Thrush and breastfeeding?

[podmumlet]

I made a post earlier without a subject line (rookie mistake!) and HettyAmaretti recommended I repost my thread - thanks Hetty!

I have been having a really difficult time establishing breast-feeding and my most recent challenge is likely to be thrush and I could do with some of your collective wisdom.

What kind of treatment could I expect for nipple or ductal thrush for baby and I? Is it just topical creams or oral medicines too?

Just some background as to why I think it's thrush:
My baby is now 12 days old and we spent the first 5 days in hospital. We were told our latch was good from the get go, but during the feed, baby slips off ever so slightly into a bad latch and I had bloody, scabby, cracked nipples. On day 3, baby went under the blue lights for phototherapy for jaundice and we had to top up expressed feeds with formula to keep his fluids up. This stretched his tummy and we have had a tough time getting my breast milk supply back up (and still not sure I have that right yet?) and taking him off the formula. Expressing was painful, breastfeeding was impossible during these few days.

I have gone to a breastfeeding workshop at the hospital and had sessions with the advisers there during my 5 days on the wards following a severe third degree tear. I have also since gone to 2 breastfeeding support groups and a lactation consultant came to visit.

Seems I have the latch 'right' and baby is now feeding well, but it is excruciating when he latches, like little shards of glass shooting into my breasts.

Today, I have noticed the typical white coating over baby's tongue and some nappy rash. Having read around the topic, it seems these are all symptoms of thrush, and that thrush is not uncommon if mom or baby have had antibiotics (which I had three different courses to prevent infection following my 3rd degree tear).

I found the following two articles really informative (in case anyone has a similar situation) - www.bbc.co.uk/dna/h2g2/A810082
and www.breastfeedingnetwork.org.uk/pdfs/BfN_Thrush_le afletFeb2009.pdf

To be perfectly honest, I would prefer if this wasn't thrush, and to keep working on the latch and perfecting that.

But poor baby is getting a sore bum rash, a small blister and a white tongue and is more unsettled than usual. While there is a /small/ chance that he might have a tongue tie affecting his latch, I don't want to wait for the other symptoms to worsen before doing anything.....

I am calling the GP at 8am tomorrow to try get an appointment. We're both in a lot of pain.

I found my nipples itched like crazy when I had thrush. But it's not the same for everyone.

My GP was incredibly sympathetic but I have read that not all are so persevere if you have difficulties.

That Breastfeeding Network Leaflet is really good.

I had the same - thrush following anti-biotics for both of us. Only ds had symptoms really, my nips were a bit pink and itchy but that was it. Ds had the white spots in his mouth though, and the thrush nappy rash.

We went through a range of treatments!
Nystatin - rubbish, don't be fobbed of with it as it does nothing

Daktarin Oral Gel - ds had this at 11 days, you may be told babies can't have it under 4 months but they can. It says 4 months due to the choking risk of sticking a glob of gel in their mouth, but you just have to be sensible and smear a little round the mouth. It cleared his mouth up in days. BUT - at first I was just told to put the oral gel on my nipples, but it doesn't work.

Canestan - eventually was prescribed this for my nipples

Daktarin Cream - ds had this for him bum, it improved it but didn't shift it completely

Canestan HC - hydrocortisone, this did finally clear the nappy rash almost immediately.

So in the end it was a combination of Daktarin Gel and Canesten HC for ds, and Canestan for me (plus scrupulous hygiene!). If you have pain in your breast rather than just the nipples you'll need fluconazole too though.

My nipples were itchy too! Dr came me some cream to use but i had to wipe it off b4 a feed which was a pain. I also had to ask him for something for baby and he gave mouth drops which smelt devine! were both fine now! My dr told me if the white marks move when you scrape them a little then its just milk, if it doesnt then its thrush...never tried it tho.

a few tips:

make sure you both get treated otherwise you'll keep passing it back to each other

wash all bedding and bra's on a hot wash to stop you reinfecting yourself.

change breast bads often and after you apply cream/when you wipe it off (thats if u get a cream)

wash/wipe babys hands often and she/he puts them in their mouth and could spread the infection this way.

Wow - I post my question at 11pm the nighht before I am going to call the doctor at 8am, and within the hour, a stream of really useful replies - thats why I love MN!! Thank you ladies!!

Thanks for the tip about persevering Missmarjoriebanks - boggles the brain that the GP could be anything but sympathetic to thrush?

Moonunitalpha - thank you for the detailed post. Its good to be informed and ot go to the appointment knowing what to expect (and what to avoid!)

And great tips pinkp! Seems washing everything regularly is going to be a big part of clearing this infection and stopping the reinfection.
Almost feel like I need a HazMat suit! ;)

The BfN leaflet is good. I think similar advice is actually in the BNF now (haven't checked tho) as my GP looked up flucanozole and then prescribed me 50mg a day for 14 days. We also got Daktarin oral gel, both for DD's mouth and my nipples (which I was a bit about but don't see why it couldn't work tbh).

