Breastfeeding can provide the right conditions for thrush to grow and the nipple pain associated with the infection can make feeding extremely difficult. Here is what you need to know about recognising, treating and preventing breastfeeding thrush.
What is breastfeeding thrush?
Thrush isn’t just to be found in your nether regions, it’s fond of any dark, damp place so your baby’s mouth and your nipples are the perfect spot for the yeast-like organism to grow. Breastfeeding thrush (candida albicans) is the name given to the fungal infection when it develops in your breasts and/or spreads to your baby’s mouth.
What causes breastfeeding thrush?
Candida albicans may sound like an excellent name for a drag queen, but is in fact a fungus that lives in all of our bodies. The good bacteria in our digestive system usually helps to keep the fungus in check without developing uncomfortable symptoms.
Some babies will come into direct contact with the thrush as they pass through the birth canal. Babies’ immune systems are not yet fully developed so they are more prone to infection at this stage – this is particularly true of premature babies born before 37 weeks.
If your baby picks up the infection, she can pass this on to you through direct contact when breastfeeding. If your nipples are cracked as a result of breastfeeding, they can easily become infected by the fungus, too, and it can really take hold there.
If you’re suffering from thrush in any other area of your body (it’s usually vaginal), then there is also a higher chance of getting breastfeeding thrush.
Thrush can also develop following a course of antibiotics. Taking a probiotic as a supplement after antibiotics can help to offset that risk a bit.
What are the symptoms of breastfeeding thrush?
If you have breastfeeding thrush, then you’ll probably notice the following symptoms:
- Sharp, shooting pain in the nipples; breastfeeding gives no relief and the pain is felt deep in the breast long after feeding.
- Cracked nipples that don’t heal.
- A burning sensation in the breast.
- Itchy, red and flaky skin on the nipple.
- Red or shiny areola.
If your baby has thrush – symptoms to look out for:
- White, creamy patches or spots that look like curdled milk inside your baby’s mouth, usually found on the tongue, gums, inside cheek and roof of the mouth. If you wipe these away, it leaves a red, sore-looking patch which may bleed.
- Nappy rash. The infection can travel to the other end of her digestive system and cause a rash with red or white spots that takes a while to heal.
- White film or coating on tongue and lips.
- Saliva may increase and look whitish.
- Unsettled behaviour, as discomfort from the infection may cause a change in temperament.
- She’ll be reluctant to feed due to pain caused by the infection in her mouth.
- Poor weight gain caused by a reluctance to feed.
Occasionally, breastfeeding thrush can come with no obvious symptoms so it takes an eagle eye to spot it. If you notice any of the symptoms above and they are particularly persistent, speak to your GP.
What’s the difference between sore nipples and thrush?
The difference between sore or cracked nipples and a case of thrush is in the pain factor. Thrush-associated pain is felt deep into both breasts after feeding and can last for up to an hour.
Although painful nipples is one of the key signs of thrush, it’s not the only sign. Be careful not to mistake it for something else.
Sore nipples can also be caused by:
My baby and I were treated three times for thrush that wasn't actually thrush! It turned out that the pain was caused by poor latch and tongue tie.
- A poor latch. If your baby is not latched on properly it can cause pain during breastfeeding. Ask your health visitor to observe you feeding to check whether your latch and positioning is right. Your baby could have a tongue tie or just need better positioning. A poor latch can also result in slow weight gain as your baby isn’t feeding properly, but it could lead you to assume you have thrush when you don’t.
- It's a new sensation. When you're getting breastfeeding established for the first time, you may experience some initial pain. It can take a while to get used to the letdown (the release of milk from the breast) and the slightly weird and sometimes painful feeling that goes with it, particularly in the first few days. If the pain lasts more than a week, speak to your health visitor or GP.
- Engorged breasts or blocked milk ducts. Engorgement or mastitis can also cause nipple pain or tenderness, which could be mistaken for thrush. However, the pain associated with mastitis is often accompanied by swollen, painful lumps.
