There are three things moms worry about when they start breastfeeding. Sore nipples, not having enough milk and mastitis. I have written about all three. Thrush falls under sore nipples but deserves an article all of its own.

Thrush and yeast refer to the same thing, and I will be using the terms interchangeably in this article.

A yeast infection in your nipples not only hurts like the dickens, but it can also be very challenging to diagnose. Other than being painful and annoying, thrush can cause a mom choosing to wean before she planned to. Breastfeeding should not be painful. Let’s chat about what this nursing demon is all about.

What It Feels Like, What It Looks Like

Moms

Photo credit: pixel pro photography south africa on VisualHunt / CC BY-NC-SA

  • Nipple and breast pain
    • Your nipples might burn or sting.
    • You may have shooting, stabbing pains from your nipples through your breasts.
  • The nipple area may be bright pink, possibly be shiny or have a flaky appearance.
    • The nipple may have a white area on it (but look different than a bleb)
    • They may look perfectly normal
    • The greatest frustration can be having a health care provider look at your breasts and say, “doesn’t look like yeast to me.”

Babies

  • Your baby can have thrush in the diaper area or in his mouth.

  • The diaper area will have a red, raised rash.
  • If you Google nipple, oral or diaper thrush and look at the images, you’ll get lots of examples. Be warned though, some of the diaper thrush pictures made even this nurse cringe.
  • I never recommend a mom try to diagnose her baby’s rashes and encourage you to take your little one to his health care provider if he has a rash.
  • Thrush in the mouth will be white patches on the cheeks or palate and a white tongue
    • A whitish tongue isn’t uncommon in babies who only drink milk. I call it milk tongue, which is different than thrush, and with thrush, there will usually be white patches that won’t wipe away in places other than his tongue.
    • The worst case I ever saw looked like a little white rug on the baby’s tongue

What Can Put You at Risk?

  • Moms who have a history of yeast infections have a higher chance of getting thrush in their nipples.
  • A baby with thrush can cause you to get thrush and vice versa.
    • For this reason, many lactation consultants recommend treating both mom and baby simultaneously, even if only one of you has a diagnosed case and the other one has no symptoms.
    • I wouldn’t do a hard-core treatment, but I don’t think there is anything wrong with an antifungal ointment for the non-symptomatic party.
  • Antibiotics put a mom at higher risk.
  • Keeping the nipples in a warm, wet environment. Think a milk-soaked bra pad. Yeast loves sugar, and there is lots of sugar in breastmilk.
  • Diabetic moms
  • For a mom who is prone to yeast infections, a diet high in sugars puts her at higher risk

Treatment

Gentian Violet – Women with nipple thrush often will get a full cure with Gentian Violet

Gentian Violet is a purple dye that is an antifungal and can kill bacteria.

  • It’s available without a prescription but may be kept behind the counter, and you’ll have to ask for it.
  • Gentian Violet Precautions
    • Be sure to ask for a 0.5% – 1% strength. It is easier to find 2% preparations, but that would be too strong to put on your nipples. You don’t want the cure to be worse than the problem.
    • Gentian Violet is hard to find where I live, so I do recommend moms call a store or pharmacy first to save a wasted trip or driving all over. You can order it from Amazon, but in all honesty, most women want relief sooner than that. It’s messy and stains everything it comes in contact with, including your baby’s mouth. It will go away, but it will look like you’ve been feeding him blueberry pie. If someone asks why his mouth looks like that, say, “I’m embarrassed to admit it, but he ate our Smurf.” Then look guilty and say, “is that bad?”
  • As far as your clothing goes, disposable bra pads are your friend bamboobies Disposable Nursing Pads for Breastfeeding, 60 Breast Pads.
  • Use it once a day and no more, for no more than seven days. Gentian Violet is not the type of stuff where if some is good, then more is better. Too much can break down the tissue and then you have a whole new problem.

Nystatin ointment, a prescription ointment, for mom or drops for baby is a frequent treatment. It can work but seems to work about as frequently as it doesn’t. Miconazole (also prescription), which is the antifungal agent used in APNO, is an effective antifungal https://www.breastfeedinginc.ca/informations/all-purpose-nipple-ointment-apno/

Some research has supported the use of probiotics in the treatment of thrush. I personally think there are many good reasons to take probiotics.

If the first lines of defense don’t work, a course or two of Diflucan, generic name fluconazole, should do the trick. Diflucan is an oral antifungal that would be prescribed by your health care provider. It is usually effective if given in the proper dosage and duration for this type of yeast. It requires a higher loading dose, and you have to take it for a longer period of time.

 

Other things that can cause nipple pain which can mimic yeast

  • Staph
  • Raynaud’s
  • Vasospasm or Mammary Constriction http://ibconline.ca/information-sheets/vasospasm/

Precautions during active infection

To help get rid of yeast make sure that you sanitize anything that comes in contact with your baby’s mouth or your breasts every 24 hours.

  • Bottles, nipples, and pacifiers. If your baby is older and putting toys or teethers in their mouth, those count too.

    Photo credit: yoshimov on Visual hunt / CC BY-ND

  • Pump parts
  • Bras, tanks or anything that milk has leaked on to
  • This is one time that I recommend disposable nursing pads and change them frequently.
    • If you absolutely hate disposable pads, just make sure that you change the cloth pads often and wash them, along with the bras and any other clothing in hot water before reusing.
    • Don’t wear for any longer than one day.
    • For the mom who leaks a lot when she sleeps, put down a towel and wash that in hot water after 24 hours.
  • Good handwashing!
  • It is not recommended that you freeze any breastmilk that you might collect during this time and you’d want to use any milk that you pump within 24 hours.
    • While there has never been a documented case of yeast causing an infection this way, freezing does not kill yeast.

Photo credit: yoshimov on Visual hunt / CC BY-ND

Final Thought

I hope you never have to deal with this, but if you do, I hope this article will help you get rid of it quickly.

Have you ever had to deal with a case of thrush? Let me know if it was particularly difficult to get rid of. I would also love to hear if it ended up being something else entirely and how that condition was treated.

Next Time

How birth can affect breastfeeding

References

Berens, P., Eglash, A., Malloy, M., Steube, A. M., & Academy of Breastfeeding Medicine. (2016). ABM Clinical Protocol# 26: Persistent pain with breastfeeding. Breastfeeding Medicine11(2), 46-53.

Jiménez, E., Arroyo, R., Cárdenas, N., Marín, M., Serrano, P., Fernández, L., & Rodríguez, J. M. (2017). Mammary candidiasis: A medical condition without scientific evidence?. PloS one12(7), e0181071.