Is thrush causing my sore nipples?
Persistent nipple pain in the early weeks of breastfeeding, or nipple pain that appears after several weeks or months of pain-free nursing, may be caused by thrush which is a yeast infection of the nipples. Additional symptoms can include
- Itchy or burning nipples that appear pink or red, shiny, flaky, and/or have a rash with tiny blisters.
- Cracked nipples.
- Shooting pains in the breast during or after feedings.
- Intense nipple or breast pain that is not improved with better latch-on and positioning.
- Deep breast pain.
You may be at higher risk for developing thrush if you or your baby has had a recent course of antibiotics, your nipples are cracked or damaged or you are taking oral contraceptives or steroids (such as for asthma).
Be sure to examine other causes of nipple and breast pain. (There is a thorough list at the end of this article.) Positioning and latch-on problems are the most common causes of pain. Breastfeeding isn't supposed to hurt! Check out the LLLI Sore Nipples FAQ for additional information.
Thrush can be very difficult to treat. It is essential for both you and your baby to be treated for thrush as not only is it easily spread but it also thrives in warm moist environments such as your baby's mouth and your nipples. According to the BREASTFEEDING ANSWER BOOK, Nystatin is considered to be less effective than other treatment options. There are other medication options, including gentian violet and the over-the-counter treatment Miconazole. There is also an oral medication that can be given for resistant cases. Check with your health care professional about these options. Treatment should continue for 2 weeks beyond the end of the symptoms and may be given 4 times a day or after every feeding (if using Miconazole, apply to nipples and areolae 2 to 4 times a day for 7 days).
After treatment for thrush begins, the symptoms may appear to get worse for a couple of days before improving. While the pain continues, offer your baby short, frequent feedings, beginning of the least painful side. Be sure to rinse your nipples and let them air dry after each feeding.
If your baby uses a pacifier or bottle nipple, they should be boiled for 20 minutes a day and replaced every week. Don't forget to boil all breast pump parts that come in contact with milk, if you are pumping. (The milk you pump during a thrush outbreak can be fed to your baby but not frozen. Freezing breastmilk does not kill the yeast in it.) Toys that go in your baby's mouth should be washed with hot, soapy water.
In addition to the medical treatment, there are other steps you can take.
- Wash all bras, bra pads, nightgowns, etc (anything that comes in contact with your nipples) in HOT water with bleach and dry on hot in the dryer or in the sun.
- Rinsing your nipples with a vinegar and water solution (1 tablespoon vinegar to 1 cup water) after every feeding is helpful. Use a fresh cotton ball for each application and mix a new solution every day.
- Some women add acidophilus supplements (40 million units per day) to their diet.
- Some women find that reducing yeast and sugar in their diet helps.
These home remedies can be effective but they should be in addition to the medication, not instead of it.
Be careful with hand washing, especially after diaper changes. Babies can get yeasty diaper rashes very easily. If you use cloth diapers or nursing pads, the yeast can be passed through the laundry.
Attend a La Leche League Group meeting in your area for additional information and support. To find a Leader of a local Group, visit the section of our Web site entitled "Finding a Local LLL Group."
Resources for Additional Information
A thorough article written for Leaders describing thrush, other causes of sore nipples, as well as treatment options and prevention measures.
These items may be available from the LLLI Online Store or through your local Leader.
THE WOMANLY ART OF BREASTFEEDING, published by La Leche League International, is the most complete resource available for the breastfeeding mother. It contains a section on breastfeeding while treating thrush. (Softcover, 480 pages.)
Treating Thrush in the Breastfeeding Family, by Rebecca Butler and Kathy Koch-- Written by two LLL Leaders, this pamphlet provides information on prevention and treatment of thrush.
Candidiasis and Breastfeeding (Unit 18, LLLI Lactation Consultant Series), by Lisa Amir, MBBS, IBCLC, Kay Hoover, MEd, IBCLC, and Chris Mulford, RN, BSN, IBCLC--Fully explores the issues of nipple thrush and deep breast pain caused by yeast infections. Describes a complete care plan that outlines comfort measures, dietary changes, and household hygiene techniques to treat various forms of thrush. Also gives specific treatment plans ranging from the use of home remedies to anti-fungal medications that need to be prescribed by a physician. Fully referenced.
Our FAQs present information from La Leche League International on topics of interest to parents of breastfed children. Not all of the information may be pertinent to your family's lifestyle. This information is general in nature and not intended to be advice, medical or otherwise. If you have a serious breastfeeding problem or concern, you are strongly encouraged to talk directly to a La Leche League Leader. Please consult health care professionals on any medical issue, as La Leche League Leaders are not medical practitioners.