Please help before contacting GP tomorrow re. thrush/breastfeeding: is this GP correct?

[dontrunwithscissors]

My lovely little DD2 is now a week old, and so far breastfeeding has been going well (latches on very well etc.) Since Friday night, however, I've been experiencing breast/nipple pain that I am sure is thrush. I/DD1 suffered with it for 3 months before I was able to clear it up, and I clearly recognise that pain. DD2 has been showing signs of being affected since yesterday (a couple of white patches on the roof of her mouth/gums.) She's also been getting difficult to feed - latches on, feeds for a minute and then pulls off, cries out.

Today, I discussed this with the community midwife who came to see us. She was very understanding, and arranged for a prescription from the out of hours GP so that we could start treating it straight away. My DH went to collect them, only to be told the GP would treat me, but dd2 is too young to be treated. When dh got home, I found the GP had prescribed Canesten cream.

So....

• Does anyone know if he's correct regarding dd2 not being old enough for treatment?

• The Canesten cream for me is just the regular over the counter stuff. Is this suitable? It says for external use only, and to contact A & E if swallowed. Even if I wash it off before feeding, surely it can't be good for her? I believe that with dd1 I used a cream called Nyastan.

I'd be grateful for any advice, in advance of me contacting my health centre tomorrow.

In the meantime, any advice on how to get dd2 to feed? She's just been pulling off/crying the whole time this afternoon, and has now given up, sleeping on my knee.

Congratulations on your DD. I am suffering thrush at the moment and was initially prescribed the wrong treatment (canesten) by GP, according to my BF clinic who I trust implicitly. Daktarin cream for you is supposedly the most appropriate treatment. Regarding DD, Daktarin gel is apparently not supposed to be used in babies under 4 months due to risk of choking, but you can have Nystatin drops for younger babies.
Regarding getting DD to feed, I don't know really, apart from urging you to make sure her attachment is good/ perfect each time. I didn't do this, just desperately wanting each feed to be over quickly, and have found it very hard to recover. Now trying to get it right every time.
Good luck (and sympathy - it HURTS!)

I have also been prescribed canesten, is this the wrong treatment then?! also how do you know when its gone - no pain but nipples still red - is this normal or thrush?

I was also given Canesten for thrush but you have to remove it before bf which is a pain for younger babies that feed often. IIRC, you don't have to remove Daktarin before feeding.

I think there is currently a lot of confusion within the medical profession about how to treat bf mothers with thrush as you are experiencing.

My LLL leader recommended a "natural" remedy but at the risk of sounding very, very unhelpful I have forgotten what it was. She was adamant that it worked well although I didnt try it. I will rack my brains and get back to you if I remember (unless anyone else can help)

Thrush is an absolute bugger to get rid of. I have had it 4 or 5 times so you have my sympathies.

Can you print this leaflet off and take it to discuss with GP

www.breastfeedingnetwork.org.uk/pdfs/BfN_Thrush_leaflet_Feb_2009.pdf

Gp won't prescribe daktarin for baby, but should give nystatin suspension. Otherwise, could try your HV.

As leaflet says, if deep seated thrush in you, fluconazole is suggested, but needs your GP to agree (as it is prescribed off license). Unfortunately, your GP seems a bit out dated.

Good luck, thrush can be a pita to clear!

The Breast Feeding Network have a good website with very helpful advice and a section with an info sheet about nipple and breast thrush. Hope that helps.

DS2 had Nystatin at a week old, I used canesten then Daktarin. DS strarted on the Daktarin gel at 3 months, but I had to listen to a patronising lecture about not putting a glob of it on my boob in order to get it in baby's mouth.

BigWeeHag - my untrustworthy GP TOLD ME to but a glob of it on my boob in order to get it in baby's mouth!! Fortunately I didn't listen to him.
Thrush is seriously evil!

Belinda, I was told that was why it wasn't licensed for under 4 months, because a mum had done that, and the baby had choked!

My GP is a bit dim. I'm not really trusting him on anything now!

DS and I have thrush. We have Daktarin for his mouth and my boobs and Canestan for his thrush nappy rash. He is 6 weeks old.....

Do take the "Breastfeeding and thrush" leaflet from the Breastfeeding Network with you (as linked to above)!

Topical Canesten cream will be useless to treat thrush of the lactating breast. You will need oral medication for at least 1, if not 2 weeks.
Your GP is right in that there is no licenced medication for young babies under 3 months, however off licence Daktarin Oral Gel is safely used in v young infants. Nystatin oral suspension has also been used, but is v liquid and far more likely to cause coughing and spluttering.

A lot of GPs do not know a lot about BFing (I say that as a GP) and medical/GP training includes nothing about BFing. I am not saying this to excuse your GP or my profession, just to say go prepared and that leaflet is great (it contains all the evidence any dr could wish for ).

Good luck!

tryharder would the natural remedy be gentian violet? I have heard that it really works, but can stain everything purple...
other than that, we used nystatin drops and daktarin oral gel - for very tiny babies just applying the gel to the nipples and not washing off can help to treat them (not putting it in their mouth is because of a choking hazard, i think). i wouldn't be happy with canasten cream for the reasons the OP said. If it is stubborn, you could try to get a prescription for a fluconazole tablet, with treats from the inside out if the thrush has got into the milk ducts.

Good luck - it's a bugger!

Thank you for the replies. It was an out of hours GP (not my own, or at our health centre), and I didn't get to see him. (The midwife rang up and requested a prescription.) The GP I saw at my health centre when I had thrush with DD1 was very good. (She prescribed DD1 Daktarin at 4 weeks old, and Nyastan cream for me. When that didn't work, she prescribed flucanozole, I think.) I'm hoping they'll be more helpful than the out of hours GP was today.

As another GP this is something no one teaches us - I learned more as a Mum than I ever knew before. I hope I don't get bad thrush again this time as have developed a full blown allergy with facial hives (attractive!) to fluconazole since DD was born.

I've heard grapefruitseed extract is a good natural remedy.

Hope you have success. I've just rang to speak to a GP at my surgery and she said she wouldn't be able to prescribe fluconazole either. I'm really struggling and dreading every feed, just as poor DD needs more to help her through her nasty cold.

You should be using miconazole (daktarin) cream and dd should have the same in oral gel. An alternative for dd is nystatin suspension, but it's not quite as good. some GP's are not keen on miconazole oral gel as it isn't actually liscensed for newborn, but it is in widespread use so is ok to use. Hope this helps!