Nearly all newborn babies have a white coating, or film, on the top of their tongues in the early weeks. This is very normal, and is due to a build up of milk sitting on their tongue. The coating can be comparatively thicker, if the baby is formula fed. The milk builds up because babies do not produce much saliva in the first 2 to 3 months after they are born. After this time, they produce more saliva, which will tend to wash the milk residue off.
Image 11-70 shows the white coating that normally accumulates on the baby's tongue.
It is common for parents to confuse the normal appearance of a 'white tongue' with thrush. However, thrush appears as patchy, white areas or spots (called 'plaques') on the inside of the baby's cheeks, gums and the roof of their mouth. If breastfeeding, the mother's nipples can also have thrush
in them, usually making them feel quite painful to feed from (even though there is no obvious damage to the nipples). You may wish to read more in Thrush in the nipples.
Thrush plaques cannot be 'wiped away' (like white tongue). If thrush is left untreated for a long period, it may start to irritate the baby, with the skin around the plaques looking red and inflamed and sometimes bleeding. If you think your baby (and/or you) have thrush, you will usually need to seek medical advice, or ask the opinion of your early childhood nurse
. Caregivers' will tend to prescribe an antifungal gel that is placed on the inside of the baby's mouth (and possibly on the nipples of the woman, if appropriate), after each feed.
Occasionally a baby will have raised, white pearly spots on their gums, and sometimes on the roof of their mouth. They are often thought to look like little teeth emerging, however they tend to come out on the side of the gum (rather than the top). They do not worry the baby and therefore are not the cause of them being unsettled or irritable. The spots can come and go during the baby's first year, and require no treatment.