Thrush and breastfeeding

Breastfeeding and thrush – Transcript


If you’ve been feeding for a little while and everything has been going fine, absolutely pain free, and then suddenly you’re getting pain in both nipples, and this pain is actually quite severe and lasting maybe up to an hour after the feed, then it is possible that you have a thrush infection.

It’s also possible that your baby may have a thrush infection in his mouth too. So how would you get a thrush infection? Now one of those ways is if you or your baby have been treated with antibiotics for some other reason. Now the antibiotics are important for that particular thing, but as a side effect, antibiotics can kill off some of your natural normal bacteria. When that happens other things can flourish, and one of those things is something called thrush (the other name is Candida Albicans). Thrush can also occur through an open wound like cracked or sore nipples – so if you’ve had this situation even a couple of weeks ago, it is possible that the infection has occurred that way.

Baby being breastfedHowever I really must stress that thrush is not always the culprit here when it comes to sore nipples. There can be many other causes. One of the most common one is if your baby isn’t latching adequately and your nipple is getting squashed, and this could be happening on both sides. Another point I’d like to make is that if you’re only experiencing pain on one side (breast) then it’s very very unlikely that you have a thrush infection.

I do understand that it has to start somewhere but because you and your baby are a unit, very soon you would experience THRUSH on both sides. Now the only caveat to that is if you’re feeding only from one side, and some women do feed for weeks or months just from one side. So please bear that in mind that if you’re only getting pain on one side then it is likely to be related to something else.

So before you consider getting treatment for thrush, it would be important to rule out all of these other potential reasons for sore nipples, and I would encourage you to look carefully at all of the related videos was in this section.

So let’s assume that you do have THRUSH – what symptoms might you see? Your baby is likely to have a coated tongue – it might look quite white and cottage cheese – like, even on the inside of the gums and inside the cheeks, and it can even be on the lips as well. Many babies do have a bit of a white sheen on the tongue and we’re not talking about that – because if everything is going okay and you and your baby are fine, there’s no need for treatment – but one thing you can do is to put a little bit of gauze on your clean finger, wipe your baby’s tongue – if that white does not come off, (sometimes it can be milk), then it is likely to be a thrush infection.

Sometimes babies might get a thrush infection in the nappy area too. You would expect a nappy rash that doesn’t clear up with normal creams that are used.

So what about your symptoms? You’re likely to notice that your nipples have changed colour a little bit (maybe pink or red or flaky or itchy). Some women say there is a burning sensation and some will even say that it feels like broken glass in the nipples, and it is both sides here, but it could be any one of those things.

But it’s also important to know that YOU may have symptoms and you baby may not have any symptoms at all, or your baby may have symptoms and you don’t have symptoms at all – but in both of those situations treatment must be given to both of you. Too often I’ve actually seen situations where only the mother or the baby was treated, and although symptoms cleared up they then started again in the person who didn’t have the treatment, and so the thrush infection went on.

So if you feel that either you are you baby have these symptoms then it’s important to see your healthcare provider, health visitor or a doctor to get treatment as quickly as you can, and for both of you to be treated simultaneously.

Some doctors will arrange for a swap to be taken to confirm the diagnosis of thrush, and others may just treat straightaway. So you might easily assume that breastfeeding needs to stop while you’re both being treated but this isn’t the case, and breastfeeding can carry on as normal.

If your baby is younger than four months of age, then the treatment of choice is Nystatin oral suspension four times a day which is a yellow liquid. If however your baby is over four months of age, the treatment of choice is Miconazole Gel 2 percent. The other name for that is Daktarin (medications video)

– and you yourself will be given an antifungal cream, usually Miconazole cream 2 percent, and really, this can be applied straight after feeding on the nipple and around that area. You don’t need to wash that off before you feed your baby again. You may need to just dab off any excess. But there are some treatments particularly Clotrimazole, which would have to be washed off –  something to think about when you’ve been prescribed the antifungal. Just be aware that Clotrimazole has been associated, certainly for some women, with an allergic reaction but this isn’t true for all.

Your doctor might in some cases prescribe Miconazole cream two percent with a combined hydrocortisone cream, and sometimes your doctor may prescribe an antibiotic cream alongside the antifungal, if swabs reveal bacterial infection as well. And the good news is that once this treatment has begun there should be an improvement within 2 to 3 days.

But sometimes a fungal infection has actually started to go inside the breast – and if you are experiencing shooting pains while you’re feeding, and sometimes up to one hour afterwards, this can be an indication that this is happening – a medication called Fluconazole is usually the one of choice. But I really do need to make you aware that although Fluconazole is recognized by the World Health Organization as compatible with breastfeeding. It isn’t licenced for breastfeeding mothers but it is recognized that the amount of Fluconazole that actually gets to the baby through breast milk is a lot less than the amount that can actually be given to your baby under the licence itself. It’s also important to be aware that the first dose that is given is usually a higher dose, and then twice a day you’ll be given a lower dose for at least 10 days, sometimes up to 14 days.

So you may be wondering how you can prevent the spread of thrush? There are some measures that you can take, and one is to pay real attention to good hand hygiene especially after nappy changes, and giving a separate towel to each member of your family to prevent the spread from family member to family member.

And it’s also really important to wash and sterilize anything that your baby tends to put in his mouth so it could be teats or dummies or toys. It’s also really important to wash bras at a very high temperature and even change breast pads frequently if you can.

I do certainly find a lot of mothers saying that they tend to use probiotics particularly to prevent THRUSH because it can restore some of that good bacteria to help to keep you healthy and prevent this kind of infection. So remember that breast feeding can continue while you’re being treated – but sometimes mothers will tell me that the pain is so severe that they really want to stop breastfeeding. Now rather than doing this, you can pump your milk. You can hire a hospital grade double pump if you really cannot bear one more feed at the breast on either side.

Breast pumpsA hospital grade double pump (expressing by pump) can be used every two to three hours to keep your supply up and protect your supply while you’re getting this treatment, and your baby can still be given that milk as long as you’re both being treated at that time. If you happen to freeze any milk then it is possible that that milk COULD pass on that thrush infection at a later date. So certainly give your baby that expressed milk while you’re both being treated.

So if you are in the middle of treating thrush and feeling distressed, which is very understandable – just know that with the treatment and maybe some extra help with pumping perhaps you will be able to enjoy breast feeding again.

Review dates, references & further resources

Review Dates

Version 1.1 published in March 2019. Next review date: Jan 2022


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