Thrush, or candida yeast, normally lives on our skin and other areas (up to 90 percent of babies are colonized by it within a few hours of birth). It only becomes a problem under certain circumstances such as:
- Warm, moist, dark environment;
- When there is a break in skin integrity;
- Mothers with recent or recurrent vaginal yeast infections, and nipple trauma are predisposed to candida infection of the breast;
- May be associated with recent use of antibiotics by the baby or mother (the use of antibiotics encourages the overgrowth of candida);
- Greater incidence of oral thrush in an infant has also been associated with pacifier use and prematurity.
Symptoms in the mother:
- Persistent, burning nipple pain that can come and go.
- Pain in the breast that is “shooting” or “burning” and which radiates to the mother’s armpit, back, or shoulder. This pain can be felt throughout or in between feedings.
- There may be redness, streaking, deep-pink inflammation, tiny blisters, scaling, the skin of the areola may be smooth and shiny, and the nipple may be cracked, especially around the base; or there may be no change in appearance of the mother’s nipples or areolas.
- May be itchy;
- May occur in one breast or nipple only.
Symptoms in the Infant:
- White patches on the inside of the mouth, cheeks, or tongue, which do not wipe off;
- Breast refusal or a reluctance to nurse (because of a sore mouth), or may exhibit frequent suckling;
- Diaper rash, with skin break down;
- Infant may be fussy;
- May have no symptoms.
It is very important to get the best latch possible when you have sore nipples. Even if the cause of sore nipples is Candida, improving the latch can decrease the pain.
Other possible causes of burning nipple pain, poor latch, bacterial infections (mastitis) asospasm/Raynaud’s phenomenon, and dermatologic conditions which should all be ruled out before candida is assumed.
It is safe to continue breastfeeding even if you or baby has a yeast infection. Only a physician can diagnose and prescribe medical treatment for thrush, so please contact your physician for treatment for you, and your pediatrician, for treatment for your baby.
Adding active culture yogurt or acidophilus to the diet. Mom may want to ingest acidophilus three times a day for one to two weeks, or may take one tablet (40 million to 1 billion viable units, found at pharmacies and health food stores) take for at least two weeks beyond the disappearance of symptoms.
Drink more water and add garlic (three triple-strength deodorized tablets, three times daily for two weeks or more), zinc (45 mg daily), and B vitamins (100 mg of each from sources other than nutritional yeast) to the diet.
Decrease the consumption of concentrated sweets, honey, sugar, and alcohol. For early cases, a warm vinegar and water soak (one part vinegar, four parts water), for mother’s nipples and areola after feedings, followed by air-drying and then an antifungal preparation, may be helpful.
In the case of stubborn candidiasis, a strict yeast-free diet is recommended, including the avoidance of alcohol, cheese, bread, wheat products, sugar, honey and condiments.
Allow the nipples to be exposed to the air as much as possible, consider not wearing a bra at night, and leaving bra flaps open during the day. Expose nipples directly to the sun for a few minutes twice a day.
Discard disposable nursing pads as soon as they become damp; cloth nursing pads should be changed after each feeding and not be used again until they’ve been washed in hot, soapy water. All clothing in contact with breasts and infant must be changed daily, and washed and dried in very hot temperatures.
Wearing 100-percent cotton bras that can be boiled in plain water for five to ten minutes, or washed in very hot water (above 122 degrees Fahrenheit) with bleach, to kill candida spores, is recommended.
If a breast pump is being used, boil all parts (except the rubber gaskets) that touch breast milk each day for 20 minutes. Boil bottle nipples, tethers, and pacifiers, if they are used, once a day for 20 minutes; after one week of treatment, discard them and buy new ones.
Anything the baby puts in his/her mouth should be washed frequently in hot, soapy water, and avoid sharing these items with others.
Avoid baths with other members of the family.
Expressed milk can be fed to the baby, but milk expressed during a candida outbreak should not be frozen and used later.
In some cases, after treatment has begun, the symptoms may seem worse for a day or two before they improve, and usually, the more severe the Candidiasis, the longer it takes for the treatment to work and for the pain to disappear. Recurrent yeast infections can be the result of inadequate treatment of the initial infection.
If yeast is not treated successfully after the mother and baby have had two full courses of treatment, it is suggested that all members of the family may need to be treated simultaneously, as family members can pass it back and forth without all having symptoms.
Some experts recommend that both mother and baby be treated together even if the baby is not showing symptoms of oral thrush or diaper rash.
For medical treatment of thrush, contact your physician.