Thrush, or Yeast Infection

By Krista Gray, IBCLC. Last updated February 8, 2013.

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What is it?

Candida albicans is an organism that can cause thrush and vaginal yeast infections.  Everybody has candida in their bodies, but it typically lives in balance with other organisms.  Things such as pregnancy, antibiotics, and illness can allow candida to thrive and grow to unhealthy levels.  Once there is a candida overgrowth on the nipples, it is important to treat both mother and baby aggressively to ensure it doesn’t continue to thrive.

What are the symptoms?

Thrush can be very painful for a breastfeeding mother.  Symptoms such as burning nipples, itching nipples, painful breasts – including stabbing pain, and shiny or flaky skin on the nipples and/or areola can all be signs.  In her baby, a mother may notice white patches in his mouth (when wiped off they may look red or even bleed), and/or a diaper rash.  It is important to note that symptoms may occur in just the mother or just the baby. . . or both.  Regardless, if thrush is diagnosed, both mother and baby should be treated so they don’t continue to reinfect one another.

How is it diagnosed?

Thrush can be tricky to identify (since its symptoms are similar to other common culprits of nipple pain) and most doctors diagnose it based on symptoms alone (rather than swabbing and culturing the area).  It is rather common for mothers to be treated for thrush only to find the symptoms remain after treatment and later learn their pain was from something altogether different (such as Raynaud’s Phenomenon or a bacterial infection).  However, when symptoms appear in both mother and baby, and the history contains a risk factor, it is much more likely the cause could be thrush. 1

Causes

Some common causes of thrush include:

  • the use of bottles and pacifiers2
  • antibiotics
  • illness
  • maternal diabetes mellitus
  • a break in skin of nipple – which can create moist environment where thrush thrives,
  • pregnancy

It can also be acquired from vaginal candidiasis during birth where the mother passes it along to her baby.  Thrush takes time to develop so if the nipple pain occurs during the first week after birth, it is much more likely to be other causes such as poor latch, tongue tie, bacterial infection, etc.

Treatment

There are a variety of methods that can be used to treat thrush.  For the mother:

  • Virgin coconut oil – in vitro studies kill 100% of candida 3
  • Gentian violet – OTC (Over the Counter) which has been found to be more effective than nystatin 4
  • Miconazole – OTC
  • Ketoconazole – OTC
  • “All-Purpose Nipple Ointment” (APNO), created by Dr. Jack Newman, can be prepared by a pharmacist (by prescription).  It has antibiotic, anti-fungal, and anti-inflammatory properties. 5
  • Clotrimazole
  • Nystatin
  • Oral fluconazole

For baby:

  • Gentian violet – OTC
  • Nystatin (only found effective in 32% of cases) 6
  • Miconazole gel
  • Clotrimazole gel
  • Fluconazole

For mild cases, symptoms should begin to get better within 1-2 days. For severe cases of thrush, it can take 3-5 days or longer. It is important to note that treatment should continue for two weeks after the symptoms have disappeared.  During treatment, it is a good idea to rinse nipples in water and air dry because thrush thrives on moist areas as well as milk.  Rinsing nipples in a weak bicarbonate of soda solution can also help.

Can I still breastfeed?

It is still perfectly safe to nurse your baby while being treated for thrush, whether at the breast or through expression. If you are expressing your milk for later use, you may want to label this milk.  When you need this milk later, try using it once and wait and see if you any symptoms.  If not, you may continue to use the milk you expressed while you had thrush.  While freezing does not kill candida albicans, it is not likely to cause problems due to the anti-infective properties of breast milk. 7

Precautions to Prevent Thrush

Thrush can live in many places and can be spread easily.  Here are some tips to rid your home of thrush:

  • Wash hands often, especially after changing diapers.  Dry hands with paper towels that you can discard.
  • Wash all baby toys that go in baby’s mouth with hot and soapy water.
  • Wash baby’s hands often, especially if they go in his mouth.
  • Boil any pacifiers, bottle teats, or pump parts for 20 minutes every day.
  • Use disposable breast pads and discard after each feeding.
  • Dry bras and cloth nursing pads in the sunlight, which kills candida
  • Many women have found eliminating simple sugars and taking probiotics to be helpful.

 

Show 7 footnotes

  1. Morrill, J.F., et al. (2005). Risk factors for mammary candidosis among lactating women. Journal of Obstetric, Gynocologic, and Neonatal Nursing, 34(1), 37-45.
  2. Ibid
  3. Ogbolu, D.O., et al. (2007). In vitro antimicrobial properties of coconut oil on Candida species in Ibadan, Nigeria. Journal of Medicinal Food 10(2):384-7.
  4. Kozinn, P.J. (1957). Therapy of oral thrush: a comparative evaluation of gentian violet, mycostatin, and amphotericin B. Monographs of Therapy 2:16-24.
  5. For additional information on Dr. Jack Newman’s protocol for candida:  http://www.breastfeedinginc.ca/content.php?pagename=doc-CP
  6. Goins, R.A., et al. (2002).  Comparison of fluconazole and nystatin oral suspensions for treatment of oral candidiasis in infants. Pediatric Infectious Disease Journal, 21(12), 1165-1167.
  7. Newman, J., & Pitman, T. (2000). The Ultimate Breastfeeding Book of Answers. New York, New York: Three Rivers Press, 149.
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