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What is thrush?
Thrush is a common yeast infection in a baby's mouth that can affect your nipples during breastfeeding. The condition is called thrush when it's found in the mouth, and candidiasis or simply a yeast infection when it's found elsewhere on the body.
It's caused by a type of yeast called Candida, which also causes some diaper rashes and vaginal yeast infections in women.
Having a little yeast in your body is harmless, and it's normally found on the skin and in the genital area, mouth, throat, and digestive tract. It lives alongside the "good" bacteria that help keep the amount of yeast in the body under control.
But if the immune system weakens, or if levels of good bacteria fall, the balance is disrupted and the yeast multiplies and sticks to body surfaces, causing symptoms of an infection.
Many infants first come in contact with Candida as they travel down the birth canal. (It's possible to have a vaginal yeast infection during pregnancy and not be aware of it.) After your baby is born, or during labor and delivery, antibiotics – taken by you or your baby – can trigger a case of thrush. That's because antibiotics, which get into your breast milk, kill off the good bacteria that regulate the amount of yeast in the body.
Your baby can also encounter Candida on his pacifier, bottle nipple, or even on your hands.
What caused thrush to develop on my nipples?
If you're breastfeeding, it's possible for you and your baby to infect each other. Yeast thrives in warm, moist, sugary environments, and that's exactly what your baby's mouth and your nipples provide during nursing.
Sometimes it's hard to pinpoint one particular cause. Some women and babies are simply more susceptible than others.
If you have a yeast infection on your nipples, it's important for you and your baby to be treated at the same time. Otherwise, you may just pass the infection back and forth.
What are the symptoms of thrush in breastfeeding moms?
Not all mothers have symptoms, but those who do may have:
- Nipples that are pink, red, shiny, or flaky (They may also be cracked.)
- Itching, burning, or deep, shooting breast pain during or after feedings
- Vaginal yeast infection
(Note that pink, tender nipples can also be a sign of a bacterial infection or dermatitis, which should be diagnosed and treated by a dermatologist.)
It's possible for both you and your baby to have thrush even if one of you is symptom-free. That's why it's important to contact your healthcare provider for diagnosis and treatment if either you or your baby has symptoms.
What are the symptoms of thrush in babies?
Babies with thrush may not have symptoms, but those who do may have:
- White or yellow patches in your baby's mouth or throat. The patches look like cottage cheese and aren't easily washed off. (If you notice a white coating on your baby's tongue but nowhere else, it's probably just milk residue.)
- Crying when nursing or sucking on a pacifier or bottle. The white or yellow patches may be painful and make feeding uncomfortable if the infection is severe. (Note: Some babies with thrush don't feel any pain or discomfort and are able to feed normally.)
- Raised, patchy, or bright or dark red yeast diaper rash with distinct borders. Small, red spots frequently appear around the edges of the main rash. The affected area is red and may be tender or painful, and the rash can creep into the folds of skin around your child's genitals and legs. It almost never appears on the buttocks.
What's the treatment for thrush in breastfeeding women?
Your provider may prescribe an antifungal cream for your nipples. Or she may recommend applying an over-the-counter antifungal cream, like Lotrimin or Monistat, to your nipples after every nursing for a week to 10 days. If your nipples are cracked, your provider may also prescribe a topical antibiotic.
If you're still in pain after being treated with topical medicine, you may need a more potent oral antifungal medicine.
Before every feeding, use olive oil or coconut oil (instead of soap and water, which can be irritating) to remove any medication on your nipples. After nursing, let your nipples air dry completely, then reapply the medication.
To ease any deep breast pain, you may want to take 600 mg of ibuprofen every six hours (with a maximum of 1,200 mg over 24 hours) until the worst is over and your treatment starts working.
You may also want to add lactobacillus acidophilus to your diet to recolonize your digestive tract with the bacteria that keep yeast in check. Look for yogurt containing live lactobacillus acidophilus cultures, or take it in pill form (40 million units per day).
In the meantime, try to keep your nipples as dry as possible in between feedings. For example, if you use nursing pads for leaking breasts, change them as soon as they get damp.
Note: Some moms find the pain so excruciating that they can barely stand to nurse their baby. If that's the case for you, pumping may be more comfortable until your nipples start to heal. (It's fine to give your baby milk you pumped while being treated for thrush.)
What's the treatment for thrush in babies?
It's likely that your baby's provider will prescribe an antifungal medicine, such as nystatin, so you and your baby won't reinfect each other. You "paint" the medicine on the white patches inside your baby's cheeks with the enclosed applicator (or your finger) several times a day for up to two weeks. Be sure to give the nystatin after nursing so the medicine will stay in your baby's mouth longer.
If your baby also has a yeast diaper rash, your provider may prescribe an antifungal cream to use in the diaper area.
In the meantime, disinfect any toys that your baby puts in his mouth, and clean all pacifiers, bottle nipples, and breast pump parts after every use by washing them in hot, soapy water or running them through the dishwasher. That way, you can avoid reinfecting yourself or your baby. For the same reason, wash your hands frequently, especially after feedings and diaper changes.
Call your baby's provider if the infection doesn't seem to be clearing up. (It may take up to two weeks to go away.)
See more details on treating your baby's thrush.
Can I use gentian violet to treat my nipples?
Some women do, but first check with your baby's provider.
Gentian violet is an over-the-counter liquid dye that can also be an effective alternative treatment for thrush when applied to your nipples. However, there are drawbacks: If it's used for too long (or in a concentration that's too high), it can cause mouth sores in infants and nipple skin irritation in nursing moms. It's also very messy to use because it stains anything it comes in contact with.
If your provider thinks gentian violet is appropriate for you, she can give you instructions on how to use it safely.