Side effects are rare due to local use. Precautions - do not use the drug for systemic use in newborns.
3. Clotrimazole is a broad-spectrum drug. It is prescribed for lesions of the tongue and mucous membranes caused by various types of fungi, as well as for candidiasis of the mucous membrane with secondary infection. In small concentrations, clotrimazole has a fungistatic effect, in large concentrations - fungicidal, and not only on proliferating cells. The method of application is the same - the tablet must be crushed and applied to the affected areas 2-3 times a day and rubbed in gently. A single dose should not be more than a quarter of a tablet. Before and after applying the drug, rinse the child's mouth with warm boiled water.
4. Probiotics can be used as an adjuvant in the treatment of white plaque on the tongue, since this disrupts the beneficial microflora that needs to be restored. The mechanism of this phenomenon is complex, it helps to restore the level of beneficial flora, which displaces pathogenic fungi, bacteria or viruses from the oral cavity. Bifido- and lactobacilli exhibit antagonistic activity against a wide range of pathogenic and opportunistic microorganisms. The colonization of bifidoflora ensures the normalization of the gastrointestinal tract, improves metabolic processes, prevents the development of protracted forms of infection, and increases non-specific resistance of the body. They have the ability 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 plaque on the tongue of infectious etiology, dried or lyophilized monocultures of microbes or a mixture of 2-4 types of bacteria can be used.

Hilak forte is a probiotic that contains the waste products of lactobacilli. This drug, getting into the baby's intestines, immediately begins to work due to the prebiotic content. It inhibits the reproduction of pathogenic bacteria and prevents their further growth. This inhibits the growth of bacteria, fungi, viruses and in the oral cavity. Method of application in newborns in the form of drops - the first few days of illness are taken three times a day, 20 to 60 drops. Preventive administration can be continued for another two weeks.

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

Folk remedies

Folk methods of treating white tongue are used very often, since the problem is widespread and has been known for a long time. How to clean a newborn's tongue from white plaque? The most well-known methods are the use of baking soda.

1. To prepare a soda solution, take 2 grams of soda, which is half a teaspoon, and add 250 milliliters of water. The water should be well boiled, and then you need to stir this solution well. After thorough hand hygiene, the mother should wrap a sterile bandage around her index finger and soak it in a soda solution. With this solution, you need to wipe the baby's tongue carefully without additional effort, so as not to damage the mucous membrane. The procedure should be repeated four times a day for several days.
2. Very effective in caring for the oral cavity of a newborn when a white coating appears on the tongue is a 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 a pharmacy. It should be used in the same way - by soaking a bandage in this solution and wiping the mucous membrane several times a day.
3. It is very important that the white coating on the tongue is formed after the child has been fed and there are food remnants left in the oral cavity. Milk is a breeding ground for many bacteria and fungi, so in the future, a simple coating on the tongue after eating can become stomatitis. To avoid this, it is very important to give the baby a little boiled water after each feeding. This washes away food remnants and eliminates the problem very quickly, like a kind of rinsing of the oral cavity.
4. Honey has many useful properties, including a pronounced antibacterial property. For home use, you need to dilute a teaspoon of honey in 100 grams of boiled water and wipe the baby's mucous membrane. But you need to be careful when using honey, since it is a very allergenic product.

Herbal treatment is used for the purpose of oral antisepsis, which allows you to quickly see results.

1. A medicine made from an infusion of chamomile and calendula flowers also has antiseptic properties and promotes wound healing, especially when ulcers form on the mucous membrane. To prepare the infusion, take 50 grams of chamomile and the same amount of calendula flowers, add 250 milliliters of water. After the solution has been infused for two hours, you need to rinse the mucous membrane or wipe it with a bandage.
2. It is very useful to give your child rosehip tea, as it has pronounced antitoxic properties. To do this, take ten rosehips per liter of water and prepare an infusion. Give your child half a teaspoon twice a day.
3. Sage can also be used to wipe the mucous membrane of the mouth and tongue. To prepare a medicinal tincture, take forty grams of the herb and pour hot water over it. After it has been infused for half an hour, rinse the mucous membrane every three hours.

Homeopathy is used very rarely in the acute period. If the child has recurrent problems with the mucous membrane, indicating a chronic infection, then some homeopathic preparations are used.

Prevention

Prevention of the formation of white plaque on the tongue of a baby is proper feeding, hygiene of the mammary gland, hands of the mother and the child. If the white tongue of a newborn is due to the peculiarities of nutrition, then it is necessary to wash the mucous membrane after each feeding. In case we are talking about stomatitis of different etiology, then the main principle of prevention is washing the mother's hands before each feeding, the child's toys and hygiene of the baby.

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Forecast

The prognosis is always favorable if we are talking about simple stomatitis. When stomatitis is recurrent, then problems with the child's immunity are possible, which in the future must be carefully diagnosed. The risk of complications and an unfavorable prognosis is always higher in children with concomitant pathologies - cerebral palsy, congenital pathologies.

A white tongue in a newborn is a very common problem at this age. The main thing to remember is that if the child eats normally and there is no increase in body temperature or changes in 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.

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