Typical Age Range for Thrush
Thrush (oral candidiasis) is most commonly seen in infants, particularly those under 6 months of age, and in immunocompromised adults, though it can occur at any age.
Typical Age Distribution
Infants and Young Children
- Oral thrush is extremely common in infants, particularly those under 6 months of age 1
- It is a familiar presentation in both general practice and pediatrics, usually responsive to treatment in the community 2
- In infants, thrush typically manifests as white patches on the oral mucosa that cannot be easily wiped away
Children
- While most common in infants, thrush can also occur in older children, though less frequently 2
- Treatment-resistant thrush in children (such as in a 3-year-old) may warrant further investigation for underlying conditions 2
Adults
- In adults, thrush is less common in healthy individuals but increases in frequency with:
Risk Factors Across Age Groups
Medication-Related Factors
- Use of inhaled corticosteroids can cause thrush at any age, but particularly in adults 3
- Broad-spectrum antibiotics disrupt normal oral flora, predisposing to thrush 3
- Systemic corticosteroids suppress immune function, increasing risk 3
Immune System Factors
- Immature immune systems in infants contribute to their higher susceptibility 1
- Immunocompromised adults, particularly those with HIV/AIDS, have significantly higher rates 4
- Diabetes affects immune function and increases glucose in saliva, promoting fungal growth 3
Clinical Presentation Variations by Age
Infants
- Usually presents with white patches on tongue, gums, and inside of cheeks 1
- May cause feeding difficulties or irritability 1
- Generally responds well to treatment, though recurrences are common with nystatin 1
Adults
- May present with white patches or redness of affected mucosa 3
- When affecting the larynx in adults, hoarseness is always present 3
- Pain is inconsistently present in laryngeal thrush 3
Treatment Considerations by Age
Infants
- Fluconazole suspension (3 mg/kg daily for 7 days) has been shown to be superior to nystatin suspension for treating oral thrush in otherwise healthy infants 1
- Clinical cure rates with fluconazole reached 100% compared to only 32% with nystatin in one study 1
Adults
- Oral fluconazole is effective for treatment and prevention of recurrent thrush in adults 4
- For vulvovaginal candidiasis in adult women, both oral and intravaginal antifungals show similar clinical cure rates 5
Key Points for Clinicians
- Suspect thrush in any infant with white patches in the mouth that cannot be wiped away 1
- In adults, consider underlying conditions or medication use when thrush is present 3
- Treatment-resistant thrush at any age may warrant investigation for underlying immunodeficiency 2
- Prophylactic antifungal therapy may be appropriate for recurrent thrush in high-risk adults 4