Just an update to say that the GP diagnosed thrush and I am on the above suggested treatments. Thankfully, my GP was very understanding.

Got the plain canestan lotion for baby's bum (not the hydrocortisone version) and we've both started treatment today.

Thanks again for all the advice and suggestions ladies!

Get really high strength probiotics too. I still take these to keep it bay - these are good bacteria. Have you tried gentian violet? I think this may have helped me-see the Jack Newman site. I have a bottle of you want it - pm me

I was actually thinking that I would recommend putting probiotics in a mum to be's hospital bag.

Not that one plans on a third degree tear needing surgery oe an EMCS, both needing aggressive antibiotic treatment. Would be good ti gave some probiotics to hand to try prevent thrush.

CamperFan - would you suggest acidophillus, and what dosage? Just had a look at Jack Newman's site and would be delighted to try your Gentian Violet. Will message you.... :)

Sorry did not see this. I take the biocare ones, at least 8 billion bacteria per capsule I think, will check. Yes I would also suggest them in hospital bag! I think a lot of mums get thrush but don't even realise, just think bfing is beyond painful!!

Also try grapefruit seed extract - from what I can remember you swab baby's mouth with a solution - I think there are details on the Jack Newman website. I also took the tablets - the doctor was only willing to give me one course of flucanazole (sp?) which didn't work. I was about to try Gentian Violet as a last resort but it spontaneously cleared up.

Hi there,
I had a real die-hard problem with thrush with DD1. She was born with a dilated renal pelvis (over sized kidney tubes I think) so they put her onto preventative course of trimethroprim from newborn until her first Ultrasound at a few weeks old to see if the renal thing had resolved, which it did.

However....not one healthcare prof, doc, midwife, hv mentioned that there was a chance that DD may be more prone to oral thrush.
Had about a week of excrutiating pain before enough was enough, I came on mumsnet and basically diagnosed it myself through talking to the lovely ladies on here and comparing symptoms etc.

Took DD to Docs...many times....2 bottles of nystatin, a tube of hydracortisone and a large tube of daktarin oral gel later and I was at wits end, nipples were red raw and I was a gnats whisker from giving it all up when somebody on here recommended
Grapefruit SEED extract not to be confused with grape seed extract - completely different thing.

anyway, looked everywhere in shops, not available. eventually found it online and bought some capsules for me to take and some liquid to mix with sterile water to wash around DD's mouth before, after and between feeds and to wash my nipples with.

FANTASTIC - cleared it within days. Apparently Grapefruit seed extract is a powerful natural antibiotic and antifungal.
I'm sure people on here will have similar experiences who can tell you more.

I tried to get hold of gentian violet but failed, but this stuff worked wonders.
Just google "Grapefruit seed extract for thrush in babies" and there is a wealth of info.
It might not be something your willing to try as it's not a prescribed treatment but it worked for us.

Good luck and well done, your doing a fab job!

p.s. scrupulous hygiene is a MUST to echo others on here

Thanks juleswill and TettyLouBar for the Grapefruit Seed Extrsct recommendations - definitely going to give that a try to (feeling rather desperate here, as I am now howling out loud again when baby feeds on my right breast!)

Baby's mouth seems to have all cleared up and thte nappy rash is almost gone with the canesten. Sadly, I haven't seen as much improvement. My nipples still have shooting pains (with the right one being almost constant). This is my fourth day of treatment - when did any of you start to notice an improvement?

With all the angst around the initial poor latch, bloody nipples, expressing, jaundice and formula bottles, I am starting to wonder whether baby has unlearnt all his good nursing habits and he has to relearn good latch techniques? Maybe my pain isnt thrush at all? Maybe he has a tongue tie? But this may be a discussion for another topic.... Feeling rather bleak and not wanting to give up but Am dreading the next feed, let alone the next 6-12 months!

Oh, and about the grapefruit seed extract - liquid or tablet, and what dosage is recommended?

It took me at least a week to feel at all better tbh. Can you get someone to check the latch so you know what is what?

pod IIRC DD did have a few issues surrounding her latch after we got over the thrush but nothing too bad, resolved quickly with a few days of repositioning her or re-latching if first attempt not quite right.

Have a look at this regarding grapefruit seed extract

and I bought this It has to contain "citricidal" someone on here advised me once, but not sure why??

the capsules are further down same page, I took them to treat me. And I treated baby and nipples with liquid wash. I made the wash up in a sterilised baby bottle and changed it every 24 hours IIRC.

I bought some giant oversized baby cotton buds and soaked one in the wash and washed all around bubbas mouth, gums and tongue before, after and between feeds.

Good luck

Yes everything TettyLouBar says - the Dr Jay Gordon website is really good. I hate to say this but I had it for a good few weeks, possibly a couple of months, I can't quite remember now - but all the time trying various different remedies.

The Grapefruit Seed Extract was the last thing I tried, so hopefully if you start it now you will not have to suffer for as long as I did.

I didn't notice any immediate relief - in fact I had given up on that working too, and was about to start trying Gentian Violet, when it suddenly went away. I really feel for you though - the pain is horrible.

