Thrush

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. Thrush is caused by a yeast fungus, usually Candida albicans. 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. (See a list below this entry for an extensive list.) Positioning and latching problems are the most common causes of pain. Breastfeeding isn’t supposed to hurt! Check out our post on Sore Nipples for more information.

Treatment for Thrush

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. A baby may also have yeast rashes in the diaper area. Any skin that touches other skin is especially vulnerable for the breastfeeding dyad: under arms or breasts, between fingers or toes, in the groin area, and even in the creases of the eyelid. Yeast can spread to other family members as well, especially with shared bedding or eating utensils or cups.

According to a recent study, fluconazole (common name brand: Diflucan) has been shown to be the more effective than Nystatin in treating thrush. Treatment should continue for 2 weeks beyond the end of the symptoms. 

Of course, different people react better to different medicines, so you may have to try more than one. There are other medication options, including gentian violet and the over-the-counter treatment Miconazole. Check with your health care professional about these options. (If using Miconazole, apply to nipples and areolae 2 to 4 times a day for 7 days.) Taking mild over-the-counter pain medication (whatever you find effective for a headache) can also be useful.

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 on the least painful breast. Using crushed ice on the nipples before breastfeeding will often numb them enough to make nursing bearable. Be sure to rinse your nipples and let them air dry after each feeding.

Very painful nipples can be protected from contact with clothing by wearing hard plastic shells in the bra between feedings. The shells come in contact with leaking milk and need to be cleaned frequently.

Pumping your breasts and offering baby milk via a bottle or cup may be another alternative, especially if you have cracked nipples. Just make sure you are sterilizing pump parts after each use. (The milk you pump during a thrush outbreak can be fed to your baby but should not be frozen for future usage. Freezing breastmilk does not kill the yeast in it.)

Healing your nipples is a priority. Not only does it make for a more pleasant breastfeeding experience, it also cuts off an area for yeast to enter the body. There is a section on treatment for sore nipples in this post.

If your baby uses a pacifier or bottle nipple, they should be boiled for 20 minutes a day and replaced every week. 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.
  • If you are using cloth diapers, each one of them needs to be washed with HOT water and bleach or a similar alternative. Consider using disposable diapers until the yeast infection is gone.
  • Rinsing your nipples with a vinegar and water solution (1 tablespoon apple cider vinegar preferred 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 a probiotic to their diet. Acidophilus supplements (40 million units per day) is commonly cited.
  • Some women find that reducing yeast and sugar in their diet helps.
  • Consider switching to a non-antibacterial handsoap during this time. Antibacterial soaps kill both good and bad bacteria, and good bacteria keeps yeast in check.
  • 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.

These home remedies can be effective. They should be in addition to the medication, not instead of it.

Persistent Thrush

Maybe you and your family have been dealing with thrush for weeks or months. A persistent thrush infection can be exhausting, and you are to be commended for sticking it out so long through this challenge!

Remember, it is important to treat the nursing parent and the baby. If you find that all of these treatments for your yeast infection do not improve your situation, it is possible that you have a bacterial infection and not yeast. Bacterial infections of the nipple often mimic yeast symptoms. Talk to your healthcare provider about this possibility.

Family member are also susceptible; men particularly do not exhibit outward symptoms.  Thrush can be passed back and forth between parents during sexual relations. It can go from child to child if shared toys are put in their mouths or in a tandem nursing situation. If thrush continues to recur after you and your baby have had two full courses of treatment, all members of the family may need to be treated simultaneously.

Points to Consider with Recurrent Yeast
  1. Avoid sugar, including fruit and artificial sweeteners.
  2. Avoid anything with yeast, including breads. Cut back on high carbohydrate foods, which are full of yeast.
  3. Avoid dairy products, except yogurt with live cultures.
  4. Ask your partner to be checked for a yeast infection, where yeast can live.
  5. Check everyone in the family for cracks in the corner of the mouth.
  6. Set your dishwasher to heat the water hot enough to kill yeast on glasses, dishes and utensils for oral yeast in family members using these dishes. If you handwash, dip the dishes and utensils in a bleach solution first.
  7. Eliminate the use of Natural B vitamins, such as Brewer’s Yeast, for a time.
  8. Brush your tongue as well as your teeth.
  9. Replace toothbrushes regularly. Boil or soak in a 10% bleach solution after each bout of thrush.
  10. Disinfect dental or orthodontic appliances each and every time they are removed from the mouth.
  11. Discard roll-on or solid deodorant after the initial yeast outbreak has cleared.
  12. Check for yeast growing in or under/around finger or toenails, under arms or breasts, in the groin or baby’s diaper area. Does baby suck thumb, finger or knuckles? Check them carefully. Wash baby’s hands frequently. Also check the finger and toenail beds and where skin touches skin for the entire family.
  13. Take precautions to avoid the spread of yeast with family underwear, bras,and towels.
  14. Wear underwear and pantyhose with a cotton crotch. Cut the crotch out of the panty or wear thigh-high hose.
  15. Avoid synthetic underwear and tight jeans.
  16. Change quickly out of sweaty exercise clothes or wet swimsuits.
  17. Notice any correlation between your menstrual cycle and thrush reoccurrence, particularly a few days before menses starts.
  18. Wash your hands every time you use the toilet, handle your breasts or milk, put your fingers in your own or your baby’s mouth, or change diapers (nappies).
  19. Treat every single thing possible that you put in your mouth or your children put in theirs to kill yeast.
  20. Disinfect inhalers or breathing treatment machines for asthma or other conditions between uses.
  21. Replace makeup after clearing up a yeast infestation. Yeast can live on lipsticks, lip and eye liners, eye shadows, mascaras, foundations and powders. Disinfect or replace makeup applicators.
  22. Have a veterinarian check animals for yeast. Pets with fur can harbor yeast, particularly in their ears. Feathered pets can have yeast overgrowths, too.

Yeast can be passed through the laundry. Wash everything on hot water and consider adding bleach.

Diet plays an important role. Many women find that reducing yeast, sugar, and dairy products in their diet helps. In particularly severe cases, it may be necessary to eliminate most or all refined sugars and starches. One rule of thumb that some moms have used while treating stubborn thrush is to eat a “MEVY” diet: most of the diet should be meat, eggs, vegetables, and plain yogurt.

Here are some other ideas you might try to balance the yeast levels in your body:

  • Take grapefruit seed extract, 250mg, three times daily.
  • Consider applying infection diluted grapefruit seed extract directly to your nipples. (Recommended 5-15 drops in 1 ounce of water, applied with a clean cotton swab each time. No double dipping. Start with the lowest concentration and increase drops until pain improves. Never apply full strength GSE onto skin.)
  • Drink more water and add garlic (three triple-strength deodorized tablets, three times daily for two weeks or more), zinc (45mg daily), and B vitamins (100mg of each from sources other than nutritional yeast) to the diet.

Finally, Dr. Jack Newman’s has a Candida (yeast) Protocol many mothers have found to be helpful. Here is a link to his handout.

If the infection continues to resist treatment, you might also want to have medical tests done to rule out anemia and diabetes.

Attend a La Leche League Group meeting in your area for additional information and support.

Resources for Additional Information

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.)

Comparison of fluconazole and nystatin oral suspensions for treatment of oral candidiasis in infants. By R.A. Goins, D. Ascher, N. Waecker, J. Arnold, E. Moorefield.