This is all from the Breastfeeding network website:
The Signs
Signs of thrush in the mother
- sudden start of breast and/or nipple pain after some days or weeks of pain-free breastfeeding - the nipple may also be itchy or be super-sensitive to any touch - even loose clothes
- shooting pains in the breast (may be deep in the breast) after feeding - pain can be severe and can last for up to an hour after the feed
- cracked nipples which don't heal
- loss of colour in the nipple or areola
- pain occurs in both breasts (except in the early stages) because the baby transfers the infection during feeding
NOTE: Mother may show no signs of infection or may experience no pain on feeding.
Signs of thrush in the baby
- creamy white patches in baby?s mouth or on tongue (may be far back or in the cheeks) which do not rub off
- white sheen on baby?s tongue which does not rub off
- baby keeps pulling off or away from the breast whilefeeding, seems unhappy or uncomfortable - this is probably because the baby?s mouth is sore
- the baby may be windy, fretful and find it hard to settle down
- nappy rash (usually red spots or soreness which is difficult to heal)
NOTE: Baby may show no signs of infection.
If you think you have thrush
It can be difficult to be sure that the problems you are having are due to thrush. It is possible to confuse some of the symptoms of thrush with the difficulties resulting from poor attachment (fixing) of the baby to the breast. Before deciding that thrush is the cause of your painful breastfeeding, you should ask your midwife, health visitor or volunteer breastfeeding supporter to sit with you and observe a full breastfeed. BREASTFEEDING SHOULD BE PAIN-FREE. (Pain from thrush begins after a feed).
If the slightest doubt exists, seek someone experienced to help you with attachment and positioning.
Other causes of nipple pain:
- attachment of the baby to the breast: may need fine-tuning
- eczema, including reactions to breast pads or creams
- tongue-tie in the baby
- Raynaud?s syndrome (poor circulation)
- white spot or bleb
- bacterial infection (may be present at the same time as thrush)
Self-help measures
- thrush can be passed between you and your baby - and also your partner and other children
- it is necessary to be very careful with hygiene in order to get ride of thrush completely - be sure to wash your hands well after each nappy change
- use a separate towel for each person in the family
- if your baby is also sucking on a dummy, bottle teat, nipple shield or plastic toys, make sure these are carefully washed and sterilised (boiling for 20 minutes while the infection lasts may be best)
- if you have expressed your milk and saved it in the freezer during the time you or your baby had thrush, it is better not to use it as it could cause another bout of thrush
- acidophilus capsules can help to restore bacteria which can keep thrush under control (available from health food stores or chemists)
- you may find you need painkillers to help you cope with the pain of thrush
- carry on breastfeeding
IMPORTANT - To make sure that you get rid of thrush infection, both you and your baby need treatment. Usually once treatment begins the pain and other symptoms will begin to improve within 2 or 3 days. It may take longer for full recovery and treatment should not stop before 10-14 days.
References
Amir L, Hoover K. 2002, Candidiasis and Breastfeeding, LLLI Schaumberg.
Brent N. 2001, Thrush in the Breastfeeding Dyad: Results of a survey on diagnosis and treatment, Clin Paed 40:503-506.
Fraser DM, Cullen L. 2003, Post-natal management and breastfeeding, Current Obstet & Gynecol 13:127-133.
Hale T. 2002, Medications and Mothers Milk (10th Ed), Pharmsoft, Texas.
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 16:288-93.
Kaufman D, et al. 2001, Fluconazole prophylaxis against fungal colonisation and infection in preterm infants, N Eng J Med 345(23):1660-6.
Lawrence R. 1998, Breastfeeding: a guide for the medical profession (5th Ed), Mosby.
WHO. 2002, Breastfeeding and Maternal Medication, WHO.
www.who.ch/child-adolescent-health
Presenting symptoms which suggest the presence of candidial infection:
- bilateral pain
- pain which increases after a breastfeed has finished and continues for up to an hour afterwards
- increased nipple sensitivity
- nipples may become red or lose colour permanently
- absence of red area on the breast
- history of recent use of antibiotics
- history of nipple trauma which has been resolved by optimal positioning and attachment
- absence of pyrexia
- baby with oral symptoms of thrush