What does it mean if a baby has a thick white coating on the tongue?

Mar 18, 2025 Source: Cainiu Health

Dr. Zhou Xiaofeng

Introduction

Under normal circumstances, a baby's thick white tongue coating may be caused by residual milk curd, tongue mucosa metabolism, indigestion, candida infection, or weakness of the spleen and stomach. It is recommended to seek medical attention promptly and follow the doctor's instructions for treatment. Babies who consume milk for a prolonged period are more likely to develop a thick white coating on the tongue due to milk residue. This is particularly common in infants with reduced saliva secretion and underdeveloped oral self-cleaning abilities.

Generally, thick white tongue coating in infants may be caused by residual milk curd, tongue mucosa metabolism, indigestion, candidiasis infection, or weakness of the spleen and stomach. Medical attention should be sought promptly, and treatment should follow medical advice. Details are as follows:

1. Residual milk curd: Infants who consume milk for prolonged periods may develop thick white coating on the tongue due to milk residue. This is especially common in infants with reduced saliva secretion and underdeveloped oral self-cleaning abilities. Parents can gently wipe the infant's tongue surface with gauze soaked in purified water to remove milk curd and maintain oral hygiene. No special treatment is required.

2. Tongue mucosa metabolism: Due to differences in the mucosal metabolism rate of the tongue's ventral surface among infants, some infants experience rapid turnover, causing the tongue mucosa to shed easily and deposit on the tongue surface, forming a thick white coating. Parents can similarly use gauze soaked in purified water to clean the infant's tongue locally, preventing bacterial growth. This situation also does not require special treatment.

3. Indigestion: Infants have relatively weak gastrointestinal function. Improper feeding or inappropriate introduction of complementary foods can easily cause indigestion. Prolonged retention of food in the intestines can lead to damp-heat, which manifests on the tongue coating, making it thick and white, possibly accompanied by loss of appetite. Digestive-promoting medications such as compound pepsin granules, aromatic spleen-stimulating granules, and zinc gluconate oral solution should be used as directed by a physician.

5. Candidiasis infection: Infants have immature immune systems and are susceptible to infections by pathogens such as Candida. Candida infection can cause curd-like white membranous patches on the oral mucosa that are difficult to remove, thereby affecting the normal state of the tongue coating, often accompanied by fever. Treatment with medications such as clarithromycin ointment, erythromycin ointment, or amoxicillin granules may be administered under medical guidance.

4. Weakness of the spleen and stomach: Weakness of the spleen and stomach in infants leads to poor digestion and absorption, making food retention more likely. Food retention generates damp-heat, which rises to the tongue, causing thick white tongue coating, possibly accompanied by loss of appetite. Appetite-stimulating medications such as infant Qixing tea granules, compound chicken gizzard membrane powder for children, or spleen-nourishing pills for children may be used following medical advice.

During treatment, parents should closely monitor changes in the infant's symptoms and seek timely medical attention if necessary.

References:

1. Wang Weiping, Sun Kun, Chang Liwen. Pediatrics [M]. 9th edition. Beijing: People's Medical Publishing House, 2018.

2. Pediatric Dentistry Committee of the Chinese Stomatological Association. Expert Consensus on Oral Health Management for Infants and Young Children [J]. Chinese Journal of Stomatology, 2018.

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