Thrush is a common, harmless yeast infection found in many different parts of the body, affecting both men and women. This blog post will discuss breastfeeding thrush, its causes, symptoms, and treatments.
What Is Thrush?
Thrush is an overgrowth of the yeast organism candida albicans. This organism is always present in our bodies but has a tendency to overgrow when we are ill, tired, pregnant or using antibiotics.
It thrives in warm, moist environments such as the vagina, nappy area, mouth, and nipple (in lactating women). Overgrowth may also happen when our microbiome is out of balance.
What Causes Nipple Thrush?
Nipple thrush is likely to occur when the infection is affecting other parts of the body, usually the vagina. There may be a higher chance of breastfeeding thrush if you have the tendency to vaginal yeast infections.
The infection can also be caused if any other family remember has the infection such as a nappy rash or athlete’s foot. Antibiotics are another cause of thrush as they kill good bacteria, giving room to bad bacteria to flourish. If a mother has experienced recent nipple trauma, that can also lead to thrush.
Nipple Thrush Symptoms
Thrush in breastfeeding mothers can be painful, and problems can start after a period of breastfeeding without issues sometimes affecting both breasts. It’s therefore important to look out for the following symptoms when identifying whether you have thrush on your nipples:
- Itching, burning or shooting pain on the nipple or deep within the breast, often towards the end of a feed, and for quite some time after. It’s important that other causes of breast pain should always be ruled out before a thrush diagnosis is made.
- Nipple trauma that won’t heal.
- A white ‘plaque’ or residue may be present in the crease around the nipple.
- Pain does not reduce with improved latch.
- There is NO related pyrexia.
- There are NO red areas on the breast.
If you think you might be suffering from cracked and sore nipples try our HPA Lanolin Nipple Cream.
What Does Thrush on a Nipple Look Like?
When you have nipple thrush, your nipple appearance may change to being shiny in appearance, sometimes chapped, blistered with white patches but may also look completely normal. You may also experience itchy, flaky and red nipples or areola.
Breastfed Baby Thrush Symptoms
Babies can also display symptoms of thrush (though they may not) these can consist of:
- White patches in baby’s mouth
- White coating on the tongue that does not go away when cleaned
- A pearl-like sheen to lips
- Nappy rash
- Fussiness and windiness when breastfeeding
All of these signs and symptoms can help confirm diagnosis but are not necessarily present in their entirety which can make differential diagnosis difficult. However, a swab can confirm diagnosis (using a charcoal swab).
Nipple Thrush Treatment
You can carry on breastfeeding while you and your baby are being treated for this fungal infection. However, it’s essential to get full treatment to kill the bacteria. The first route consists of a thrush cream that can be applied to the skin of the nipple, the baby’s mouth, and bottom.
Miconazole cream 2% can be prescribed to apply to nipples in minimal quantities, after every feed. If nipples appear very sore topically, miconazole 2% in combination with hydrocortisone 1% may be most effective (such as Dactacort cream).
The second route, is systematic/oral treatment for deep breast pain that does not improve with topical treatment. As a drug unlicensed for breastfeeding women, physicians take responsibility for prescribing this. The amounts of fluconazole getting through to baby from the breastmilk would be less than that prescribed for a baby.
However, fluconazole has a half-life of 88 hours in babies under 6 weeks therefore the risk of accumulating doses needs to be considered when planning this treatment. Treatment generally comes as a loading dose of 150-400mg and maintenance doses of 100-200mg for at least 10 days.
Fluconazole does not kill off yeast as such but stops overgrowth, which is why shortened treatment courses may well be ineffective and could arguably cause sensitisation.
It is also recommended to keep your nipples as dry as possible by regularly changing your breast pads to avoid any moist environment.
Baby Thrush Treatment
Miconazole oral gel for thrush seems to be the most effective treatment for babies. Gel does not penetrate the skin and is not suitable for nipples. Nystatin suspension is also sometimes prescribed for baby’s oral use.
Additionally, make sure to:
- Clean teats and dummies after use by boiling them for five minutes.
- Wash your hands thoroughly after applying the cream on babies and nappy changes.
- Wash anything that comes in contact with the fungal area, such as clothes, bedding etc.
Preventing Recurring Nipple Thrush
A recurring thrush while breastfeeding can be prevented by:
- Ongoing support with attachment and positioning.
- Considering a good quality probiotic to support a healthy microbiome.
- Having good hygiene as candida albicans can thrive in shared towels, laundry, clothes, breast pump parts, hands, toys etc.
- Changing breast pads/bras frequently and washing them as hot as possible to kill off yeast. Disposable breast pads may be preferable to washable ones during an outbreak of thrush.
- Making dietary adjustments such as reducing sugar, processed foods, carbohydrates, dairy and increasing iron intake may be helpful.
- If thrush seems recurring, consider testing for diabetes.
Sometimes, nipple thrush pain is quite similar to other health issues – some of the most popular issues that get mistaken as a yeast infection are:
- Vasospasm/Raynaud’s Phenomenon
- Micro-fissures due to suboptimal attachment.
- Tongue tie in baby.
- Nipple eczema.
- Bacterial infection (staphylococcus aureus possibly).
- Other skin conditions like psoriasis or dermatitis.
- Amir L, Hoover K. (2002) “Candidiasis and Breastfeeding.” LLLI Schaumberg
- Chetwynd EM, Ives TJ, Payne PM et al. (2002) “Fluconazole for postpartum candidal mastitis and infant thrush.” J Hum Lact;18:168-71.
- Hale T. (2012) “Medications and Mothers Milk” (15th Ed), Hale Publications
- Hoppe JE, et al (1997) “Treatment of oropharyngeal candidiasis in immunocompetent infants: a randomised multicentre study of miconazole gel vs nystatin suspension.” Paed Infec Dis. 1997; 16:288-93
- Mohrbacher, N., Stock J. (2008) “La Leche League International: The Breastfeeding Answer Book” 3rd revised edition, LLLI.
- Weiner S. (2006)” Diagnosis and Management of Candida of the Nipple and Breast.” J.Midwif. Women Health; 51:125-128
- (2002) “Breastfeeding and Maternal Medication” WHO.