Good luck!

Yes, I echo jules, I had it for weeks and weeks and when I started GF Extract regime I didn't notice change initially and then suddenly it just went! time scale varies, but I think it took about 7 days ish and I continued regime for further 7

Hello again,

I have 5 days of my 2 week course of fluconazole left, but still have nipple pain. I see that treatment needs to continue for 7 days post the ending of the symptoms, so I suspect that I should go to my GP tomorrow and ask for another weeks supply. What would you do in my situation?

Also, I have started the GSE - thanks for the tip! I do think that its all helping and while the pain isn't gone, it's subsiding.

Also, we are being seen at the tongue tie clinic tomorrow to rule out any possibilities that the nipple pain isnt being caused by the tie.

I keep reminding myself this will all be worth it in the end!

Gentian Violet is no longer recommended in this country as it's slightly carcenogenic. I wouldn't use it myself. It was used as a very effective thrush treatment before Miconazole (sold as Daktarin) became available and is still used in other countries, but it's best avoided.

Tongue tie can cause terrible nipple pain, even if the tie is really mild. Get him checked for bubble palate as well, and check the top frenulum. The thrush can be cured but you may still be getting pain from the TT. Try to get as deep a latch as possible by tipping the nipple slightly towards the roof of his mouth as he latches.

Fluconazole is great - but you may need several courses.

I would recommend ironing the inside of your bras, and also washing your clothes, towels, your baby's clothes and his nappies if you use cloth on at least a 60 degree wash, and put about 3-4 drops of grapefruit seed extract liquid into the softener part of the washing machine drawer. You could use a facecloth to dry your nipples after a bath or shower, and don't let your towel touch your nipples (wash the facecloth each time), and be careful to not transfer the nipple thrush down below as it's VERY contagious and can lead to vaginal thrush.

Your partner should avoid your nipples while you're being treated as it's possible to give him oral thrush, too....

Nightmare, but, incredibly common and really easy to cure now that you have the right stuff. So good your GP is supportive. Many are totally and utterly rubbish

Also,

Grapefruit seed extract (GSE) is very powerful and effective but it has the disadvantage of being very drying, which is not good for sore nipples. If your nipples are sore, I'd avoid putting it on there and stick with the Daktarin CREAM. MUST be gel for babe, cream for you.

You can take GSE tablets which are brilliant for ductal thrush (and will support the Fluconazole), and yes, acidophillus too. You can split the capsules and carefully put a little of the powder on your baby's tongue if you want. Just a little, say by wetting the end of your little finger and dabbing it on the powder. Gently rub this small amount on his tongue, ensuring it's all wet so he won't inhale the powder.

Thank you so much for the detailed response organiccarrotcake and the facecloths and acidophillus for baby tips.

I went to the Tongue Tie clinic and baby did indeed have a moderate tongue tongue. The procedure was quick, baby was quickly soothed and very professional staff at Kings College. I may have to start a separate thread (to not confuse the issue here) about improving the latch. Sadly, there hasn't been a miracle improvement in the pain overnight. Which means that baby learnt some bad latch habits (would love to chat more about this organiccarrotcake)and is now still continuing with them, or its the thrush pain.

And as for the thrush.....

I am REALLY not enjoying breastfeeding, or the thrush. I went to the GP (different one, same practice) to request additional fluconazole. I got told that as it hadn't gone away, it may well be a more generalised mastitis across the entire breast, so I got prescribed antiobiotics instead!! I said I was really sceptical about that as it was the antibiotics that got me into this pickle in the first place....

There was a breastfeeding (or lactation) consultant at the Tongue Tie clinic when we fed baby post the procedure, and I asked her about the fluconazole. Turns out that I was on the wrong dosages.... I was prescribed 200mg once daily, but apparently its supposed to be 50-100mg twice daily to keep levels of the drug constant in the blood. She recommended I start the course all over again with a double dose on day one followed by 14 days with tablets twice daily. So, I am back off to the GP tomorrow.

I am spritzing GSE mixed with distilled water into baby's mouth after every feed (I remember! When he cluster feeds, it all gets a bit mad....) and on my nipples too. This was the recommendation on the Jay Gordon website.

organiccarrotcake - are you suggesting that I be using the GSE undiluted on baby's bottom?

Thanks again for all the support!

oh, and one more thing, the thrush might not be gone because of my lack of impeccable hygiene...

Just to continue my monologue...

Went to the doctor again, and have been represcribed fluconazole - 200 mg upfront, and 100 twice daily for two weeks....

Just did more laundry with GSE in the softener - thanks for the tip organiccarrotcake

Hi Podmumlet,

I'm really suffering with thrush too so have been looking at all the advice you've been getting. I hope it clears up soon for you.

I've been on 200g a day of fluconzole for a week now and it's no better, not sure how much longer I can carry on it's making me so miserable and feel like it's stopping me enjoying my 5 week old DS. Have ordered the GSE so will see how I get on with that.