Another Look at Thrush and Breastfeeding

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By Elizabeth Pantley

Thrush (Candida albicans) is a common yeast infection that occurs in a baby’s mouth and diaper area and on a nursing mother’s nipples. It is almost always harmless, but because it thrives in these warm, moist places, it is extremely stubborn and difficult to eliminate. In addition, it can be very annoying because it is quickly and easily transferred back and forth from mother to baby, until both are totally clear of it.

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The signs of thrush in the baby
You baby may have all of these signs, some of them or even none. If you suspect thrush, review both the signs for a baby and the symptoms that you have.

The following are typical signs of thrush in a baby:

• white or gray spots or patches on the inside of your baby’s mouth, gums or on his tongue; a milk coating on the tongue wipes off easily, while thrush does not.
• an opalescent shine on your baby’s lips or inside his mouth.
• red face, particularly on the cheeks.
• persistent diaper rash that doesn’t respond well to usual remedies.
• fussiness that appears worse during or after feeding.
• bleeding of the mouth or gums in severe cases.

Signs of thrush in the mother
The following are typical signs of thrush, but many of these can signal other problems as well. If you review the list for yourself and that for your baby and suspect thrush is the problem, call your health care provider, lactation consultant or La Leche League leader.

• pain in the nipples or breasts during or after feedings that may persist between feedings
• deep pink, red or purple discoloration of the nipple and areola
• a shiny glow on the areola
• dry, peeling nipples
• rash or white spots on the nipples
• itching or soreness that indicates a vaginal yeast infection

You are particularly susceptible to thrush infection following the use of antibiotics, as these medications kill off not just bad bacteria but the “good” types that keep candida under control.

Treating the family
If you suspect a thrush infection, both you and your baby will need treatment simultaneously until all signs of thrush are gone. If you are also nursing an older child, you will have to treat her, too. In some cases, your partner or other members of the family may shows signs of thrush (athlete’s foot, severe dandruff, jock itch, vaginal yeast infection) that will have to be treated to prevent the recurrence of thrush in the family.

Treating the baby
Many babies with thrush show little response to the yeast infection. For others, it is painful and prevents proper nursing. In that case, the infection should be treated promptly and aggressively so that your baby’s growth is not compromised.

It’s important that you talk to your baby’s doctor, who may prescribe a topical medication that can be applied directly to your baby’s mouth for pain relief and to clear up the infection. The most common medication is a prescription anti-fungal cream. A homeopathic doctor can talk with you about using a tincture made of usnea lichen, mugwort, rosemary or unsweetened yogurt with active cultures.

An alternative treatment is 1 percent gentian violet solution, painted with clean cotton swabs onto affected areas once a day prior to breastfeeding. These areas include your baby’s mouth as well as your nipples and areolae. It’s very messy and will turn your baby’s lips and your nipples purple for a few days, but it is often very effective.

Watch your baby’s mouth carefully for any signs of negative reaction, such as sores, from the treatment. Too much of the solution can burn the skin’s surface. If anything seems amiss or if no relief occurs within four days, stop treatment and visit your doctor.

More thrush tips
In addition, the following may help your baby feel better, speed up the eradication of the infection, and prevent it from recurring:

• Change diapers immediately when your baby’s wet or soiled.
• Coat baby’s bottom with a diaper ointment between changes.
• Avoid using diaper wipes with ingredients that may cause stinging.
• Let your baby’s bottom dry thoroughly before re-diapering and allow your baby to be naked for a time during the day.
• Avoid using plastic diaper covers. Instead, use coverings that allow air to circulate, or go cover-less if you’re not expecting a big poop anytime soon.
• Wash cloth diapers, cloth wipes, towels and washcloths in very hot water to remove all traces of the yeast. A vinegar rinse will complete the disinfecting process.

Treating the mother
Talk with your doctor or lactation consultant about your suspicion of a thrush infection. She will confirm the diagnosis and prescribe a medication to clear up the thrush and any accompanying vaginal yeast infection. As mentioned earlier, if thrush is confirmed in the mother, the baby must be treated also or the infection may continue to be passed back and forth between you. The following also can be helpful when treating thrush:

• Take an over-the-counter medication, such as acetaminophen (such as Tylenol) or ibuprofen (such as Advil), for breast pain; alternatively, try chamomile, skullcap or low doses of valerian.
• Place ice packs on the nipples prior to feeding to reduce pain.
• Massage the breasts to stimulate letdown before attaching your baby to the breast.
• Start feeding sessions on the least painful side.
• Take extra care in ensuring a proper latch when nursing.
• Position your baby tummy-to-tummy with you for feeding to create a straight latch position and reduce pulling on the nipple.
• Break the suction with your finger to gently detach baby from your breast.
• Go braless or topless, or keep the flaps down on your nursing bra to allow your nipples to air dry.
• Avoid using breast pads, as these create a warm, moist place for yeast to thrive.

How to prevent recurring infections

• Clean and sterilize all pacifiers, teethers and bottle nipples after each use.
• Let nipples dry after breastfeeding before covering them with clothing.
• Avoid letting your baby suck for long periods on a bottle or pacifier.
• Discard breastmilk that was expressed and stored during a thrush infection.
• Maintain diligent hygiene with frequent handwashing after breastfeeding, diapering and using the toilet. Pay attention to underneath the fingernails, too. Wash your baby’s hands frequently.
• Avoid excess sugar for you and baby.
• Add plain yogurt to your diet (and to your baby’s diet if she is eating solid food).
• Avoid fermented foods such as cheese, beer and wine.
• Wear clothing that allows the skin to breathe and avoid synthetic fabrics.
• Use regular hand soap instead of antibacterial soap - it kills beneficial bacteria that control yeast growth.
• Disinfect toothbrushes and mouth appliances regularly with a bleach and water solution, or put them in the dishwasher.
• Wash dishes in very hot water.
• Discard solid deodorants used during a thrush infection.

If the thrush infection isn’t going away, have other family members and even pets checked to see if they are carriers.

© Elizabeth Pantley; Excerpted from Gentle Baby Care (McGraw-Hill, 2003).

Parenting educator Elizabeth Pantley is the author of numerous parenting books, including the widely cited The No-Cry Sleep Solution: Gentle Ways to Help Your Baby Sleep Through the Night. Buy her books at Powells.com. She is a regular radio show guest and is quoted frequently on the web and in national family and women’s publications. Her next book, Gentle Toddler Care, will be available in 2004. Elizabeth lives in Washington state with her husband, their four children and her mother. Visit her at www.pantley.com/elizabeth.