How do I treat breastfeeding thrush?
If you think you have thrush go to see your GP. They should take nipple swabs in order to diagnose you. It’s important that both you and baby are treated together. This prevents the likelihood of you passing the infection back and forth between you during feeding.
Treatment of breastfeeding thrush in the mother usually comes in the form of an anti-fungal cream that you apply to your nipples after feeding. You’ll need to make sure to wipe this off before the next feed. The cream is safe if your baby comes into contact with it but it’s better to be cautious and wipe off the excess – your baby probably won’t like the taste of it anyway.
If you have persistent thrush or ductal thrush (where the infection is in your milk ducts), you might be given anti-fungal tablets (fluconazole) to take orally.
Treatment of breastfeeding thrush in your baby is in the form of a gel such as miconazole that you apply to the affected areas, avoiding the back of their mouth. Occasionally, babies who are treated with miconazole are sick after the gel is applied. This usually passes as they get used to it.
Some younger babies are prescribed Nystatin, a liquid that is applied with a dropper to the affected area.
Whichever treatment you and your baby are prescribed, make sure to finish the entire course to prevent a recurrence. You will usually notice the treatment taking effect within two to three days. If symptoms persist beyond a week, go back to your GP.
What else can I do to get rid of breastfeeding thrush?
Medical treatment is only half the battle. There are other things you can do to help see the yeasty blighter on its way:
- Keep your nipples dry. Remember thrush loves damp conditions. Try to avoid breast pads but if you need to use them, use disposable ones rather than reusable – these may not always be dry after a wash and can hold bacteria.
- Sterilise dummies, bottle teats, toys and anything else your baby puts in her mouth while infected, as well as breast pump parts.
- Wash your hands every time you change a nappy. Be aware of what you're eating. I was getting through the days with lots of sugary snacks, which definitely made things worse.
- Reduce your sugar intake. An excess of sugar or refined carbohydrates can make symptoms worse, particularly yeast-based foods like bread, alcohol, mushrooms and certain dairy products.
- Use a separate towel for everyone in the family to avoid spreading bacteria.
- Take a probiotic.
- Wash anything that comes into contact with the infected area at a high temperature, so make sure you are changing your bras daily.
Mumsnetters' tips for treating breastfeeding thrush
“I gave my baby the oral gel and put some on both nipples after each feed. I used everything the doctor gave me until it ran out. The best thing that helped me was walking around as much as I could with no top on to really air my nipples. I also washed towels, pyjamas and tops on 90 degrees and even ironed my bras so the heat would kill any remaining bacteria.”
“A tip I had from a breastfeeding counsellor was to put cling film over your nipples after you've put the cream on. That way it doesn't dry or soak into your bra.”
“I've just got rid of nipple and ductal thrush after 10 weeks, and am firmly convinced I would have given up breastfeeding without Fluconazole. The pain was initially unbelievable; I took the maximum dose of paracetamol and ibuprofen just to stay sane. I also found washing anything that came into contact with milk or vomit at at least 60 degrees helped.”
Can I carry on breastfeeding while I have thrush?
Yes – but be prepared, it’s going to hurt. If you can withstand the pain and soldier on, you’ll be glad you did. Breaking up with breastfeeding suddenly can be difficult for both you and your baby to cope with. And, you don’t want engorged, leaky breasts and blocked milk ducts to deal with on top of thrush, so it is worth ploughing on like a trooper if you possibly can.
Your nipples will heal. You realise one day that you’re not curling your toes in agony when feeding. 10 months on and I'm still breastfeeding. There were many days when I was going to stop but I'm now so glad that I didn't.
Giving your baby expressed milk could be a good way to avoid the worst of the pain of breastfeeding until your treatment kicks in as you’re more in control of the breast pump than you are when it’s your baby on the breast. It also helps to prevent passing the infection back and forth through direct contact.
Remember not to freeze the expressed milk for later use though; freezing does not kill the infection and you could risk reinfecting your baby if the milk contains thrush bacteria.