Recognizing and Treating Thrush
by

Your baby has been nursing well for several months, and all of sudden your nipples are sore. You’ve got shooting pain in your breasts, and your areolas are red, shiny and itchy. Your baby has a diaper rash, and when you look in his mouth, you notice lots of little white spots. Sounds like you’ve got thrush.

What is Thrush?

ThrushThrush is the overgrowth of a fungus that normally lives in our mouth, intestines and genital area, called Candida albicans. This organism thrives in moist, dark places, and is the same fungal infection that causes a vaginal yeast infection for women. Thrush affects one in 20 babies, and is more common in babies who were born before 37 weeks gestation. Thrush does not seem to have any long-term consequences on a baby’s health.

If you or your baby have recently finished a course of antibiotics, a yeast infection may be more likely. Babies or mothers who have immune system dysfunctions may also be prone to thrush. The hormones of pregnancy increase the risk of a yeast infection, as does warm, humid weather. Sometimes dietary factors play a role – the most common culprits leading to yeast overgrowth include dairy products, sugars (including alcohol) and artificial sweeteners. Nutritional deficiencies may also increase the risk. Moms with low levels of vitamins A, B, C, and K, as well as folic acid and iron, seem to have more frequent yeast infections. Broken skin on the nipple or areola is also susceptible to a yeast infection as it heals.

What Symptoms will I Notice in My Baby?

The most telling sign that your baby has thrush are the white patches on baby’s tongue, gums and inside his cheeks. These patches may look like cottage cheese and do not come off when wiped. Other symptoms may include a pearly look to baby’s saliva, gassiness, fussiness, and a red diaper rash with small bloody patches that doesn’t resolve with typical treatments. A baby with thrush may refuse to nurse, or pull off the breast throughout a feeding. Sometimes you will notice a clicking noise while baby is nursing from the brief release of the breast. Some babies may be asymptomatic – meaning they show no signs of the yeast infection – but mom has a yeast infection of the breast.

What if I’m Breastfeeding? Will I Get Thrush, Too?

If your baby has a yeast infection, you should be treated, as well, even if you have no symptoms.

The most common symptom pointing to thrush is sudden nipple pain after a period of pain-free breastfeeding. Your nipples and areola may be red, shiny, swollen, and itchy; and, you may have some white dots or flaking skin on the nipple, areola or breast. You may notice a rash on other parts of your body, such as under your arms, in your groin or in any creases of skin (inside the elbow, behind the knee, on the eyelids, or under the breasts). If you have recurrent vaginal yeast infections, or bacterial infections such as vaginitis or mastitis, you are more prone to thrush.

How is Thrush Treated?

The first step is to determine if the infection is indeed thrush. It will be necessary to work with your baby’s doctor as well as your own to get the most thorough treatment. Working with a lactation consultant is also advisable, as she will be able to rule out other causes of sore nipples or to identify thrush more quickly from experience. Mother and baby should both be treated for thrush, even if one does not have symptoms.

The most common treatment for baby is Nystatin suspension, a prescription medication swabbed inside baby’s mouth after every feeding for 2 weeks. Another option is gentian violet. This substance is an over-the-counter liquid that is “painted” inside baby’s mouth once or twice a day for several days to a week. It can be used in conjunction with other antifungals, and can be discontinued after 4 days if symptoms clear. Gentian violet is available in different strengths with different dosages, so be sure to read the instructions.

Babies with thrush are sometimes treated with other oral antifungal gels, such as miconazole or clotrimazole, which are available by prescription. Some doctors may prescribe oral fluconazole instead. Fluconazole is more effective than other treatments. No matter which type of medication you are using, be sure to complete the entire course of treatment.

If your baby has a diaper rash, the antifungal gels or creams can also be used to treat the genital area.

For moms, gentian violet can be used directly on the breasts, though it does stain everything purple, so be sure to protect your clothing (this is true if you’re using it in baby’s mouth, too!). Over-the-counter yeast treatments such as miconazole, clotrimazole, and ketoconazole can also be used on the nipples and areola. Your doctor may prescribe nystatin cream or ointment, instead. If these topical treatments don’t seem to be working, you might consider oral fluconazole, though this treatment may need to be used for up to two weeks (some doctors only prescribe a single dose for a vaginal yeast infection and may not be familiar with the dosage needed to treat thrush). You may feel a decrease in symptoms after only one or two days of medication, or you may notice an increase in symptoms for several days before they start to improve.

If you have a vaginal yeast infection at the same time as the thrush on your breasts, it can be treated with over-the-counter medication. If you are taking oral fluconazole, it will remedy both the vaginal and breast thrush.

Acidophilus, a probiotic naturally found in the digestive tract, can also be used in conjunction with other yeast treatments to promote the regulation of your gut flora. Supplements can be found in powder or capsule form in many health food stores. The powder can be used along with water or breastmilk to make a paste to coat the inside of baby’s mouth.

White vinegar is another possible treatment for thrush. Simply mix one tablespoon of white vinegar in one cup of water, then use a cotton ball to dab a bit onto each nipple after each nursing. Use a new swab each time. This should be used in conjunction with other pharmacological treatments rather than in place of them.

Is There Anything I can do to Prevent Thrush?

The key to deterring recurrent thrush infections is to fully treat it the first time in both mom and baby. Aside from that consider these other precautions:

  • If you are using breast pads because of leaking breasts, be sure to change them often. Allow your nipples to air dry before replacing them.
  • Your partner may need treatment as well, especially if you have been intimate.
  • If you are tandem nursing, the older sibling should be treated, as well.
  • Make hand washing paramount! Wash your hands after nursing, diaper changing, and using the bathroom. Wash baby’s hands often, especially if he sucks his thumb.
  • Sterilize all toys that come in contact with baby’s mouth, either in the dishwasher or with diluted bleach and hot water.
  • Boil pump parts, bottles, nipples/teats, and pacifiers daily. After treatment, discard and replace.
  • Consider probiotics as a preventive measure, especially when taking antibiotics.
  • Wash all underwear, bras, nightgowns, and cloth diapers in hot water (with bleach, if possible). Microwaving wet clothes on high for 5 minutes will also kill yeast (just be sure there’s no metal in any of the pieces). Sunlight will also kill yeast. Any towels or washcloths used during a yeast outbreak should be cleaned in the same way.

References

  1. Zeretzke, K. 1998 Oct-Nov. Yeast infections and the breastfeeding family. Leaven 34(5), 91-96.
  2. Mohrbacher, N. 2010. Breastfeeding answers made simple. Amarillo, TX: Hale Publishing. 652-656.