Thrush and breastfeeding

If you’ve been feeding for a while and everything has been going fine, with absolutely no pain, but you are now experiencing pain in both nipples, and this pain is quite severe and lasting 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?

One way this can happen is if you or your baby have been treated with antibiotics for an unrelated infection.

The antibiotics, although important for the treatment of the infection for which they were prescribed, have an unfortunate side effect.

They can also kill 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 even if you’ve had these cracks a couple of weeks ago, it is possible that the infection has occurred that way.

However I really must stress that thrush is not always the culprit if you have sore nipples.

There can be other causes too, e.g if your baby isn’t latching adequately and your nipples are getting squashed, (this could be happening on both sides). 

Another point I’d like to make is that if you are experiencing pain only on one particular breast then it’s very unlikely that you have a thrush infection.

Of course, it’s true that the infection would have to start on one side, but because you and your baby are a unit, very soon you would expect the infection to spread to the other breast too.

The only caveat to that is if you are only using one particular breast to feed your baby. I have met a number of women who have fed like this for weeks or even months.

So please bear that in mind that if you are only getting pain on one side then it is likely to be related to something else.

Before you consider getting treatment for thrush, it’s important to rule out other potential causes for sore nipples.

I would encourage you to look carefully at the information on all potential causes of sore nipples.

So let’s assume that you do have THRUSH – what symptoms would you expect to have?

Your baby is likely to have a coated tongue. It might look quite white and appear like cottage cheese on the inside of your baby’s gums and on the cheeks inside the mouth.

It may even be seen on the lips as well. Many babies do have a white sheen on the tongue, but if everything is going okay and you and your baby are fine, with no other symptoms, there’s no need for treatment.

One thing you can do is to put a little bit of gauze on your clean finger, and wipe your baby’s tongue. If the white does not come off, (sometimes it can be milk), then it is likely to be a thrush infection.

Sometimes babies get a thrush infection in the nappy area too. The type of nappy rash would not clear up with normal creams.

So what about your symptoms?

You are likely to notice that your nipples have changed colour, usually pink or red. They may also be flaky or itchy.

Some feel a burning sensation and some say that it feels like broken glass in the nipples. These symptoms will occur on BOTH breasts. 

It’s also important to know that YOU may have symptoms and your 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 simultaneously.

Too often, only the mother or the baby are treated, and although symptoms clear up for a time, the symptoms often then occur in the person who didn’t have the treatment, and so the thrush infection continues.

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

Some doctors will arrange for a swab to be taken to confirm the diagnosis of thrush, and others may just treat straightaway. 

You may easily assume that breastfeeding must stop while you’re both being treated but this isn’t the case. Breastfeeding can carry on as normal.

If your baby is younger than four months of age, 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.

You yourself will be prescribed an antifungal cream, usually Miconazole cream 2 percent, and this can be applied straight after feeding on the nipple and areola area (the area around the nipple).

You don’t need to wash the medication off before you feed your baby again. You may, however, need to dab off any excess. 

Some treatments, particularly Clotrimazole, must be washed off before breastfeeding.  Clotrimazole can sometimes cause an allergic reaction in the area where applied (for some women).

Your doctor may prescribe Miconazole cream two percent with a combined hydrocortisone cream or an antibiotic cream may be prescribed alongside the antifungal, if swabs reveal bacterial infection as well.

The good news is that once this treatment has begun there should be an improvement within 2 to 3 days.

Sometimes a fungal infection may have progressed INSIDE the breast. If this is the case you may experience shooting pains while you’re feeding, and sometimes even up to one hour afterward. 

A medication called Fluconazole is usually the one of choice.

This medication is recognized by the World Health Organization as compatible with breastfeeding, but it isn’t licenced for breastfeeding mothers.

However, it is recognized that the amount of Fluconazole that 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, a lower dose for at least 10 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 close attention to good hand hygiene, especially after nappy changes, and ensuring that each family member uses a separate towel.

This will help to prevent the spread between family members. 

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

A lot of breastfeeding mothers use probiotics to prevent THRUSH because it can restore some of the good bacteria to help keep you healthy and prevent this kind of infection. 

It’s also good to know that breastfeeding can continue while you’re being treated, although some mothers tell me that the pain is so severe that they really want to stop breastfeeding.

Some women temporarily pump their milk instead. It’s possible to hire a hospital grade double pump if you feel unable to feed at either breast due to pain.

A hospital grade double pump can be used every two to three hours to maintain your supply while you’re receiving treatment, and your baby can be given this milk.

It is advisable not to freeze any milk during the treatment period as it is possible that this milk COULD pass on a thrush infection at a later date – but certainly give your baby the expressed milk while you’re both being treated.

So if you are in the middle of being treated for thrush and quite likely feeling distressed, which is very understandable, be reassured that with the treatment and maybe some extra temporary pumping, you will be able to enjoy breastfeeding again.

Review dates, references & further resources

Review Dates

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

References

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